Have you ever felt a nagging, achy pain along your shin, maybe after an intense season of training? Pain that occurs along the inner side of your shin and persists or gets worse over time, is commonly diagnosed at Shin Splints, also known as Medial Tibia Stress Syndrome (MTSS). It’s an overuse injury that occurs commonly in running and jumping athletes and is especially common in adolescents with growing bodies.
Medial Tibial Stress Syndrome most often starts off feeling like an achy pain along the lower 1/3 of your inner shin. When it first starts, it only hurts with aggravating activities, like jumping. And your shin may be sore to the touch. As the condition gets a little worse, you might notice swelling above your ankle, and pain that becomes sharp, more intense, and more frequent. It may even start hurting with walking or at rest in more severe cases. If it goes untreated, it can sometimes result in a stress fracture.
There are two muscles that contribute to the onset of MTSS. The Soleus muscle and Tibialis Posterior muscle. The Soleus muscle makes up the bulk of your calf and is the power behind your jumps. Tibialis Posterior lies along the inside of the shin and its role is to help lift and prevent collapse of the arch in the foot. They both play important roles in shock absorption when you land.
Both muscles are subject to fatigue and microtrauma when they are constantly stressed. This causes irritation along the tibia (shin) bone where the muscles attach, resulting in this classic shin splints pain. Most commonly we see this when the amount of training is too much for the strength of the muscle.
Common scenarios for injury include:
- The muscles are generally weak and undertrained (sometimes happens after a growth spurt)
- The training volume is too high (too many hours per week), or there has been a recent increase in intensity of training
- There is insufficient recovery/rest time between training sessions
- Dancing on hard surfaces
- Difficulty landing softly or quietly
- Dancers with really high arches
- Dancers with arches that “collapse”
Here’s what to do to prevent MTSS:
Gradually increase the strength and endurance of your Soleus muscle and the Tibialis Posterior muscle. A good starting goal is to be able to do 25 Single Leg Bent Knee Calf Raises without fatigue and without collapsing through your arch. Also, 3 sets of 15 Ankle Inversion exercises against a resistance band.
Assess what kind of control you have in the arch of your foot, both when you stand and when you land from jumps. If you notice that your arch “collapses,” you may need a foot and ankle strengthening plan to better support the lower leg before an injury occurs. See the pictures for some examples of what a collapsed arch might look like.
It’s normal for the arch to roll in (pronate) a little but, but when we have poor control of the rolling in it becomes a problem. Here are some exercises to improve the strength of your arch.
Practice landing softly or quietly. This encourages you to use all of the foot muscles and to eccentrically load the Tibialis Posterior and Soleus muscles to decelerate the leg. Exercises for your toes and your glutes can also help prevent hard landings. Here are some examples to help.
Honor your rest and recovery time. This is when your muscles grow and get stronger. Try not to overdo your training. As a general rule, I recommend dancing up to the same number of hours per week as your age. Anything over that amount can increase your risk for overuse injuries.
Pay attention to the surfaces you dance on and the fit of the shoes that you wear, both in and out of dance classes. You may need to make some changes to decrease the stress on your body. Avoid practicing on tile or concrete floor at home. And if you spend a lot of time jumping in class, choose footwear outside of class with good arch support so your muscles have some time to rest.
Balanced nutrition is always a good idea. Active, athletic bodies need a good balance of nutrients, protein and hydration to build muscle, recover from exercise and grow strong bones. Choose protein, fruits, vegetables, and complex carbohydrates to fuel your body whenever you can.
Of course, if you’re experiencing pain in your shin that is persisting or getting worse, make sure and have your symptoms checked out by a qualified healthcare professional who can give you a full assessment and personalized recommendations for proper healing and recovery!
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Dr. Carrie Skony is a Certified Chiropractic Sports Physician®, dance medicine specialist, and owner of PERFORM Active Wellness + Dance Medicine in Lisle, IL where she enjoys working with dancers from all over the Chicago area. You can learn more about Dr. Skony at www.drcarrieskony.com or follow her on Instagram and Facebook, @drcarrieskony, for more dance related tips.