Tibialis Anterior tendinopathy is pain arising from the tendons around the front of the shin. It often presents as “shin splints” and is often an overload or overuse injury causing pain and/or stiffness around the front of the lower leg.
Tibialis Anterior is the large muscle that runs from the top of the tibia (shin bone) and tracks down the front of the lower leg, more so on the outer part. It is the muscle that you can see when you lift your foot towards you. In patients with Tibialis Anterior tendinopathy it is often this movement which is painful, particularly when walking or running. Walking or running uphill are often worse and at times swelling can be visible along the path of the tendon.
Pain is often associated with activity and may stop a person doing their activity. There could be signs of local swelling or inflammation around the area. The pain often improves with rest but reoccurs with activity. There may also be some stiffness following periods of immobility until the tendon has a chance to get warmed up.
Injury can come about through prolonged bouts of activity such as running – particularly on undulating services, and particularly if the person is not used to walking or running up and down hills. Poorly fitting footwear can also contribute if the patient is having to work hard to keep the shoes on as they are walking.
Your Physiotherapist will complete a thorough examination including taking a history of your symptoms and performing a clinical assessment so that an accurate diagnosis can be given. This in turn, will allow the most effective treatment and management to be implemented for optimal outcomes to be achieved. Your clinician will also work with you to set goals personalised to what is important to you. Regular re-assessment will make certain you are making progress towards those goals and will allow adjustments in your treatment and management to be made.
Tibialis Anterior tendinopathy is managed the same as other tendon issues. The tendons should be exposed to high-load training on an alternating daily pattern to augment the response to loading, whilst allowing for recovery and adaptation to take place. Your Physiotherapist will educate you on your condition so that you are able to help manage your symptoms and support recovery. You will be given useful ways of reducing your symptoms and methods of gradually increasing load and activity on the affected structures.
To favour loading the Tibialis Anterior tendons, resisted exercise with theraband is recommended as it allows it to be exposed it to resistance in an easy way. Your clinician may recommended performing specific exercises, personalised to your needs for up to 12 reps and 3 sets, with a degree of pain/discomfort.
On a scale of 0-10 (10 being the most severe pain imaginable) you should not exceed 5/10 after performing the exercise or 24 hours following a ‘loading’ day. Alternating between a loading day followed by a rest day allows you to gauge the irritability of the tendon whilst also establishing the ‘sweet spot’ for load that it responds positively to. With this patterning, we also recommend that you plan your physical activity on the same day as loading so that you can the most explicit ‘on’ and ‘off’ days within practical limits. If this is managed well, you should find that your symptoms will progressively decrease as your activity levels increase.
Our skilled Physiotherapist at Pure can work with you to develop a personalised activity modification and strength training protocol to effectively alleviate your symptoms and restore your function. At Pure Physiotherapy, we can help decipher factors that may play a role in your development of this issue so that you can negate the chances of this re-occurring. We will assist in equipping you with the skills and knowledge to manage you condition and take back control.