Author: Matt Callison, L.Ac.
Sourced From: Acupuncture Buzz
From professional to recreational sports, running is a common activity in which tibial stress syndrome, commonly known as shin splints, becomes a primary complaint of lower leg pain.
Most Common Causes of Shin Splints
Runners who push themselves too far, change to a harder running surface or start running uphill are at an increased risk of shin splints. You don’t have to be an athlete to suffer from shin splints, however. Anyone who is active can get them if they push themselves too far or change their workout in any way. The following conditions can put you at an increased risk of shin splints:
- Flat feet, also called overpronation
- Shoes that lack support or don’t fit correctly
- Weak core muscles, hips or ankles
- Exercising without stretching before and after
Types of Shin Splints
There are two types of shin splints, medial and anterior. Both can be quite painful.
Medial shin splints involve the tibialis posterior muscle. This type of shin splint is common among people who have a collapsed medial arch or flat feet (i.e., they’re moderately to severely pronated). When medial shin splints occur, extra tension is placed on the tendon of the tibialis posterior muscle and its tendon.
Anterior shin splints involve the tibialis anterior muscle. This is the same muscle responsible for foot dorsiflexion, which is the raising of the foot upwards toward the shin.2 It is this type of shin splint to blame for runners who over-train on hills, as it requires repetitive use of the tibialis anterior muscle. Ironically, pain is typically worse when running downhill.
How Are Shin Splints Most Commonly Treated?
Unfortunately, conventional Western medicine techniques don’t do much for treating shin splints, other than suggesting icing and resting the leg, and using painkillers.3 Athlete or not, people will do anything to get rid of shin splint pain, but they sometimes make poor choices. Common routes of pain relief include buying different running shoes or trying different stretching exercises. There is also reliance on non-steroidal anti-inflammatory drugs (NSAIDs), however these typically mask the pain. Many runners continue to exercise as normal while taking NSAIDs, however, doing so can lead to micro-fractures or bony stress reactions.
Although the aforementioned methods are fairly routine, they do not “treat” shin splints. Another option worth considering for treatment of shin splints is acupuncture.
Acupuncture for Shin Splints
There are a variety of techniques that different acupuncturists employ for treating shin splints. Some may use specific points on the calf, while others use a technique that involves inserting the needle nowhere near the shin. Instead, the point of insertion is about halfway between the elbow and the wrist. In addition, if the shin splint is on the left leg, the acupuncture needle may be inserted on the corresponding area of the right arm.
Regardless of the system used, the goal of acupuncture is to promote circulation, loosen the muscles in the tibia and prevent recurrences of the syndrome.
Acupuncture & Tibial Stress Syndrome: A Three-Week Study
The following study, also published in The Journal of Chinese Medicine, involved forty athletes who were diagnosed with tibial stress syndrome by the author and certified athletic trainers. In preparation for this study, a past review of any similar research was needed. A limited amount of information was found in the MEDLINE data base from 1966 to the 2000 concerning the use of acupuncture on tibial stress syndromes.
Participants were divided into the following three groups based on the type of treatment received:
Sports Medicine Group: Using a standard form of treatment, the athletic trainers used modalities such as pulsed ultra-sound, stretching, and strengthening exercises in addition to cryotherapy. Pulsed ultrasound and cryotherapy were used to increase circulation and decrease inflammation. Proprioceptive Neuromuscular Facilitation (PNF) stretching and strengthening exercises were primarily used and directed toward the involved lower leg and foot. Other stretching and strengthening exercises were given with the objective of decreasing the tension on the affected musculature.
Acupuncture Group: The primary treatment, developed by the author, was directed at the edge of the tibia where micro-tearing of the affected muscle takes place. The anterior edge was treated when the tibialis anterior was affected, with the medial edge treated when the tibialis posterior muscle was involved. Motor points of the soleus, gastrocnemius, and tibialis anterior were also used, in addition to two-three palpable “ah shi” (or tender) points along the medial arch. Other points were chosen at the practitioner’s discretion to balance and remove obstruction from the channels. Five minutes of tui na massage techniques followed the acupuncture treatment. See the full study for detailed information on this treatment protocol.
A Combination of Sports Medicine and Acupuncture Group: Treatment modalities utilized would vary based on time available and concern for “over treating” the injury. Understandably, not every modality was used during each treatment as the athletic trainer and supervising acupuncturist discussed what techniques would be appropriate. Acupuncture, tui na, and facilitated stretching were the consistent modalities used along with one or two others mentioned above.
At the beginning of the three-week study, participants filled out an intake questionnaire before receiving treatment. They were all treated twice per week and completed follow-up questionnaires at the beginning of the second and third weeks. Questions related to the duration and intensity of the pain they felt between activities, and how many doses of anti-inflammatory medications (NSAIDs) they took.
Results of the Study
Every athlete in the study reported feeling better at the beginning of week two; however, the athletes in the two acupuncture groups (acupuncture alone and acupuncture with sports medicine) reported feeling the most pain relief.
In contrast, the sports medicine group, although feeling a slight reduction in pain, reported that treatment did not significantly improve their pain. What’s more, they also took more NSAIDs than the two groups who received acupuncture. For more detailed results, see the full study.
How to Know When Your Shin Splints Have Healed
Besides the absence of pain, you might wonder when it is safe to return to your normal workouts after experiencing shin splints. A few indicators that they’ve healed include4:
- Your leg with the shin splint is as flexible as your other leg and feels just as strong.
- You can now put excessive weight on the leg that had the shin splint without pain.
- You can exercise without pain.
With proper treatment and rest, shin splints often heal on their own. Be cautious of taking NSAIDs like aspirin and ibuprofen for the pain, however. If you can manage the pain without them, that is the best bet considering the side effects of long-term use.
Your acupuncturist or medical provider can also advise you as to when it is safe to resume your normal activities to avoid further damage.