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Hamstring Strain Injuries: Lessons from Personal Experience and the Latest Research

Hamstring Strain Injuries: Lessons from Personal Experience and the Latest Research

by | May 29, 2023 | Gym and Strength, Return to Sport, Running Injuries

Recently, in an effort to keep the ballooning effects of the all-you-can-eat buffet at bay during my Cricket Australia Indian tour, I ramped up my high-intensity running load. Things were going splendidly — four days of high-intensity running under my belt — until day five, when 90% of the way through a very intense interval session, I tore my hamstring.

I felt the tell-tale sensation so many of my patients describe: a sharp tearing and retraction sensation in my outer thigh while sprinting. I had to pull up immediately and iced the injury straight away. You’ll be happy to hear that I’ve since fully recovered. No longer ‘gun shy’ at my top speeds (which, admittedly, are not that fast!), my strength has vastly improved, and I’m back running at full capacity.

Having treated countless hamstring injuries through my long involvement in recreational, semi-elite, and elite sport — especially with Cricket Australia teams and the Aspley Hornets NEAFL squad — this experience gave me even deeper appreciation for how tricky these injuries can be. Hamstring strains are one of the most common injuries in running athletes, responsible for significant downtime and lost performance. Hamstring injuries have remained the most prevalent injury in professional AFL for the past 21 consecutive seasons (Orchard et al., 2013), with the average 2012 injury costing clubs over $40,000 per player!

Understanding Hamstring Injury Mechanisms

Most hamstring tears occur during the late-swing phase of running, where the hamstring undergoes rapid lengthening while producing high forces (Danielsson et al., 2020). Key risk factors include:

  • High eccentric loading demands.

  • Poor neuromuscular control.

  • Muscle imbalances (particularly hamstrings vs quadriceps).

  • Fatigue — as evidenced by my own injury, occurring late in a demanding session!

Importantly, the long head of biceps femoris is the most commonly injured muscle, partly due to its higher proportion of fast-twitch fibers and its anatomical position under stretch during running (Martin et al., 2022).

Fatigue, poor trunk/pelvic control, and sudden spikes in high-speed running are emerging as significant contributors to hamstring strain risk, particularly in field and court sports (Martin et al., 2022).

Preventing Hamstring Injuries

The good news is, hamstring injuries can often be prevented with smart training. Strengthening the hamstrings through eccentric exercises like Nordic hamstring curls and single-leg Romanian deadlifts has been shown to reduce injury rates significantly (Al Attar et al., 2017; Martin et al., 2022).

Effective prevention programs should also include:

  • Agility and trunk stabilization exercises — not just strength work (Martin et al., 2022).

  • Warm-up routines with dynamic stretching and sport-specific drills.

  • Monitoring high-speed running loads to avoid sudden spikes in intensity.

Addressing muscle imbalances is key too. Maintaining a healthy strength ratio between the quadriceps and hamstrings — and ensuring good trunk and gluteal control — promotes optimal biomechanics and reduces injury risk (Martin et al., 2022).

Recovering Well After a Hamstring Injury

A proper recovery should include:

  • Early management: Controlling swelling and pain with ice and appropriate activity modification.

  • Progressive eccentric strengthening: Integrated carefully to build resilience.

  • Functional rehabilitation: Sprinting drills, agility work, and sport-specific movements are crucial before returning to full play (Martin et al., 2022).

Interestingly, studies show athletes who follow programs that include eccentric training and trunk stability work have lower reinjury rates than those who just focus on basic strength and stretching (de Visser et al., 2012; Martin et al., 2022).

Return-to-play decisions should be made carefully. Factors like strength symmetry, absence of pain, and readiness for high-speed running should all be considered to reduce the risk of reinjury, which can be as high as 30% otherwise (Martin et al., 2022).

Final Thoughts

Even as a physio, my personal hamstring tear was a stark reminder that fatigue, progressive loading, and structured rehab are vital ingredients for both prevention and recovery. Whether you’re a weekend warrior, a professional cricketer, or just trying to beat the buffet, hamstring health is crucial.

If you’d like help strengthening your hamstrings, managing an existing injury, or optimising your running and performance, feel free to reach out. I (and my hamstrings) would be happy to help!

Till next time, Praxis what you Preach!

Backed by evidence. Trusted by athletes. Here for every body.

References

  • Al Attar, W.S.A., et al. (2017). The effectiveness of injury prevention programs in reducing the incidence of hamstring injuries in soccer players: a systematic review and meta-analysis. Journal of Physiotherapy, 63(1), 11–17.

  • Danielsson, B., et al. (2020). Mechanisms of hamstring strain injury: current concepts. Sports Medicine, 50(4), 669–682.

  • Martin, R.L., et al. (2022). Hamstring strain injury in athletes: Clinical Practice Guidelines. Journal of Orthopaedic & Sports Physical Therapy, 52(3), CPG1–CPG44.

  • Orchard, J.W., et al. (2013). AFL Injury Report 2012.

Split Squat vs Squat vs Deadlift: How to tailor your lower body training

Split Squat vs Squat vs Deadlift: How to tailor your lower body training

by | May 26, 2023 | Gym and Strength, Return to Sport, Running Injuries

The age old question: What’s the best gym activity for my sport? Well – the answer should always be “it depends”. Even the same athlete playing the same sport will have different requirements at different parts of a season. Generally speaking, there are some common exercises in utilised by strength coaches when programming for athletes. The split squat, squat, and deadlift are all compound exercises that target various muscle groups and are commonly included in strength training programs. In today’s Praxis What You Preach article, we are going to breakdown the kinematic (joint angles) and inverse dynamic (joint forces from assumed joint angles) differences between these exercises. We’ll also briefly discuss what sports may benefit, but as just mentioned, the answer is “it depends”.

The Split Squat

The split squat is a unilateral lower body exercise that primarily targets the quadriceps, hamstrings, glutes, and hip stabilisers. It is a personal favourite of mine as I believe it replicates many athletic positions and helps identify any asymmetries there may be. In this exercise, you start in a staggered stance with one foot forward and the other foot positioned behind. The front leg performs most of the work, while the back leg provides support.

The Movement

  • The front knee flexes and extends, moving vertically.
  • The rear leg remains relatively stationary, providing balance and stability.
  • The hip joint of the front leg moves through flexion and extension.

What’s working?

  • The front leg experiences greater joint forces and moments due to supporting most of the load.
  • The knee extensors (quadriceps) and hip extensors (glutes) generate the majority of the force to extend the knee and hip joints.
  • The rear leg primarily acts as a stabilizer rather than generating significant force.

Sports?

The split squat is a versatile exercise that can benefit individuals participating in a wide range of sports. Running, jumping and change of direction field sports such as AFL and soccer seem to benefit well due to the asymmetrical load on the pelvis. The increased loading of the hip stabilising muscles make this a useful exercise for tennis players, volleyballers and track and field (eg triple jumpers) athletes as well.

The Squat

An absolute staple of the gym! The squat is a bilateral lower body exercise that primarily targets the quadriceps, hamstrings, glutes, and lower back muscles. For the sake of this argument, talking about a Barbell back squat. It involves descending into a squatting position while maintaining a relatively upright trunk and then returning to a standing position.

The Movement

  • The hips and knees flex simultaneously, moving in a coordinated manner.
  • The knees move forward, tracking over the toes
  • The torso tilts forward slightly, maintaining a neutral spine but a bit of flex here is fine (and biomechanical studies show you can’t not flex the spine)

What’s Working?

  • The quadriceps, hamstrings, and glutes generate force to extend the hips and knees during the ascent phase.
  • The erector spinae and other lower back muscles provide stabilization and contribute to maintaining an upright posture.
  • The knee extensors (quadriceps) experience higher forces and moments during the descent and ascent phases.

Sports?

Squats help with vertical force generation so jumping sports like basketball and volleyball are sports that would benefit. The Barbell back squat is also central in powerlifting, olympic lifting and Crossfit. Given you can load significant weights to the bar, back squats are also useful for football codes whe are required to absorb impacts during tackles.

The Deadlift

The deadlift is a bilateral exercise that primarily targets the posterior chain, including the glutes, hamstrings, erector spinae, and upper back muscles. It involves lifting a loaded barbell or other weight from the floor while maintaining proper form.

The Movement

  • The hips hinge backward, allowing the torso to lean forward while maintaining a neutral spine.
  • The knees flex to a lesser extent compared to the squat.
  • The barbell moves vertically in a straight line close to the body.

What’s Working?

  • The glutes, hamstrings, and erector spinae generate force to extend the hips and maintain a neutral spine.
  • The quadriceps contribute to knee extension.
  • The upper back muscles help stabilize the spine and prevent excessive forward flexion.
  • The lower back muscles experience significant forces and moments due to their role in maintaining spinal alignment.

Sports?

Powerlifting, Olympic lifting and Crossfit are the obvious ones that spring to mind. But tackling sports such as rugby can benefit. Given the predominance of back musculature, rowers will benefit here. Wrestlers and MMA athletes will also benefit due to the whole body nature of a deadlift.

Overall, while all three exercises involve lower body movements, they differ in terms of joint angles, muscle activation patterns, and force distribution. Understanding these differences can help tailor training programs to specific goals and individual needs. We also modify these exercises further to tailor our rehabilitation needs, In that vein, it’s important to be conscious of technique when performing these exercises to maximise their effectiveness and reduce the risk of injury.

So if you are growing stale in your lower body workouts, try and mix it up with some of the above. There are also plenty of variations of the above to alter the movement and forces even more! If you are after some help to modify your gym program, chat to us today – we are here to help!

Until next time, Praxis What You Preach…

📍 Clinics in Teneriffe, Buranda, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

Plantar Fasciopathy: Understanding how to heal your heel pain

Plantar Fasciopathy: Understanding how to heal your heel pain

by | May 16, 2023 | Ankle and Foot, Running Injuries

Feel like your walking on glass in the mornings?  Those first few steps after a long period of sitting hurt the underside of your heel? Struggling to stand at the end of a long day due to your feet? If so, then you may have plantar fasciopathy, also known as plantar fasciitis. Plantar fasciopathy is a common condition that affects the plantar fascia – a thick band of connective tissue on the bottom of the foot. Plantar fasciopathy commonly affects individuals between the ages of 40 and 60, but can affect almost anyone. In this article, we will delve into the causes, symptoms, treatment options, and preventive measures to help you understand, and more importantly manage, this condition.

Causes and Symptoms

Plantar fasciopathy is often caused by repetitive strain or excessive loading of the plantar fascia, leading to microtears and inflammation. Factors such as overuse, improper footwear, high-impact activities, flat or high-arched feet, and tight calf muscles can contribute to its development. The condition is characterised by sharp pain or a dull ache on the underside of the heel or along the arch of the foot. Pain is typically worse in the morning or after periods of inactivity, and may improve with movement. Standing for long periods or walking on hard floor can also be aggravating.

Treatment Options

The treatment of plantar fasciopathy focuses on reducing pain, promoting load tolerance, and addressing the underlying causes. Physiotherapy interventions play a crucial role in managing this condition. Therapeutic techniques such as manual therapy, stretching exercises, and strengthening exercises can help relieve pain, improve flexibility, and restore foot function. Specifically, improving the windlass mechanism (a phenomena that refers to the tightening of the plantar fascia during the push-off phase of walking or running when you big toe extends). This mechanism helps distribute forces evenly throughout the foot and reduces strain on the plantar fascia. More generally, improvement of the footy intrinsics and plantar flexors more generally have been shown to reduce the severity and duration of symptoms as well.

Additionally, the use of orthotics, taping, or night splints may provide support and alleviate symptoms. Extracorporeal shockwave therapy (ESWT) and ultrasound therapy are also viable treatment options in some cases. In severe or persistent cases, corticosteroid injections or surgery may be considered, though this is usually reserved for when conservative measures have failed.

Preventive Measures

Prevention is key to reducing the risk of plantar fasciopathy starting in the first instance. If you are keen to ‘pound the pavement’ for example, then gradually increase activity levels. Avoid sudden changes in intensity or duration to prevent overloading the foot. This may mean dancing long bouts for the first time in a while, or returning to running post injury. Wear footwear that provides adequate arch support and cushioning. Understand the importance of regular stretching exercises for the calf muscles and plantar fascia.

As physiotherapy professionals, we understand that addressing the symptoms of plantar fasciopathy early is essential for providing effective care. At Praxis, effective care means arming you with adequate advice and education so you can help manage the symptoms yourself. Further, implementing appropriate treatment options and emphasizing preventive measures, we support individuals in overcoming foot pain and restoring quality of life. After all, we aim to Prevent, Prepare, Perform! So if you have heel pain that is stopping you from doing what you would like to do, discuss it with our knowledgeable team today!

Until next time – Praxis What You Preach!

📍 Clinics in Teneriffe, Buranda, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

Understanding Sever’s Disease: A Common Foot Condition in Active Growing Children

Understanding Sever’s Disease: A Common Foot Condition in Active Growing Children

by | May 16, 2023 | Ankle and Foot, Return to Sport, Running Injuries

Understanding Sever’s Disease in Growing Children

Sever’s disease — medically known as calcaneal apophysitis — is a common heel condition affecting active children, especially during growth spurts. Despite its name, it’s not a “disease” in the traditional sense, but an overuse injury of the growth plate at the back of the heel.

What Causes Sever’s Disease?

Sever’s disease develops when repetitive stress irritates the growth plate in the heel bone (the calcaneal apophysis). During adolescence, especially between ages 8–15, the heel bone may grow faster than the surrounding muscles and tendons, causing excessive tension at the Achilles insertion site. When coupled with repetitive impact — such as running, jumping, or playing on hard surfaces — this mechanical overload leads to inflammation and pain.

It’s especially common in sports like soccer, basketball, AFL, netball, and gymnastics. Kids going through growth spurts, or who are highly active without sufficient recovery, are most at risk. Tight calf muscles, poor footwear, and biomechanical factors like flat feet or poor shock absorption may also contribute.

Common Symptoms

The main symptom is heel pain that worsens during physical activity and settles with rest. Children may complain of:

  • Pain or tenderness at the back or underside of the heel

  • Limping or toe-walking, particularly after sport

  • Discomfort when pressing on the heel or squeezing it from both sides

  • Stiffness first thing in the morning or after periods of inactivity

Symptoms are usually one-sided but can be bilateral. If left unaddressed, the pain can start to interfere with participation in sport and physical education at school.

Diagnosis

A diagnosis is usually made through clinical history and physical examination by a physiotherapist. Key indicators include heel pain during activity, recent growth, and tenderness at the posterior heel. The “squeeze test” — applying gentle pressure to both sides of the heel — is often positive.

Imaging (X-ray or MRI) is rarely needed unless symptoms persist longer than expected, or there is suspicion of another diagnosis. Importantly, a visible growth plate on X-ray in this age group is normal and not a reason for concern in itself.

Treatment and Management

Treatment is focused on reducing inflammation, offloading the heel, and supporting the child’s return to normal function. It is important to reassure both child and parent that this is a temporary, self-limiting condition.

Key management strategies include:

  • Load modification: Avoiding or reducing high-impact activity is key, especially sports with frequent jumping or sprinting. Your physio can help create a weekly plan to reduce flare-ups while keeping your child engaged and active.

  • Ice: Icing the heel after sport can reduce inflammation and pain, especially in the early stages.

  • Heel lifts or orthotics: Studies, including the 2016 randomised trial by James et al., show that both orthotic devices and cushioned heel lifts can effectively reduce heel stress. These inserts help absorb shock and reduce Achilles tendon tension.

  • Calf stretching and strengthening: Tight calf muscles increase load on the heel. Scharfbillig et al. (2008) emphasised the role of flexibility programs, particularly eccentric calf training, in improving outcomes.

  • Footwear advice: Supportive, well-fitted athletic shoes are essential. Avoid barefoot running or flat-soled footwear during recovery.

  • Manual therapy and taping: In some cases, hands-on techniques and taping methods may be used to reduce load on the Achilles insertion.

According to the trial by Weert et al. (2016), physical therapy combining load management and exercise-based rehab was just as effective as orthotic devices. This supports a flexible treatment approach tailored to the child’s specific needs and activity level.

Medication: Short courses of anti-inflammatory medication such as ibuprofen can help in more severe cases, especially when pain interferes with sleep or daily function. However, these should always be used under medical advice.

Prevention and Long-Term Outlook

The prognosis for Sever’s disease is excellent. Most children recover fully once the growth plate fuses — typically by age 15 for boys and 13 for girls. The condition does not cause permanent damage, though symptom duration can vary from a few weeks to several months depending on activity levels and adherence to management.

To reduce the risk of recurrence:

  • Encourage a proper warm-up and cool-down routine

  • Ensure sport participation is balanced with adequate rest

  • Maintain calf flexibility and foot strength

  • Use shock-absorbing shoes or orthotics during growth spurts

  • Avoid large increases in training volume or intensity

It’s also helpful to educate kids and parents that some discomfort during growth phases is normal, but persistent pain warrants a review. At Praxis Physiotherapy, our clinicians are experienced in managing growing athletes — and ensuring they don’t miss more game time than necessary.

Summary

Sever’s disease is a common and manageable cause of heel pain in growing children. Early recognition, temporary load reduction, and a guided rehab program can ensure a smooth recovery and quick return to sport. If your child is experiencing heel pain that isn’t improving with rest, book in with the friendly and knowlegable team at Praxis Physiotherapy for a tailored management plan.

Until next time, Praxis What You Preach

📍 Clinics in Teneriffe, Buranda, and Carseldine

💪 Trusted by athletes. Backed by evidence. Here for everyone.

References

James, A. M., Williams, C. M., & Haines, T. P. (2016). Effectiveness of footwear and foot orthoses for calcaneal apophysitis: a 12-month factorial randomised trial. British Journal of Sports Medicine, 50(20), 1268–1275. https://doi.org/10.1136/bjsports-2015-094986

Scharfbillig, R. W., Jones, S., & Scutter, S. D. (2008). Sever’s Disease: What Does the Literature Really Tell Us? Journal of the American Podiatric Medical Association, 98(3), 212–223. https://doi.org/10.7547/0980212

Weert, H. C., van Dijk, C. N., & Struijs, P. A. (2016). Treatment of Calcaneal Apophysitis: Wait and See Versus Orthotic Device Versus Physical Therapy. Journal of Pediatric Orthopaedics, 36(2), 152–157. https://doi.org/10.1097/BPO.0000000000000417

Tibialis Anterior – The missing link to pain free legs and performance?

Tibialis Anterior – The missing link to pain free legs and performance?

by | May 16, 2023 | Ankle and Foot, Return to Sport, Running Injuries

Shin splints? Painful knee with jumping? Recurrent ankle sprains? These are the types of injuries we fix day in and day out at Praxis Physio. There are number of recommended paths for rehabilitation in theses injuries backed by the research and our clinical experience, but has the evidence been missing something? There is some social media traction in the fitness and exercise world recently around tibialis anterior (TA) loading as a ‘cure all’ for every lower limb injury. Being the physio nerds that we are, we looked in to it for you!

The tibialis anterior is located on the front (anterior) portion of the shin (tibia) – hence the name. Its role is to lift the foot (dorsiflex) the ankle as well as provide some stability for the outside of the ankle . This action is key for movements in walking and running especially in negotiating steps and hills as the foot needs to clear a certain height before landing. It is also very important in landing from a height and changing directions rapidly, as it acts as shock absorber for the knee and ankle joints (reference).

Like any muscle or joint in the body, the TA is not without its problems. Physios are regularly confronted with patients who complain of pain and stiffness around the muscles of the shin. Such conditions may include shin splints, compartment syndrome, patellofemoral pain syndrome (aka runner’s knee) and general ankle joint pain and stiffness post ankle sprain.

As mentioned, there has been a lot of discussion lately in the strength and conditioning community about whether training this muscle can prevent or treat musculoskeletal conditions, such as the ones mentioned above. Anecdotally, training of the TA has been described several benefits. Specific athletes have explained that they have seen improvements in vertical jump height, running speed, running stamina and squat depth. From a prevention and treatment point of view, it has been said that training the TA has helped improve symptoms associated with knee pain, ankle pain and shin splints. Also let us not forget, that from an aesthetics point of view, a strong and bulky looking TA does make our legs look more attractive, as bodybuilders would argue.

Unfortunately, the scientific community has not provided strong evidence that training the TA can aid in affecting the above musculoskeletal pathologies, or attain the performance benefits. So what do we know from previous scientific literature? Well, Munoz et al (2015) describes the tibialis anterior as key during an efficient gait cycle as well as being critical for balance control. Furthermore, an increase in strength of the TA helps greatly reduce the risk of falling. Maharaj et al (2019) confirms that during walking and running , TA’s tendinous tissue absorbs energy during contact and controls foot position during swing.

The proposed mechanisms to aid in athletic performance include:

  1. Increased ankle stability: Strong tibialis anterior muscles provide better stability to the ankle joint during jumping movements. This stability allows for improved force transmission from the lower leg to the foot, enabling athletes to generate greater power and maintain proper alignment during takeoff and landing.
  2. Enhanced dorsiflexion range of motion: Adequate dorsiflexion range of motion is essential for optimal jumping performance. Strengthening the tibialis anterior helps to improve flexibility and mobility in the ankle joint, allowing athletes to achieve a greater degree of dorsiflexion during the pre-jump phase. This increased range of motion enables a longer and more powerful push-off, resulting in higher jumps.
  3. Improved jump height and explosive power: The tibialis anterior plays a significant role in generating propulsive force during the takeoff phase of a jump. By strengthening this muscle, athletes can produce a more forceful and efficient push-off, leading to increased jump height and explosive power. The ability to generate greater force through dorsiflexion contributes to a more powerful and effective jump.
  4. Injury prevention: Weak tibialis anterior muscles can contribute to imbalances in the lower leg, potentially leading to various conditions such as shin splints or ankle sprains. Strengthening this muscle group helps to maintain proper muscle balance around the ankle joint, reducing the risk of injuries that could hinder jumping performance.

So if we are to believe TA holds the key to athletic performance and injury mitigation, how do we unlock it?

To strengthen the tibialis anterior, physiotherapists often prescribe specific exercises that target this muscle, such as toe raises, resisted dorsiflexion exercises, or using resistance bands to provide resistance during dorsiflexion movements. These exercises should be performed in a controlled manner and progressively increased in intensity to promote muscle strength and endurance. Below you see variations on how you can load the TA and progress and regress it respectively. Remember that we need to treat the TA like any other muscle we are wanting to train – progressively overloading it!

As Physiotherapists, we greatly value and adhere to evidence-based practice, however one could argue that this particular muscle has not received the scientific study treatment it rightly deserves. So if you are having some lower leg issues, or haven’t quite got that bounce you are wanting, come and chat to one of our friendly and knowledgeable staff. We can do a full assessment and put the spring back in your step!

Until next time, Praxis what you preach!

Prevent. Prepare. Perform

References:

Maharaj JN, Cresswell AG, Lichtwark GA. Tibialis anterior tendinous tissue plays a key role in energy absorption during human walking. J Exp Biol. 2019 Jun 4;222(Pt 11):jeb191247. doi: 10.1242/jeb.191247. PMID: 31064856.

Ruiz Muñoz, M., González-Sánchez, M. & Cuesta-Vargas, A.I. Tibialis anterior analysis from functional and architectural perspective during isometric foot dorsiflexion: a cross-sectional study of repeated measures. J Foot Ankle Res 8, 74 (2015). https://doi.org/10.1186/s13047-015-0132-3

Shin Splints: Causes, Treatment & How to Get Back to Running Stronger

Shin Splints: Causes, Treatment & How to Get Back to Running Stronger

by | Nov 27, 2019 | Ankle and Foot, Return to Sport, Running Injuries, Sports Injury

Key Takeaways

  • Shin splints (MTSS) are an overuse bone stress injury.

  • Training load errors are the biggest contributor.

  • Hip strength and force control play a major role.

  • Early management prevents stress fractures.

  • Strength + smart loading beats rest alone.

    Mid Potion Achilles Tendinopathy Location

    Shin Splints

    Shin splints, known in the research as medial tibial stress syndrome (MTSS) are one of the most common running injuries we see at Praxis Physiotherapy across our Teneriffe, Buranda and Carseldine clinics.

    If you’re noticing a dull ache along the inside of your shin that worsens with running, skipping or sport, you’re not alone. The good news? With the right plan, shin splints are highly manageable — and preventable.

    Let’s break down what’s actually happening, why it develops, and what you can start doing today.

    What Are Shin Splints (Medial Tibial Stress Syndrome)?

    Shin splints are an overuse bone stress injury affecting the inner (medial) border of your tibia (shin bone).

    What does it feel like?

    • Aching pain along the lower inside shin

    • Sharp pain when running or jumping

    • Tenderness to touch along the bone

    • Morning stiffness or pain when first starting activity

    Unlike a stress fracture (which is more focal and severe), shin splints usually present as a broader area of tenderness along the bone.

    What’s Actually Happening? (The Pathology Explained Simply)

    MTSS is no longer thought to be just an “inflammation” problem.

    Current evidence suggests shin splints develop due to repetitive loading that exceeds the bone’s capacity to adapt. When running loads increase too quickly, the tibia experiences repeated bending stress. If recovery isn’t adequate, this leads to:

    • Bone stress reaction

    • Irritation of the periosteum (bone lining)

    • Localised pain along the medial tibia

    If ignored, MTSS can progress to a tibial stress fracture, which requires significantly longer time away from running.

    That’s why early management matters.

    Why Do Shin Splints Develop?

    A large systematic review by Winkelmann et al. (2016) identified over 100 potential risk factors for MTSS, with several consistently seen in clinical practice.

    Key Risk Factors Supported by Research

    1. Training Load Errors
    Rapid increases in running volume, intensity, or frequency are one of the strongest contributors.
    (Winters et al., 2013; Nielsen et al., 2012)

    2. Higher Body Mass Index (BMI)
    Greater body mass increases tibial loading forces.

    3. Biomechanical Factors

    • Increased navicular drop (foot pronation)

    • Greater plantarflexion range

    • Hip muscle weakness and poor pelvic control

    4. Previous History of MTSS
    Recurrence risk is higher without proper rehabilitation.

    Importantly flat feet alone are rarely the sole cause.

    What we often see clinically is this chain reaction:

    Poor hip control → knee collapses inward → foot over-pronates → increased traction stress on medial tibia.

    The foot is often the victim, not the culprit.

    Why Rest Alone Isn’t Enough

    Yes — rest reduces pain. But rest does not improve:

    • Load tolerance

    • Running capacity

    • Strength deficits

    • Movement control

    This explains why shin splints are common in recreational runners but less frequent in well-structured training programs. Higher-level athletes typically follow progressive loading plans that allow bone and tendon adaptation.

    Research consistently supports graded loading and strengthening as key components of recovery (Moen et al., 2012).

    .

    How to Manage Shin Splints (Early Stage Tips)

    If your symptoms are mild to moderate, here are evidence-informed starting points:

    1️⃣ Relative Rest (Not Complete Rest)

    Reduce running volume by 30–50%.
    Avoid sharp increases in load.
    Swap some runs for cycling or swimming temporarily.

    2️⃣ Strengthen the “Shock Absorbers”

    Focus on:

    • Calf strength (bent and straight knee)

    • Tibialis posterior strengthening

    • Glute medius and hip control exercises

    • Single-leg stability work

    Improving hip strength can reduce tibial loading by improving force control through the limb.

    3️⃣ Manage Running Workload

    Follow the “10% rule” cautiously.
    Allow recovery days between harder sessions.
    Avoid sudden terrain changes (e.g., grass → concrete).

    4️⃣ Consider Footwear

    Ensure shoes are not worn out (>600–800km).
    Orthotics may help some individuals — but only after assessment.

    When Should You See a Physio?

    Seek professional assessment if:

    • Pain persists longer than 2–3 weeks

    • Pain becomes sharp and localised

    • Hopping on one leg is painful

    • Symptoms worsen despite reducing load

    Early intervention reduces the risk of progression to stress fracture.

    How Praxis Approaches Shin Splints

    At Praxis, we don’t treat “shin splints.”
    We treat your specific loading problem.

    Your plan may include:

    ✔ Comprehensive running and strength assessment
    ✔ Individualised load management plan
    ✔ Targeted strength and control program
    ✔ Manual therapy where appropriate
    ✔ Gradual return-to-run progression
    ✔ Prevention strategy for long-term performance

    Because no two runners load the same way, and no two recovery plans should be identical.

    If you’re dealing with shin splints, or want to prevent them from coming back, our team can help.

    Book an in-depth running and lower limb assessment today.

    📍 Clinics in Teneriffe, Buranda & Carseldine
    📞 (07) 3102 3337
    💻 Book online

    💪 Trusted by athletes. Backed by evidence. Here for everyone.

    The Praxis Team.

    PREVENT | PREPARE | PERFORM

    References

    • Winkelmann ZK et al. (2016). Risk factors for medial tibial stress syndrome in active individuals. Journal of Athletic Training, 51(12), 1049–1052.

    • Winters M et al. (2013). Medial tibial stress syndrome: a critical review. Sports Medicine, 43(12), 1315–1333.

    • Moen MH et al. (2012). Treatment of medial tibial stress syndrome: a systematic review. Sports Medicine, 42(11), 965–981.

    • Nielsen RO et al. (2012). Training errors and running-related injuries. International Journal of Sports Physical Therapy, 7(1), 58–75.

     

    Images:

    The above images are owned by the “Trainer Academy (https://traineracademy.org/) ” and used in this article with thanks.

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