Shin splits are one of the most common overuse injuries seen in running and jumping athletes.(1) Pain typically presents along the distal posterior medial border of the shin (tibia) over an area of about 5+ centimeters.(1) It typically begins as a dull ache during and following exercise but can be alleviated with rest.(2)
Shin splints, also called medial tibial stress syndrome (MTSS), occurs in 13-17.3% of runners and typically effect more females than males.(3,4) While the exact cause of shin splits is unknown, inflammation, muscular traction on the periosteum, stress reactions, and biomechanics have all been suggested causes.(3) Factors such as overtraining, poor shoe wear, muscle imbalances in the ankle/foot, and muscle tightness in the calf can also play a role in an athlete developing shin splits.(2)
Running kinematic is another big driver in the development of MTSS. When the foot over pronates, it can lead to subsequent pelvic tilt, knee valgus, increased navicular drop, and increased hip internal rotation.(3) This stress during running activities causes an increased load to the muscles sustaining the arch of the foot which over time can become problematic leading to lower leg issues.(3)
Despite all these contributing factors, shin splints are generally a workload issue and not something that can be alleviated without rest. Rest, training volume, and load modifications are the first steps in the treatment of shin splits. After that, additional deficits in strength, flexibility, and neuromuscular control should be addressed through a rehabilitation program.(4) This is where mTrigger comes in.
Clinical Application
Let’s look at how mTrigger sEMG biofeedback can be used to help enhance a rehab program for those suffering from shin splints.
While resting from impact and running activities, it is critical for an athlete to maintain strength and flexibility of their calf muscles.(4) This will help maintain muscle strength and prevent fatigue for when the athlete returns to sport.(4) Utilizing mTrigger biofeedback during calf raise exercise variations is a great way to guarantee you are getting the most out of your training. You could even utilize the neuromuscular deficit testing function to track progress and assure strength deficits don’t go overlooked. Here are a few examples.
Neuromuscular Deficit Test:
Calf Raise Variations:
Furthermore, a 2023 review by Bhusari et al. found greater plantar flexion range of motion to be a risk factor for developing medial tibial stress syndrome. Greater plantar flexion altered the landing mechanics observed during running resulting in greater push off range from the rearfoot to the forefoot.(2) A similar effect is seen with increased navicular drop, mentioned earlier. Eccentric training of the tibialis anterior in addition to orthotics/insoles are recommend for addressing this problem.(2)
Expanding your Rehab Program
Hip, glute, and core stability are also critical for proper running mechanics and protecting the lower leg against overuse injuries.(4) Any deficits evaluated in the hip, glutes, and core should be addressed in your rehabilitation program.
To keep core stability training interesting and engaging, remember you can use mTrigger biofeedback for core exercises as well.
The role of the hip has long been considered a factor in lower leg and running related injuries. Medial tibial stress syndrome is no different. Research has shown that both deficits in hip range of motion as well as hip joint laxity (“loose jointed”) can increase tibial loading during running.(2) Furthermore, anatomical variations at the hip will alter the angle of the femoral neck in the acetabulum (hip socket) increasing torque on the lower leg and predisposing athletes to shin splints.(2) While determining how to screen for hip anatomical variations is beyond this blog post, clinicians’ must examine the hip and develop an appropriate treatment program that focuses on balancing the flexibility and strength around the hip joint.(2)
Here are some ways to use mTrigger biofeedback to promote proper movement patterns, improve muscle balance, and increase hip strength.
Finally, following any good rehabilitation program should be a gradual return to running program where progressive exercise training and loading is used to properly build up volume and prevent shin splits from reoccurring.(4)
Summery
Shin splints are a common injury that plague many athletes. While proper workload management may be the most effective tool for preventing and managing shin splints, a comprehensive rehabilitation program focused on any additional deficits should be included as part of a thorough treatment plan. With the ultimate goal of getting back to running as quickly as possible, mTrigger sEMG biofeedback can be an excellent tool for helping maximize the effectiveness of your rehab while keeping athletes engaged in the recovery process.
Using the Neuromuscular Deficit Testing Function
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Running in Real Time with mTrigger Biofeedback
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References
1. Winters M. The diagnosis and management of medial tibial stress syndrome : An evidence update. Unfallchirurg. 2020;123(Suppl 1):15-19. doi:10.1007/S00113-019-0667-Z
2. Bhusari N, Deshmukh M. Shin Splint: A Review. Cureus. 2023;15(1). doi:10.7759/CUREUS.33905
3. Menéndez C, Batalla L, Prieto A, Rodríguez MÁ, Crespo I, Olmedillas H. Medial Tibial Stress Syndrome in Novice and Recreational Runners: A Systematic Review. Int J Environ Res Public Health. 2020;17(20):1-13. doi:10.3390/IJERPH17207457
4. Deshmukh NS, Phansopkar P. Medial Tibial Stress Syndrome: A Review Article. Cureus. 2022;14(7). doi:10.7759/CUREUS.26641
Image: https://trailsidefitness.com/overpronation-and-hiking/
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