Pathology and Massage: Anterior Shin Splints

What are shin splints?

Shin splints is a blanket term for a number of lower leg problems. It causes pain and sometimes swelling on the lower leg. Shin splints is an inflammation of the periosteum (the membrane that lines the outer surface of all bones) and the attached muscle fibers. The muscles attached to the tibia are tearing loose. Generally, when someone gets shin splits, it is due to excessive or repeated pounding, or “impact loading”, on hard surfaces during athletic activities, such as running or tennis. The condition worsens with the actions the affected muscles do. Other technical terms a doctor might use when diagnosing shin splints are idiopathic compartment syndrome, acute and chronic exertional compartment syndrome, periostitis, traction periostitis, tibial fractures, and medial tibial stress syndrome. These different titles account for location of pain and severity of the condition. Most commonly, shin splints are medial or lateral. Lateral shin splints are also called anterior shin splints, because the anterior muscle compartment is lateral to the tibia.

Which muscles or other structures are involved?

Principally, the tibialis anterior muscle and the tibia are involved in anterior shin splints. Tibialis anterior originates along the lateral  surface of the tibia. Tibialis anterior is responsible for dorsiflexion (flexing your foot toward your leg) of the ankle and sustains tears along the tibia when overused or constantly impacted. It’s possible the interosseous membrane could also be involved as tibialis anterior also originates there.

How are shin splints assessed?

Chances are, if a client had shin splints, I would know. For instance, if they stood up and grimaced and then proceeded to gingerly walk across the room. They may even limp or hobble a bit. Walking would be uncomfortable for anyone with shin splints. If you superficially massaged the anterior leg muscles, it would probably feel tender, but good; a deeper massage would most likely be uncomfortable or painful. Lesser muscle injuries would not be visible on the leg, nor would they be palpable, but more severe injuries would exhibit red, hot puffiness around the tibia. Pain along the tibia is an indication, and may be superficial or deep, mild or severe. The location of the pain would indicate the injured muscles. Someone with anterior shin splints may describe the pain as an ache that runs the length of the lateral tibia.

How are shin splints treated?

Shin splints require first and foremost, rest. Ice, stretching, strengthening and massage are also indicated.  Massage is only contraindicated if the condition is advanced: that is, if the leg looks and feels hot and swollen, or is extremely painful. Once the inflammation and pain begin to subside, massage is beneficial. If the condition does not improve within a couple of days, it could be a sign of a more serious condition and requires medical attention. Massage is an excellent treatment as it increases circulation and releases adhesions. Massage can also prevent shin splints from advancing into more serious complications, such as exertional compartment syndrome. Proper stretching is a necessary preventative measure. Plantarflexion (pointing the foot down) and eversion (pointing the foot in toward the mid-line of the body) will stretch the tibialis anterior muscle. Stretching the lower leg muscles can be difficult through exercise alone, but massage can work every inch. Regardless of where the injury is, all the lower leg muscles should be stretched and massaged. The feet should be worked as well, as the lower leg muscles insert into points throughout them. Myofascial Release is a desirable modality for shin splints, as it can release the fascia binding all four muscle compartments. Plus, as it works superficially, it would most likely be more comfortable than Deep Tissue techniques.


These pictures are from Trail Guide to the Body, Second Edition, by Andrew Biel, illustrated by Robin Dorn (both massage therapists) and published by Books of Discovery.