Overview of Shin Splints
Shin splints are a common injury for military recruits and athletes, specifically running and jumping athletes. Formally named Medial Tibial Stress Syndrome, it is diagnosed by pain and tenderness along the shin bone. Shin splints can cause significant pain while walking, running, and jumping. The pain is improved with rest but some people have a hard time resuming sports and activities after experiencing shin splints. One treatment option for these patients is physical therapy. In physical therapy, multiple exercises, stretches, and hands on techniques can be used to decrease pain. Here are a few stretches and exercises you can try at home.
Research has shown that shin splints may be related to tightness in the calf muscles, specifically the soleus and posterior tibialis. Stretching these muscles has decreased patients’ pain by up to 50% in 3 weeks. Here are 4 easy stretches for your home routine to help reduce calf tightness.
- Gastrocnemius Stretch: While standing, place your painful leg behind your non-painful leg like you are standing in a lunge. Then, while keeping your back heel on the ground and your back knee straight, lunge forward until you feel a stretch along the back of your calf. Hold this position for 20 seconds and repeat 3 times.
- Soleus Stretch: While in a similar lunge position as the gastrocnemius stretch, this time you are going to bend your back knee. You should still keep your heel on the ground and bend your knee until you feel a stretch lower in your calf. Hold this position for 20 seconds and repeat 3 times.
- Anterior Tibialis Stretch: To stretch the anterior tibialis, you will kneel on both knees with your toes pointed behind you. If you feel a stretch while kneeling in this position then hold there. If you do not feel a stretch, then sit back so your bottom is on your heels. You should feel the stretch along the front of your shin. Hold this position for 20 seconds and repeat 3 times.
- Achilles Stretch: You might need a step for this stretch and possibly a handrail, depending on your balance. To stretch your achilles, place your toes on the edge of a step and allow your heels to hang off the edge. As your heels sink below the step, you should feel a stretch along your achilles tendon. Hold this position for 20 seconds and repeat 3 times.
Other causes for shin splints can be weak calf and hip muscles.Strengthening both of these muscle groups, among others, can improve your pain and help prevent shin splints from returning in the future. There are many ways to perform strengthening including with and without equipment. Below are different exercises to help strengthen your feet, your calves, and your hips.
- Toe Curls: Using your toes to curl a towel or pick something up helps strengthen the small muscles inside your foot. These muscles are responsible for helping to maintain your foot posture when you are upright.
- Towel Curls: Place a hand towel on the ground long ways in front of your foot. With your heel on the edge of the towel, use your toes to curl the towel under your foot. Continue curling until the towel is completely under your foot.
- Marble Pick Up: Put 10 marbles on the floor in front of you. Then while sitting in a chair use your toes to pick up each marble, one by one, and place them in their container. If you don’t have marbles, you may also use small crumbled pieces of paper.
- Toe Yoga: Toe yoga is about retraining your brain to use all of the muscles in your foot, even the tiny ones. These exercises are normally difficult for people and require a lot of concentration.
- Big Toe Vs Little Toes: The goal of this exercise is to move your big toe separate from your little toes. You want to keep your heel still then lift your big toe up, keeping your little toes down. Then switch, big toe down and little toes up. Continue moving your toes back and forth until you feel fatigue in your foot. Fatigue will appear faster than you expect.
- Toe Spread: Spread all of your toes apart from each other so that none of them are touching. Especially think about moving your big toe towards your other foot. If you are able to do this easily, then add a tight rubber band around your toes and try again.
- Doming: Keeping your toes and your heel on the ground, you want to make a dome with the arch of your foot. The movement with this exercise is normally very small. An easy way to see if you are completing the correct movement is to place a penny on the floor where your big toe and the ball of your foot meet. Then place a pen under the arch of your foot. Keeping pressure on the penny and your heel on the ground, try to raise your arch off of the pen. Like the other foot strengthening exercises, this takes a lot of thought and can take a while to master.
- Heel Raises: This exercise is exactly what it sounds like. You will stand with both feet shoulder width apart then raise your heels off the ground and slowly lower them back down. Perform 20 repetitions. If that is easy then you can progress to one legged heel raises. You can also perform these with your toes on the edge of step to increase the range of motion. You should notice a muscle burning/fatigue along the back of your calf.
- Band Resisted Plantar Flexion and Inversion: Loop a resistance band around your toes then hold the opposite end with your hand. Sit with your leg straight out in front you. Slowly push your toes down and inward, as if making an “L” motion. Then slowly reverse back to the starting position. Repeat this exercise 20 times on each foot. You should feel muscle fatigue along the inside of your ankle and shin. You can increase or decrease the resistance by how much tension you put on the band with your hands. You can also purchase different strength resistance bands if needed
Strengthening of the hips can be done in multiple positions and with many different exercises. Below is a common progression from easier to more challenging exercises used in physical therapy.
- Clamshells: Lay on your side with your back against a wall and with both knees bent. Keeping your trunk still, slowly lift your top knee about 30 degrees then lower it back down. You should notice a muscle burn on the side of your hip. If you are able to perform 20 repetitions without any difficulty then you are ready for the next progression.
- Bridges: While on your back, bend your knees so your feet are flat on the ground. Keeping your shoulders and feet on the ground, lift your buttocks up as high as you can. You should feel your glutes tighten. Perform 20 repetitions; if that is easy then lift one leg in the air before you lift your buttocks. Single leg bridges are much more challenging than double leg. It is important to keep your pelvis level throughout the whole exercise to avoid compensation patterns.
- Side-lying Hip Abduction: To begin, you will lie on your side with your back and buttocks against a wall. You may bend your bottom leg for support but keep your top leg straight. You will slowly raise your top leg up the wall about 40 degrees then lower it back down. It is important to keep your back, buttocks, and top leg touching the wall throughout the whole exercise. Perform 20 repetitions then switch sides. When performing this exercise correctly, you will feel a burn on the outside of your top hip.
- Band Walks: You will need a circle resistance band for this exercise. Place the band around each foot. Then bend your knees slightly and side step to one side about 10 steps before returning to the other side. It is important to keep your toes, knees, and hips all facing forward during this exercise, not facing the direction you are stepping. This exercise can be progressed with more repetitions or with a stronger resistance band.
- Side Plank: Lay on your side with your elbow placed directly under your shoulder and your feet stacked on top of each other. Place your top hand on your top hip. Then raise your bottom hip up off of the floor. You can either hold this position for 30-60 seconds. Or you can perform repetitions of lifting your hip up and down 10-20 times. To make this exercise easier, you can bend your knees to shorten the lever arm.
- Squats: Squats are a super functional and well known exercise, with multiple progressions. Begin with your feet shoulder width apart and squat back like you are going to sit in a chair then stand up. Sometimes it is helpful to actually place a chair behind you to tap with your bottom on the way down. If that is easy you can progress a few different ways: add weight, increase depth, or perform on 1 leg at a time. If you choose to perform single leg squats, make sure you continue to sit back into your squat and not lean forward.
- Single Leg Deadlifts: This exercise is a great way to target your glutes and improve your functional balance. Stand on one leg with your knee slightly bent and toes pointed forward. Then keeping your back flat lean forward about 90 degrees before returning to the starting position. Sometimes it is easy to think of this exercise as a “teeter totter”. Your standing leg is the fulcrum, and your opposite leg and trunk teeter back and forth, maintaining a straight line. You should feel the muscle burn in your glutes and maybe in the back of your leg. You should not feel any fatigue in your back. Single leg deadlifts take time to master as it is important to perform them without compensations.
Return to Activity Protocol
Another important step in reducing pain from shin splints is relative rest. Once you begin to feel shin pain during any sport activity it is important to stop performing that activity and allow your body to rest. You may continue to perform other non-painful activities during your resting period. Once you have rested and you are ready to return to your sport activity, it is of utmost importance to do it gradually.
We will use running as an example on how to gradually return to activity. If you got shin splints after running 3 miles, and took your appropriate rest period, you should start again by running just 1 mile. If you are able to run that 1 mile without any pain then you may increase your distance on your next run. You should not increase your distance by more than 10% each time and you must not have any pain while running. If you begin to experience pain as you progress then you should decrease your distance so that you can do it pain free. Continue this gradual progression until you have reached your desired distance without any pain.
There are many treatment options when experiencing shin splints. Above we have discussed different stretches, exercises, and a return to activity protocol that are frequently used in physical therapy. While these should help most people with shin splints, it is very important to note that each person is different and therefore every condition is different. If your pain persists after trying these suggestions then call your local physical therapist for a full evaluation and individualized treatment.
For an individualized treatment plan to help you with your shin splints, consult with one of our physical therapists in Chicago (virtually via our telehealth platform or in person) by calling us at (312) 374-5399 or by scheduling an appointment online. If you have further questions regarding dry needling, we would also be happy to answer them. Remember to also check out our Facebook, Instagram, and Twitter pages for more fun facts and articles on nutrition, physical therapy, and exercise!
Submitted by Kellie Stickler
Edited by Alexander Franz
Reviewed by James Caginalp PT, DPT, CSCS, CES, PES
Loudon, J.K. & Dolphino, M.R. (2010). Use of foot orthoses and calf stretching for individuals with Medial Tibial Stress Syndrome. Foot & Ankle Specialists, 3(1): 15-20.doi: 10.1177/1938640009355659.
Steinberg, N., Dar, G., Dunlop, M. & Gaida, J.R. (2017). The relationship of hip muscle performance to leg, ankle and foot injuries: A systematic review. The Physician and Sportsmedicine, 45(1):49-63.doi: 10.1080/00913847.2017.1280370.