Anatomy and biomechanics relevant to sports massage

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Medial Shin Splints

Submitted by on July 18, 2009 – 5:28 amOne Comment

Shin splints are a very common lower body injury.  In my years working as an athletic trainer, I have seen athletes from a wide variety of sports come in complaining of shin pain, including track, football, basketball and soccer.  I still see this injury all the time in the massage clinic, but now I take a much different approach to their treatment.

Most often, the pain is felt along the medial border of the shins, about 1/3 to 1/2 way up the tibia.  The muscle most commonly mentioned as a cause of this pain is the tibialis posterior, but the muscle just as likely involved is the medial portion of the soleus.  Both muscles run up the medial border of the tibia, but the tibialis posterior muscle dips underneath the soleus very distal to the usual site of pain to attach on the posterior border of the tibia.  So if the pain is higher up than the lower 1/3 of the tibia, this leaves the soleus as the muscle involved.

Tibialis Posterior

Tibialis Posterior

When looking into the biomechanics of the area, the tibialis posterior and medial soleus muscles are put under strain when the subtalar joint of the foot falls into over-pronation.  Because a function of the tibialis posterior muscle is to support the medial longitudinal arch and over-pronation involves the collapsing of the arch, this action will cause a rapid stretching of the tibialis posterior.

Likewise, repeated eversion of the calcaneus that takes place with subtalar pronation will increase the strain on the medial portion of the soleus muscle.  Over time, the strain placed on these muscles will be transmitted up to their origins on the tibia, creating strain at the attachments on the periosteum of the bone (periostitis).

The athlete will complain of  pain along their inner shin, and point to the medial border of the tibia.  This pain will increase with activity and decrease with rest.  They will have tenderness or pain on palpation of the distal medial border of the tibia.  If you find one small spot that is the source of all the pain, the athlete should be referred to a physician to rule out the possibility of a stress fracture.

Because pronation increases the stress on the medial musculature, a goal for us is to reduce the causes of pronation.  One of the first things we should address is the footwear of the athlete.  I have built strong relationships with the running shoe stores in my city, and refer my clients to them to find the correct shoe for their gait.  By supporting the medial longitudinal arch, the pronation is reduced and the strain on the medial muscles is eliminated.

With massage, it is easy to focus on the site of injury, but remember that pain is a symptom!  We need to treat the structures that are potentially the cause of the condition.  Tight peroneals will pull the foot into eversion and upon weight bearing, pronation.  Additionally, we want to focus on the lateral gastrocnemius and soleus.  With pronation, the lateral belly of the gastrocnemius will typically hold itself tighter than the medial side.

Besides the muscles of the shin, I also recommend looking at the great toe extension (see my earlier post for explanation), the lateral hamstrings and even the lateral rotators of the hip.  All these can promote pronation by externally rotating the leg and forcing the weight to roll off the inside of the foot when walking or running.


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