A recent review on research of shin splints (or medial tibial stress syndrome) in the journal Sports Medicine has given many athletes suffering from the condition little hope. Dutch researchers concluded that, “no intervention has been proven to be effective for medial tibial stress syndrome.” In the study, groups of people received various common treatments for the injury in contrast with those who did not.
Examples of the treatments used were leg braces, ice massage, ultrasound, extracorporeal shockwave therapy, and iontophoresis. The study concluded by recommending short periods of rest from weight bearing activity to allow the bone to heal. This is standard advice in the medical community, and the treatments studied in the article are also typical, if conservative methods for sports medicine practitioners.
The problem with approaching this sort of injury with conservative, standard treatments and rest, is that it fails to decipher how the injury occurred, and if it will return once the activity is resumed. Most injuries don’t just come about in one location independent of everything else going on in the body. An injury like shin splints is the final product, which is the painful conclusion, but usually a progressive buildup of other developments in the body lead to it.
This project also neglected to study whether other treatments such as A.R.T., Myofascial release techniques, massage, and changing of running mechanics, and corrective exercise would help heal the injury quicker. In my experience, this sort of injury when treated holistically and by addressing biomechanics, can be resolved very quickly. Weekly, we see runners in our clinic with shin splints that are resolved in a few treatments, and often can continue to train through the injury and treatment process.
Here’s my standard approach to treating shin splints:
1. Look at the patient’s biomechanics: Often there is too much pronation, or external rotation of the legs. At what angle does their lower leg contact the ground? Often it will be an angle greater than 90 degrees. Often there is glute weakness and some tightness in the anterior hip.
2. Corrective exercises and strength training for the weak muscles done daily at home. Stretching and foam rolling for the tibialis anterior and posterior, soleus, and peroneals and quadriceps.
3. Myofascial release and A.R.T. for the lower leg and quadriceps, TFL, and psoas.
4. Running on soft surfaces only, depending on severity and treatment frequency
5. Address shoe choices and recommend changes depending on the type of runner, mileage, training surface, and biomechanics
6. Ice cup massage for the shin, compression socks if travelling or sitting a lot.