Oftentimes, strenuous physical activity, especially involving the lower limbs like running or jogging on hard surfaces or uneven grounds produce moderate to severe pain along the anterior aspect of shins. However, if you are experiencing severe throbbing pain without running or with mild physical activity, you may be experiencing shin splints (also known as medial tibial stress syndrome) due to moderate to severe trauma to the muscles or tendons of anterior or posterior compartment of leg. Shin splints include muscle sprains, stress fractures of long bones of leg and compartment syndrome.

Shin splints are marked by pain along the outer aspect of leg (below the knee) that aggravates after activity, the skin in the region of shin is hyper-sensitive, red, inflamed and warm to touch, the pain does not disappear completely with rest, swelling along the outer aspect of shin, in compartment syndrome, swelling of fascial compartment can increase the risk of permanent damage to muscles, tendons, ligaments, nerves and vessels.

Shin splints can occur in a variety of pathological conditions. Overuse or overactivity of lower limb muscles leading to inflammation or swelling of small muscle fibers, stress fractures involving long bones of limbs (linear and hairline breaks in the continuity of bones due to weak muscles or poorly supported connective tissue. If you have flat arches (in other words flat feet) the stress and strain on your feet increases that increases the risk of arch collapse. According to the research conducted by Roger H. Michael suggested that soleus syndrome is one of the leading causes of shin splints. Difference in the size of lower limbs (limb-length discrepancy) due to accidents is another cause of shin splints. Sports activities (hiking, contact sports, running sports, marathon runners) and certain occupational activities like naval recruits, ballet dancers are at higher risk of developing shin splints. Any activity that increases imbalance in the stretch or stability of anterior group of muscles or posterior group of muscles increases the risk of shin splints.

Physical therapists examine and monitor the extent, severity and cause of shin splints. Depending upon the inciting event, your therapist not only educates and guides you to prevent further tissue damage but also makes sure that your recovery and healing does not affect your athletic endurance and range of motion. Physical therapist first recommend exercises and activities to resolve the pain symptoms like RICE therapy that include rest, ice therapy of the affected region of limb, compression wrapping and elevation of limb.

After resolution of the inflammatory symptoms, your therapist may suggest exercises and activities to achieve early remission and range of motion. Your therapist guides you to perform low impact exercises under guidance so that your tissues receive optimal circulation (low impact exercises promote healthy circulation by alleviating edematous swelling from the inflamed tissues). Long term physical therapy is helpful in strengthening shin muscles and in increasing range of motion.

Deep tissue massage is especially directed at improving the strength and stability of involved muscles, ligaments or compartments. Deep tissue massage helps in scar release and helps in restoration of normal functioning of fascia, muscles and tissues. Your therapist may explain you self- massaging techniques.

Other helpful modalities are electric stimulation therapy that deals with stimulation of muscle fibers with the help of electric current to promote muscle motion and to decrease the pain sensation by blocking pain signals, stretching exercises of calf, hamstrings and tibial muscles (after excluding the possibility of stress fractures), non–impact exercises are also promoted to strengthen muscles without affecting the physiological healing process (biking and swimming are best exercises that must be performed during healing or recovery stages) and ultrasound therapy can also be employed to reduce the intensity of pain, discomfort and swelling from deep tissues of leg. Moreover, ultrasound waves also promote elimination of inflammatory fluid from tissues; thereby promoting cellular activity and healing process.

Besides instituting therapies that promote healing of medial tibial stress syndrome, your physical therapist also monitors the pattern and nature of physical activity to minimize the risk of future injuries. Physical therapists also provide necessary training and warm up exercises that decreases the stress on ligaments, muscles, bones and joints. Your physical therapist will analyze and study your Running and Gait with the help of specialized devices for effective biomechanics by upper body carriage, observing the rise of knee, stride frequency and the position of foot and leg at the time of foot strike on ground.

Besides regular physical therapy, certain modifications in lifestyle also help in preventing shin splints. Always wear right fitted and right sized shoes; wearing too tight shoes or loose shoes while running, during sports activities increases the risk of shin splints. Always perform warm up exercises before running or vigorous muscle activities, avoid running on irregular hard and uneven surface, do not over stress or over exert your musculoskeletal system, use custom orthotics to correct limb length discrepancy for better alignment and efficient mobility.