Tag Archives: overuse injuries

Exercise, General Category, Physiotherapy, Running, Sports Injuries, Sports Physiotherapy

Running Injuries: Shin Splints vs Stress Fractures

Whether you’re a long time runner, or just getting into it now, you may have experienced the frustration of a pain in your shins. Shin splints are a common overuse injury in the running community, usually due to a new or a change in the training routine. Shin splints can be very frustrating to deal with as they can quickly ramp up in severity if ignored, and take you away from your normal routine to recover. In this blog, we’ll discuss the difference between shin splints and stress fractures in the bone, how to identify which one you have, and how to use Physiotherapy Treatment to rehabilitate your injury.

Why do shin splints and stress fractures happen?

Primarily, shin splints and stress fractures are called overuse injuries. Due to the nature of running, high impact and repetitive, the bones and muscles are forced to absorb a lot of force for sustained periods of time. Our bodies are usually very good at this and can repair itself from a lot of stressors.

However, an overuse injury occurs when the rate of breakdown outstrips your body’s speed at repairing itself. For most runners, it’s usually because of a recent increase or change in their training. For example:

  • Increasing mileage too quickly
  • Adding new types of workouts too quickly (ex. sprints, hills etc)
  • Not taking enough rest days and weeks (common while training for extended periods like preparing for a race)
  • Changing the training surface (road vs trail) or footwear (worn out or change in shoe specs) too quickly

What are shin splints and stress fractures?

Commonly, people view this as 2 separate conditions but research has shown that they are 2 injuries on the same continuum. On the bone stress continuum, shin splints are located on the more minor end, and a lack of treatment can lead to the development of a full stress fracture.

What does a shin splint feel like?

A shin splint occurs when the muscles and tendons that attach to the shinbone become inflamed from the repetitive impact. It will feel like a dull aching pain across the front of the shinbone. The characteristic pattern is a warm up pain for a couple minutes at the beginning of a run, fades as you get into the run, and then aches again after the run

What does a tibial stress fracture feel like?

If the initial shin splint is ignored, the bone itself starts to form micro cracks which can turn into a stress fracture. Unlike popular belief, there does not have to be some sort of traumatic event for there to be a fracture. Despite the different mechanism, a stress fracture is still a fracture and should be treated seriously.

A full stress fracture will feel like a very sharp, intense, pain on top of the shinbone. You are usually able to pinpoint it with a finger, and it is easily repeatable with touch everytime. This pain will NOT go away when you try to push through, and even daily activities will start to bother it such as walking, stairs, hopping on one leg etc.

How can Physiotherapy help?

First, a Physiotherapist will help you identify how severe your issue is. They will perform an detailed assessment to determine the severity and root causes of your issue. The components of Physiotherapy treatment for shin splints or a stress fracture usually includes:

Load management and back to run programming

Based on their findings, they can determine whether you need to stop running or can continue in a modified fashion. A stress fracture needs to be offloaded for a time so cross training can be implemented such as swimming or biking. A shin splint may be allowed to continue but at a reduced capacity or with a change in footwear to better protect the area

Strengthening and mobility:

The bread and butter of any Physiotherapy program is the home exercise plan. This is the personalised plan that gets you better and helps you stay better in the long run. Your shin splints could be being influenced by other body parts such as a hip, knee, or ankle instability, causing increased loading at the shin. Your Physiotherapist will capture this in the assessment and provide you with an individualised plan

Manual therapy

Your Physiotherapist will use manual therapy techniques such as soft tissue massage, joint mobilisations and more. These are helpful for pain relief, addressing joint and mobility restrictions, releasing tight muscles, and increasing blood flow into the injured area

Gait retraining

Your Physiotherapist can perform a gait assessment to determine if the mechanics in the way you run may be contributing to your pain. Areas of focus might include the type of footwear, where you land on the foot (heel vs midfoot vs forefoot striker), cadence, stride length and more. For example, someone who lands with their foot well in front of them produces a hard braking force through their leg with each step, jarring the shin. Your Physiotherapist can coach you through making these changes to produce the most efficient gait possible

    For example, landing on a straight leg with the toes very high (as above) can lead to a large amount of abrupt force in the shin. Ideally, landing on a bent knee and hip helps to absorb the landing force instead of just the ankle and shin.

    Quick tips for avoiding overuse injuries

    Prevention is always the best form of medicine. Too much and too soon are the hallmarks of an overuse injury. Key tips for reducing risk include:

    1. 5-10% increase rule: To avoid overtraining, recommendations are to increase weekly mileage by 5-10% maximum each week
    2. Adding recovery days and deloading weeks: If you are training for an event like a marathon or half marathon, your training should be spread out over a long period of time. Your body can’t keep performing at 100%, 100% of the time. Having enough recovery days and 1 lighter week every couple of weeks helps your body recover from all the heavy impact
    3. Rotate and replace your footwear: Experts recommend replacing every 500-800km as cushion and soles start to wear down over time, reducing the protective power. In addition, rotating footwear helps make the change between a fresh and old pair less disruptive
    4. Listen to your body: If you feel that nagging ache coming on already, don’t just ignore it. As we have stated, shin splints are an early point on the continuum where it is easier to catch. The more severe the issue, usually the longer it takes to recover. Take care of things earlier and you won’t have to miss out on training!

    Looking for help with leg pain, running pain, shin splints, or stress fractures?

    Look for PhysioNow! We have 10 locations across the West GTA including Burlington, Oakville, Mississauga and Etobicoke to help. We have expert clinicians that can help you resolve your issue and achieve your goals. Whether you’re training for a race or just a casual runner, we can help! Book with PhysioNow today for your first assessment and treatment!

    Achilles tendon, Knee Pain, Physiotherapy, Sports Injuries, Sports Physiotherapy

    Post Tournament Fatigue and Overuse Injuries

    With the World Cup in full swing, the soccer season is in full swing. Even if you’re not a professional athlete, whether you’re playing in a league, drop in, or registering for a friendly tournament, you should always be on the lookout for overuse injuries. Most of us are familiar with that bone-deep fatigue after the final whistle blows or the timer hits 0, and the adrenaline comes to the end. It’s that legs shaking feeling, a pain that you didn’t notice or were able to ignore before that we call a post-tournament or post-game fatigue. In this blog, we’ll break down why your body feels this way, what it means to you, and how to take proper care of yourself so you don’t have to watch from the sidelines with an injury.

    What is post-tournament fatigue?

    Tournaments require a lot from your body, asking you to play at your peak several times in quick succession. This leaves your body without a lot of rest time to repair, resync, and replenish. That drained state happens because of:

    1. Nutrient depletion: Playing requires a lot of fuel, which comes from calories. Our body’s main source of fuel is stored carbohydrates and over the course of an intense series of games, the body’s storage can be depleted
    2. Muscle micro-tears: High intensity movements like sprinting, kicking, and jumping sends a lot of force through our muscles, causing micro tears. These micro tears are a normal part of training and how the body learns to adapt and build itself stronger. The issue comes when there is a huge increase in the volume of play, such as during a tournament. As your muscles accumulate all this damage without sufficient time to repair itself, they get less efficient and the risk of injury increases.
    3. Central nervous system fatigue: Just like our muscles, our nervous system can actually fatigue as well. Research has shown that the fatigue is associated with the neurotransmitters (chemical messengers) in the brain. Ultimately, the result is reduced physical performance and even brain fog.

    What are overuse injuries?

    Unlike an acute injury like a muscle or ligament strain, overuse injuries sneak up on you over time. They may start as just a mild nagging pain that comes and goes, then gradually becomes more frequent or more intense over time. If not treated early on, they can develop into bigger issues that affect your daily life and ability to play. Another name given to overuse injuries is repetitive stress injuries.

    An easy way to think about it is that the demand (what you’re asking the tissue to perform) is overloading the supply (what your tissue is capable of). Like a rope that is supporting too much weight, it starts to fray and break. Thankfully, with the right training, overuse injuries can be caught early on and prevented.

    How do I spot an overuse injury?

    Overuse injuries tend to follow similar patterns even if the body parts can be very different:

    • Timeline of pain: Some muscle soreness, known as DOMS (delayed onset muscle soreness) is normal 24-48 hours after exercise. If there has been a recurrent or consistently present ache, stiffness, or discomfort, it is likely the start of an overuse injury
    • Warm-up pain: Usually worse after waking up, sitting for a long time, or first starting a workout. After moving around for a bit the pain goes quickly goes away, then may return worse in a couple of hours
    • Pinpoint pain: In a lot of tendon conditions, people are able to directly point towards the source of their pain. When that spot is pressed, it recreates their pain
    • Compensatory movements: If you’ve noticed that your running gait, the way you swing your racquet, or your overall performance has decreased, that could be a sign of general fatigue or an overuse injury in the making

    What are the most common soccer overuse injuries?

    Diagram depicting patellar tendinitis with the patellar tendon highlighted in red to show inflamation
    • Patellar tendinopathy: Also known as Jumper’s Knee. This is an overuse injury of the patellar tendon right below the knee cap. Constant sprinting, stopping, jumping puts a lot of pressure on this tendon. Most people will have a warm up pain and find it hard going down stairs
    • Achilles tendinopathy: The Achilles tendon is one of the strongest tendons in our body that helps us to generate and accept force through our ankles and feet. Most people complain about pain when doing anything high impact such as jumping or jogging
    • Shin splints: Your shin bone (tibia) and the surrounding musculature can become inflamed from repeated high impact stress. If left untreated, shin splints can turn into stress fractures.

    How should I take care of myself after a tournament?

    The immediate 48 hours after should be relatively restful. Light gentle active recovery such as walking and stretching are great to help blood flow and recovery, without contributing excess pressure to already compromised tissues. Lots of sleep, hydration, nutrition and sleep is essential during this stage.

    Afterwards, if there are any pains lasting or sharp pains present, a rehabilitation plan should be considered with Physiotherapy to address them. Overuse injuries are always easiest to heal the earlier you address them. When you let them progress, you run the risk of it becoming a more serious issue and might even have to take time off from your sport. Pushing through is not always the solution.

    A Physiotherapist can help you identify any weak points in your training, muscle compensations, faulty movement patterns, and more. They will use various treatment methods including manual therapy, therapeutic exercises, modalities like shockwave therapy and more depending on your unique circumstances.

    Dealing with a stubborn overuse injury?

    Don’t wait any longer, come to PhysioNow to get started on your recovery. Summer is flying by fast and we want you to make the most of your soccer season and stay away from any other sports injuries. We have 10 locations across the West GTA including Burlington, Oakville, Mississauga, and Etobicoke. Book with PhysioNow today for your first assessment and treatment! Or contact us at Email: applewood@physionow.ca or Phone: 289-724-0448 for more information.

    Massage Therapy, Physiotherapy, Sports Injuries, Sports Physiotherapy

    Stopping Shin Splints with Physiotherapy

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    What is a shin splint?

    Shin splints are a common complaint in runners or athletes with sports that involve a lot of high impact movements like dancers, volleyball, basketball players, etc.

    Usually, it presents as pain in the front of the lower leg, or the shin area. Sometimes, it may be called medial tibial stress syndrome (MTSS). Oftentimes, it’s caused by irritation of the tissues between the tibial bone and the muscles, and/or overuse of a lower leg muscle called the tibialis anterior. It can happen to just a single leg, or both simultaneously.

    The muscle, tibialis anterior, may be involved in the development of shin splints.

    The tibialis anterior play major role in lifting your ankle upwards (dorsiflexion). Functionally, it helps with shock absorption and is a major contributor during ambulation.

    Why do shin splints happen?

    1) Footwear: If you run or exercise a lot without proper running or sports shoes, it puts additional stress on the muscles around the leg. Consequently, this can result in the overuse and irritation of the structures in the area, and pain in the shin bone.

    2) Sudden change in activity: Abruptly increasing the difficulty in your exercise routine like training more frequently, for longer periods of time, or increased repetitions increases your chance of developing shin splints.

    3) Muscle imbalance: Muscle weakness or tightness can influence the biomechanics of your stride and gait. As a result, the areas you place more weight on may change and increase the pressure on certain areas of the body like the shins.

    4) Sports like dancing, running, soccer etc: Notably, these activities focus more on lower body movements that are high impact. Therefore, individuals who practice these sports may be more at risk for developing shin splints.

    5) Flat Feet: Flat or pronated feet change the pull of muscles and weightbearing in the legs. As a result, this may create muscular imbalance and result in some muscles having to work harder, putting increased stress on them.

    What are the signs and symptoms?

    1) Dull, achy pain down the shin bone

    2) Tender to the touch over the shin area, especially the inner portion

    3) Swelling over the shin area

    4) May experience redness on the lower leg after exercises

    5) Exercise makes it worse while rest makes it better

    How can shin splints be treated acutely?

    Importantly, the RICE protocol is used often on sports injuries and works well on shin splints in the acute phase. RICE is an acronym that helps us remember what to do to treat our injuries.

    1) Rest: Firstly, avoiding exercise for some time will allow muscles to recover and allow more efficient healing.

    2) Icing: Secondly, icing on the shins will reduce inflammation, pain and swelling.

    3) Compression: Additionally, compression bandages or braces can reduce stress on muscles and prevent pain.

    4) Elevation: Finally, elevating the leg can help clear swelling and reduce inflammation from the leg.

    How can shin splints be treated in the long term?

    Physiotherapy is the first line of treatment for shin splints as it is a common sports injury. The following steps will help improve your pain.

    Orthotics: Custom made insoles can correct the muscle imbalance and takes pressure off from overworked areas

    Orthotics

    Orthotics may help correct foot posture increase the risk of developing shin splints

    Footwear: Proper runners or sports shoes are needed as a proper base of support to your ankle and leg. Then, this will help the muscles and joints absorb less pressure.

    Stretching exercises: Ankle stretches will correct muscle length and after exercising, helps to clear byproducts of exercise that can make muscles sore. Eg. Calf stretch, soleus stretch, tibialis anterior stretch.

    One example of a calf stretch, but many other effective methods may be used

    Massage: Self-massage or massage therapy on tender spots and the surrounding muscles will help reduce inflammation and reduce areas of high muscular tension.

    Strengthening exercises: Strengthening certain group of muscles can make them more resilient, correct imbalances, and prevent pain. Eg. Strengthening exercises of the calves, quads, and glutes can help correct this issue, especially in areas of weakness.

    Looking for treatment? Look for PhysioNow!

    If you are experiencing leg pain or shin splints, you can get treatment quickly! Here at PhysioNow, we have many expert Registered Physiotherapist to help, with locations across the GTA including Burlington, Oakville, Mississauga, and Etobicoke. Book with PhysioNow today for your first assessment and treatment!