Most runners are familiar with the term ‘Shin Splints’. It has to be one of the most common of the annoyingly generic terms commonly used to describe a handful of similar (but importantly different) issues affecting the lower leg – particularly the medial border of the tibia – the inner aspect of the shin bone.
Collectively we can refer to these differing pathologies as ‘Medial Tibial Stress Syndrome’ (MTSS). One of the injuries that falls under the MTSS bracket is characterised by a dull-but-intense pain at the lower third of the inner part of the shin bone, coming as a result of irritation to the outer surface (periosteum) of the bone at the insertion point where the Tibialis Posterior and Soleus muscles attach.
This tenderness upon weight bearing, and particularly under direct pressure is particularly common in (but certainly not exclusive to) runners and triathletes who have recently changed to midfoot/forefoot strike pattern, and then increased training milage too quickly – not allowing the soft tissues to adapt gradually – a process that takes time and patience.
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When Tibialis Posterior is loaded more than it can tolerate, we usually see the muscle react by becoming tight and causing the pain as described around the lower medial shin.
What Can You Do?
As with the majority of running injuries, the best approach is to book-in for a thorough assessment with a running specialist physio. However I do encourage every athlete I meet to learn and develop the skills to manage their own aches and pains. The better you get at this, the less time you will spend at the physio, and the less interruptions you will experience to your training.
Stretching that Hard-to-Reach Spot
For the many runners who do suffer with tightness through Tibialis Posterior, and the dull medial shin pain that comes with it, finding a stretch to effectively target the specific muscle can be really difficult. In the video below, I demonstrate a simple but effective tweak to the classic Soleus stretch that changes it into a targeted Tibialis Posterior stretch…
Of course, the muscle gets tight in the first place because it is too weak for the demands placed on it… so we can help the situation by performing targeted strengthening exercises for Tibialis Posterior. In this article, I’ve listed a number of exercise progressions to gradually work through, increasing demand on Tibialis Posterior as you move through the progressions, from un-resisted movement to resistance band work to low level plyometric drills.
Once my athletes have progressed through this series of exercises, I usually prescribe regular short sessions of skipping (jumping-rope) to help maintain the dynamic strength, stability and relative stiffness around the ankle joint.
Tibialis Posterior it self acts concentrically to invert and plantar flex the rear-foot, helping to supinate the foot. Eccentrically it controls eversion and dorsiflexion, helping to control pronation in weight bearing. It’s the eccentric demands that come with running that most create most strain on Tibialis Posterior, hence the way in which the exercise progressions in the linked article go from slow non-weight bearing concentric exercises to dynamic weight bearing eccentric exercises – ultimately more like running.