Mr D is a 19 year-old male soccer player who presented with a 6-week history of pain down the front of both shins. The pain came on gradually during running at a cold night’s soccer training. Every time Mr D. attempted to run after this, he would have shin pain. The pain would sometimes improve when he warmed up after about 10 minutes, but would be particularly worse in the last quarter of a game. The pain was reported to be getting worse and he wanted to be able to play soccer without pain in the second half of the season. Mr D. reported that he had a year off all sport last year because he was busy with the HSC. This year at University, he was participating in sport every night of the week.
Mr D. had pronated feet (dropped arches) when standing. He had good flexibility in the calf muscle and ankle joints. When he hopped on the spot, Mr D. developed his shin pain pretty quickly on both sides. It was most sore to touch along the inside of the lower part of both shins. He had no tenderness in the muscles or bone in the front of the shin. Mr D was diagnosed with medial tibial stress syndrome, which is different to a stress fracture or compartment syndrome, other common causes of shin pain.
Mr D was instructed to rest from high impact activity for a 2 week period while he focussed on strengthening. Hopping was observed to have increased pronation and pain associated. A treatment involving taping the arch of the foot was used to see if controlling the pronation might change his symptoms. When Mr D had the feet taped he had no pain with hopping. In response to this positive test he was offered a temporary orthotic for his shoes to help lift the arch up. He was also provided with a strengthening program including not just the muscles in the arch of the foot, but the entire leg. By increasing the strength in the toes, calf, quads and glutes, Mr D will be able to reduce the load going through his shin bones by shock absorbing using his muscles. Mr D. was able to jump and hop pain free without tape after 2 weeks of physiotherapy. He then commenced some bounding and hopping (plyometric) exercises with a focus on shock absorbing and soft landing. He completed a graded return to running program and returned to light soccer training over the next 2 weeks. Mr D was able to play football pain free after 6 weeks of physiotherapy. He completed the remainder of the season, including finals football without the pain returning.
If you have shin pain with running, we can help you. Contact us on 49216879.