Posterior shin splints, medically known as medial tibial stress syndrome (MTSS), manifest as pain along the inner lower leg. This condition is frequently encountered, particularly among individuals who engage in regular physical activity. While often manageable through self-care, understanding appropriate treatment strategies is important for effective recovery.
Understanding Posterior Shin Splints
Posterior shin splints involve discomfort and inflammation along the inner aspect of the tibia, or shin bone, where muscles, tendons, and bone tissue attach. Specifically, the tibialis posterior muscle, which helps support the arch of the foot, is often implicated, along with the soleus and flexor digitorum longus muscles. The repetitive stress on these structures can lead to micro-trauma within the periosteum, the membrane covering the bone.
This condition is considered an overuse injury, rather than resulting from a single acute event. Several factors contribute to the development of MTSS. These include a rapid increase in the intensity, duration, or frequency of physical activity, such as running or jumping. Inadequate footwear that lacks proper support or cushioning can also place undue stress on the lower legs. Biomechanical issues, like flat feet (pes planus) or excessive pronation, may alter the distribution of forces during activity, further contributing to the condition.
Immediate At-Home Treatment
Initial management of posterior shin splints focuses on reducing pain and inflammation. Rest is a primary step, requiring reduction or complete cessation of activities that elicit pain. Continuing to exercise through pain can worsen the condition and delay healing.
Applying ice to the affected area helps decrease inflammation and numb pain. Apply for 15-20 minutes several times daily, particularly after activity or at the end of the day. Compression with an elastic bandage or compression sleeve helps reduce swelling and provides support to the injured tissues. Elevating the leg above heart level, especially when resting, further assists in minimizing swelling.
Over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, can temporarily alleviate pain and reduce inflammation. These should be used as directed and are not a long-term solution. Gentle stretching of the calf muscles, specifically the gastrocnemius and soleus, and the Achilles tendon, can help improve flexibility. However, it is important to perform these stretches without causing increased pain.
Reviewing current footwear for adequate support and cushioning is also helpful, as worn-out or unsupportive shoes can exacerbate symptoms.
Rehabilitation for Full Recovery
Once the acute pain subsides, focusing on rehabilitation is important to strengthen the affected area and prevent recurrence. Strengthening exercises for the muscles of the lower leg and foot are beneficial. This includes calf raises to strengthen the gastrocnemius and soleus, and toe raises to target the anterior tibialis muscle, located on the front of the shin. Exercises such as towel curls, where you use your toes to scrunch a towel on the floor, can help strengthen the intrinsic foot arch muscles.
A gradual return to activity is important to avoid re-injury. This involves slowly increasing the duration, intensity, and frequency of exercise over several weeks, rather than immediately resuming previous activity levels. For example, if running, begin with short intervals of walking and running, progressively increasing the running portion.
Incorporating cross-training activities like swimming, cycling, or elliptical training can help maintain cardiovascular fitness without placing repetitive stress on the shins. These low-impact options allow the injured tissues to continue healing while staying active.
Proper footwear is a significant factor in preventing future episodes. Athletes should choose shoes that provide appropriate support and cushioning for their specific activity and foot type. Replacing athletic shoes every 300-500 miles, or every 6-12 months, depending on usage, is generally recommended. In some cases, custom or over-the-counter orthotics may be recommended to correct biomechanical issues, such as excessive pronation, which can contribute to MTSS. For runners, analyzing running form with a professional can identify and correct gait abnormalities that might be contributing to shin pain.
When to Seek Professional Guidance
While many cases of posterior shin splints respond well to home treatment, there are situations where professional medical guidance is advisable. If pain persists despite several weeks of consistent rest and at-home care, a medical evaluation is warranted. Similarly, if the pain worsens, becomes severe, or does not improve with conservative measures, it indicates a need for professional assessment.
Pain that occurs even at rest, or pain that is significant enough to wake you from sleep, could suggest a more serious underlying issue. The presence of numbness, tingling, or weakness in the foot or toes also requires immediate medical attention, as these symptoms can point to nerve involvement.
A highly localized, sharp pain that intensifies with activity and tenderness to the touch on a specific spot along the tibia might be indicative of a stress fracture, which needs prompt diagnosis and different management. If no improvement is seen after diligently following home treatment and rehabilitation guidelines, consulting a healthcare professional is important. A physical therapist or sports medicine doctor can provide an accurate diagnosis and develop a tailored treatment plan, which may include physical therapy, gait analysis, or advanced imaging.