Pain in the front (Shin splints) or inside of the leg

The most common injury we treat are Shin splints. Though typically associated with being a runners injury. Pain can cause problems for anyone involved in high impact running and jumping activities.

The underlying cause of the problem is often due to the muscles not being able to absorb the forces through the leg because the muscle is tearing off the bone. This is why in many cases long periods of rest doesn’t do anything to improve the problem. The pain will return when the activity is started again.

The problem here lies in that the stimulus that causes the inflammation is removed, but nothing is done to improve the muscle length. When the activity is started again, the shortened muscle will continue to pull on the bone, which will cause the pain to return.

There are 3 areas where shin pain are commonly found

  • Along the inside edge of the shin bone(Tibia) – Shin Splints
  • Over the Tibialis Anterior muscle
  • Over the shin bone (Tibia) itself only covered by skin – Stress fracture

There are five other possibilities which can describe shin pain: bone stress, inflammation, vascular insufficiency, nerve entrapment and a raised pressure inside the muscles of the shin.

Calf pain

The most common injury here are calf muscle strains (Gastrocnemius-Soleus muscle tear). Three Very strong muscles that can tear at different places and can range from only a few fibres, to a complete tear of one of the three calf muscles. There are other structures like arteries and nerves that can be damaged that gives a sharp cramp like pain when starting to walk. This type of pain must not be taken lightly.

Each person’s case is unique and we want to address your specific needs. If you would like us to investigate or provide some insight, we invite you to contact us by clicking the link below.

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Our experience with calf and shin pain

We have treated hundreds of athletes with calf muscle tears and shin splints. These patients were up and running within weeks. Sometimes patients mistake a cramp or tightness in the calf with a muscle being torn (be careful). We have also had a number of Achilles tendon ruptures that we got back to playing sports again.

Most common lower leg injuries we treat:

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Symptoms

Mild symptoms

  • Muscle tightness
  • Constant cramp
  • Difficulty giving a big step
  • Pain when putting weight on the leg
  • Pain when stretching the foot up or down
  • Pain during or after activity

Moderate symptoms

  • Bleeding or swelling
  • Shooting pain up the leg
  • Unable to put weight on the leg
  • Sharp pain when stretching
  • Unable to put heel on the ground(walking)
  • Pain at rest(when not moving)

Dangerous symptoms

  • Redness of skin over calf
  • Constant throbbing pain in calf
  • Numbness, pins & needles
  • Loss of feeling in foot
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Shin Splints

Shin Splints is a term describes pain felt along the inner edge of your shin bone. The pain is due the inflammation of the muscles, tendons, and bone tissue around your shin. The more medical relevant name “Medial Tibial Stress Syndrome” or “Medial tibial traction periostitis” gives us a better understanding of the anatomical structures at fault.

How does this happen

On the inside of the the shin bone (Tibia) the Soleus and Medial head of the Gastrocnemius muscle attaches to the bone via a tendon. When these muscles contract they point the foot (jumping), but they also resist movement when you land to slowly control your heel’s decent to the ground. So the muscles absorb the force instead of just banging down on your heel.

This is the mechanism that starts giving problems. When you repeatedly jump up and down without sufficient muscle strength to control your decent, the muscle and tendons of the Soleus and Gastrocnemuis will start to tear. The tendons of these muscles attach onto a membrane that covers the bone surface called the periosium. This pulling effect of the muscles on the periostium causes it to tear and become inflamed. Small micro-tears appear in the tendon, until a large tear appears. If the pain on the shin becomes so intense that you must stop the activity, it might be an indication that a stress fracture might be developing.

The foot and toe flexors are commonly overlooked, but they attach onto the Tibia just behind the Soleus muscle.

Causes of Shin splint

Understanding the how it happens will guide you to better understand why these activities cause the pain to get worse.
Overload and overuse are at the core of this problem for example increasing the amount of time in training, or going a longer distance (Too fast, too far, too soon).
Strenuous activities like stop-start sports such as running, tennis, soccer.
Repetitive high impact landing on hard surfaces, or forceful jumping and like dancers landing on a concrete floor.

Factors that put you at risk

  1. Increasing your number of training days. (Too fast, too far, too soon)
  2. Flat feet or a very rigid foot arch
  3. Work out on hard surfaces, such as running on the street.
  4. Wearing worn out shoes. (Running shoes lose over half of their shock absorbing ability after 500 km).
  5. Tight and weak calf muscles
  6. Downhill running
  7. Running on a slanted surface or uneven terrain

Symptoms of shin pain

  • Pain in one or both legs
  • Sharp or dull, aching pain in the front of your shin usually the lower third
  • Pain when you push on your shins especially the inside edge
  • Pain that gets worse during and after exercise
  • Pain that gets better with rest
  • Swelling (Usually minimal)
  • Medial Menisci tear (inside)
  • Intra-articular cartilage damage (deep inside)
  • Hamstring tendon tear (back)
  • Gastrocnemius muscle tear (back)

Healing

Expect that you will need at least 2 to 4 weeks of rest from your sport or exercise.
Try other low impact activities as long as you do not have any pain, such as swimming or cycling.
Know that shin splints can take 3 to 6 months to heal. DO NOT rush back into your sport or exercise. You could injure yourself again.

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Physiotherapist treatment

  • Soft tissue mobilizations and massage (particularly to the Gastrocnemius, Soleus and Toe flexors muscles)
  • Peripheral joint mobilization
  • Dry needling
  • Electrotherapy
  • Stretching techniques
  • Rigid and elastic strapping
  • Orthotics or shock absorbing insoles
  • Biomechanical correction
  • Vapo-coolant spray or ice treatment
  • Lazer & Ultrasound treatment to accelerate the healing of the Periostium
  • Progressive exercises to improve flexibility
  • Strengthening exercises, especially eccentric.
  • Guide activity intensity
  • Medication and anti-inflammatory advice
  • Footwear advice

Self pain Treatment

Rest your body. It needs time to heal.
Ice – Intervals of 15-20 minutes, 3 times a day for for 3 days or until the pain is gone.
Dynamic stretches – to improve the muscle length and reduce the pull of the muscle on the bone.
Medications – Take ibuprofen, Cataflam (NSAID), to decrease swelling. Rubaxin can also assist with a muscle relaxation.
Use arch supports or special shock-absorbing insoles or orthotics to wear inside your shoes (Large verities available at Dischem and Clicks)
Go slower, for a shorter time and increase your training slowly.
Warm up before and stretch after exercise.
Avoid training on hard or uneven surfaces.

What NOT to do

Don’t do any STATIC stretches!
Don’t attempt to run through the pain!

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I have to run, can’t stop now

Worst case scenario, if you are stubborn and you refuse to listen to any medical advice, a neoprene sleeve (compression brace) could help support the soleus and gastrocnemius muscles to minimize the traction on the periostium. Strapping the calf muscle with semi-elastic strapping starting from the bottom up, overlapping by half while easing the tension in the tape the higher up you move. (If applied too tight, you will compromise the blood supply to your foot and risk permanent damage)

Alternative names to Shin Splints

Traction Periostitis, Medial Tibial Traction Syndrome, Lower leg pain, Shin pain, Anterior tibial pain, Medial tibial stress syndrome, MTSS, Exercise cause leg pain, Tibial periostitis, Posterior tibial shin splints,

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