It’s one of the most common causes of pain in athletes, yet shin soreness is often ignored. Physiotherapist Jenny Blizard explains what can be done

Shin splints, or medial tibial stress syndrome (MTSS), is a term often used to diagnose pain that occurs during or after exercise along the inside of the lower leg or medial border of the tibia.

Commonly thought to be due to biomechanical imbalances, overuse injury or poor footwear, many athletes remain at at a loss to find the root cause of ongoing pain once they have tried taking time out, treatment, taping, exercises and expensive orthotics.

So, what next?

If a stress fracture has been ruled out but shin pain persists despite attempts to treat it, then a physiotherapist like myself might look at the structural influences that might ‘refer’ pain into this area.

These can include one or all of the following:

NERVES

The sensory nerve supply to the medial border of the tibia is supplied by the saphenous nerve. This nerve branches from the femoral nerve in the groin area and descends through the adductor muscles on the inside of the thigh, around the inside of the knee and then supplies the sensation to the medial border of the tibia.

Roots of nerves originating in the lower back can also cause problems when sensitised due to an undiagnosed or ongoing back problem. Athletes might find that their back itself is not painful, but that pain is referred across the front of the thigh and down the inside of the leg to the shin.

Nerve problems can also produce what is termed neurogenic swelling and mimic local inflammation from a stress fracture or MTSS. The difference is these conditions will get better with rest.

ADDUCTOR MUSCLES

Trigger points in the adductor muscles, which sit on the inside of the thigh, can refer pain along the medial border of the tibia.

Don’t ignore it

Very often I find that the adductor muscles become tight due to weakness in the gluteal muscles on the outside of the
hip. An athlete is provided with gluteal hip-strengthening exercises and possibly orthotics to correct the pronation at the foot and cure the stress on the tibia. Neither are effective at resolving the pain because it is arising as a result of an entrapment of the saphenous nerve between the adductor muscles that are still tight.

Often, this continues over time, which can lead to the nerve root in the lower back becoming sensitive in itself, producing its own referred pain along the tibia. It makes for stronger throbbing and burning, which causes more stress for the athlete and, in turn, then winds up the nervous system. The result? Even more referred pain.

What to do

Sensitised nerves react strongly to stress, poor sleep, chemicals, poor nutrition and dehydration, so make sure you avoid all of these.

Stretch out your adductor muscles and perform self trigger-point release to the adductor muscles. If this does not produce a small but obvious improvement then I would recommend you see a manual physiotherapist who can assess and identify the role of referred pain in your ongoing pain.

They would also rule out any vascular involvement by checking pulses in the lower limbs and also referring you to
an appropriate specialist if necessary. Treatment should be hands-on and possibly include acupuncture.

You should start to notice a change within a couple of sessions and the physiotherapist can then provide you with an ongoing management plan.