#009- My Top 10 Shin Splints Management Tips

On the back of last weeks example of a rehab session, I got a few questions around the management of medial tibial stress syndrome (MTSS) in general.

MTSS is my favourite condition to manage and talk about?because it is the one that got me into podiatry in the first place. I suffered with it chronically as a young athlete, and only recently (legit in the?last 12 months) seem to finally be?on top?of it 10 years later ??

It is unfortunately something that can become quite chronic, so like anything, best to get onto it early!

Here's my thought process:

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1.?Find out WHERE?along the CONTINUUM of bone stress?the athlete is. Are they further towards a?stress fracture, or have they only just started to get a bit of irritation? Use your clinical history taking (subjective and objective) to figure this out as best you can. This determines your immediate management and prognosis. Rarely do you need imaging if it's just a bit of MTSS, but if I suspect a stress fracture then I always like to get an MRI.

2.?Look?LEFT.?What has their past fortnight, month, and year looked like as far as their training loads? This helps you in programming their return to running- less experience or a recent layoff?= generally a?more conservative approach.

3.?What CAN they do??Can?you get them running in a pool. Can they tolerate running drills? Can they do band assisted hopping? Find the entry point into their running and START THERE, and START NOW. Alot of the time this is very much trial and error using your clinical judgement... but complete rest from exercise is rarely?ever the answer. Even if they're in a moon boot, what can they do on the other leg? Can they do conditioning using their upper body or cycling?

4.?ZOOM IN.?Foot and ankle strength. Intrinsic foot muscles, gastrocnemius,?soleus and Tib Ant. Tib Post (although not involved in MTSS pathology despite popular belief) should also be targetted to help control subtalar joint eversion and improve?medial longitudinal arch stiffness.

5.?ZOOM OUT.?Entire lower limb strength, including core.

6.?STIFFNESS.?Sure they may be able to produce alot of force with their calf raises, but can they absorb force?and use it efficiently??Exercises such as skipping and pogo jumps are a good way to assess and train this.

7.?PROGRESSIVE OVERLOAD.?Pretty straight forward.?Be smart about how you?progress their running, focussing on increasing VOLUME first, INTENSITY second.?

8.?RUNNING TECHNIQUE.?I put this towards the end, because all?of the other things are probably easier to implement in a clinical podiatry setting. But if you can get your athletes out to a park and coach some technical stuff- then that's great.?Simply coaching to be "quick off the ground" and "tall and light" are great place to start. You will find that external cues like this work better than internal cues like "forefoot strike" or "land under the hips". The athlete also may need to improve their strength to cope with the changes in technique.

9.?SHOES AND ORTHOSES.?As required depending on their goals. With my orthotic scripts for MTSS I don't use anything special?in particular, I just take into consideration the amount of force that is going through the foot in comparison to just walking, so you just may need to have more control or a stiffer shell.

10.?SOME PAIN IS OK.?Emphasis on the "SOME". As you get further along the bone stress continuum, you don't want to be mucking around with pain. With less severe cases however and return to run programs, pain less than 3/10 is to be expected. In these cases, it's better to get the athlete to focus on the pattern of the pain (i.e. how does it?act over 24 hours? Does it settle and stay at the same level or less for the next run, or is it increasing?). If you make athletes fearful of pain, that's when it becomes chronic and they become fearful of running (this was me- and it wasn't until I was encouraged to?actually run through some shin?pain that I started to?get over it). As mentioned above- use your clinical judgement here.

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Let me know if there's anything you think or?do differently?!