Have you ever heard the term “Shin Splints”? Did you know that there is more than one kind?? Most people are familiar with Anterior Shin Splints, a condition in which pain occurs along the front outside (anterior lateral) portion of the lower leg. From a runners perspective, anterior shin splints are common when someone has started a new running program and tends to over-train, for example, too much too soon! Also, down hill running puts added stress on the anterior shin. The second type is Posterior Shin Splints, a condition in which pain occurs on the back inside (posterior medial) portion of the lower leg. Posterior shin splints are also referred to as Posterior Tibialis Syndrome or PTS because it is the posterior tibialis muscle and it's tendon that are affected in this condition. PTS often occurs in beginning runners because they are not accustomed to the activity and to different running surfaces. However, PTS can also occur in long time runners when they change the intensity and/or duration of their training program, when they change running surfaces, or when they change to different running shoes. We will concentrate on PTS for the remainder of this article.

The posterior tibialis muscle originates on the back of the tibia, the lower leg bone. The tendon to this muscle runs down the leg, behind the inside ankle bone, and attaches to the underside of the foot at the top of the arch. The function of this tendon is to help hold up the arch of the foot. You can imagine, when running, how many times this muscle and it's tendon are expected to do their job—every time your foot strikes the ground!

There are several main causes of PTS :

1. Overuse

2. Over-pronation (rolling inward) of the foot caused by flat

arches and/or running on tilted or slanted surfaces

3. Running on hard surfaces, such as concrete

4. Inadequate running shoes

Symptoms of PTS are an aching, sometimes throbbing or burning tenderness along the inside of the lower leg. The area is inflamed and will be tender when pressure is applied. Pain is usually most severe at the beginning of the run. Pain may go away during a run once the muscles are warmed up, however, will usually be very tender and symptomatic after the run. Treatment for PTS includes modifying your activities and resting the leg for a period of time. Most of us never like to hear that we shouldn't run, so you can try non-impact exercises like swimming, stationary cycling, or pool running until your condition is better. Other treatment alternatives include stretching the lower leg muscles including special attention to the calves, icing the area at least twice per day and making sure you are running in the right shoes and on soft, flat surfaces. Massage is also a very effective treatment for PTS as it helps to break up adhesions that have developed along the muscle and tendon. Massage also helps to increase the circulation to the area which speeds the healing process. At SMIT we have treated many runners with PTS with great success. If you would like more information on this article or have questions on PTS, stretches, or massage treatments, please contact our staff @ 770-984-8889.