The highly physical nature of such a dynamic sport as squash, means injuries are unfortunately commonplace. The stresses and strains placed upon the muscles of the lower body of the squash player, often leaves them particularly susceptible to certain types of overuse injuries. One of the most common areas of nagging pain and discomfort for many players is around the front area of the leg between the knee and ankle, along the inner edge of the tibia (shin bone) – a condition more regularly known as shin splints.
The name ‘shin splints’ is actually a collective term, which can apply to a number of injuries. The most common of these is medial tibial stress syndrome (MTSS), but it can also be used to refer to issues around the tibialis anterior muscle (such as tendonitis), exercise induced compartment syndrome, or even stress fractures of the tibia (shin bone). General symptoms for all of these conditions may be similar, which can often make correct diagnosis difficult. Further complications can arise from compartment syndrome in particular however, so if the pain is particularly deep, intense, doesn’t subside with rest, or is out of the ordinary in any way, then it is recommended that professional advice is sought at the earliest opportunity to get a full and proper diagnosis.
MTSS is by far the most common form of shin splints still however, and is generally characterized by a dull, aching pain along the shin bone triggered by strenuous activity, that increases in intensity if ignored and exercise/exertion maintained. The middle portion of the inside of the shin will often be tender to the touch, but the more acute pain usually decreases significantly once activity is halted, and can often disappear almost completely after stopping and resting for a short period.
Much of the pain associated with MTSS is theorized to occur through the layer of connective tissue that covers the surface of the bone (known as the ‘periosteum’), becoming irritated or inflamed. There is still some debate as to the exact causes of MTSS and the resultant pain, but the risk factors are generally considered to include:
Incorrect technique in running/movement
Sudden increase in intensity or frequency of training
Inappropriate or overused training shoes
Excessively hard training/running surfaces
Muscular dysfunction or imbalance resulting from excessive weaknesses or tightness in relevant musculature
Pain and discomfort caused by MTSS can be alleviated somewhat through the use of anti-inflammatory medications, and through icing – applying bags of ice to the area or using an ‘ice cup’ for self-massage for around 15mins can help control pain and swelling. That said, the most important factor in initially treating a developing case of MTSS, should be to get off court and rest – ideally for at least 2 weeks. Fitness can be maintained through non-weight bearing activities such as swimming and cycling, but just ‘playing through’ is a particularly bad idea with MTSS, as it will very rarely go away of its own accord.
What sets MTSS apart from other injuries, particularly those injuries that are acute in nature, is that regardless of the rest period and subsequent rehabilitation performed, a primary key to full recovery and avoidance of relapse is to determine and rectify what were the most likely causes of the initial onset. Returning to full training/playing should not be considered until causes have been identified and addressed (i.e. purchasing new squash or training shoes, moderating training programme volume/intensity etc.), and until the pain has been significantly reduced or eliminated. Returning to full playing/training status should be done gradually and under a controlled schedule, so as not to re-aggravate the injury and allow it to become a more chronic issue.
More severe cases that don’t clear up following simple management and rest however, may have their roots in underlying muscular dysfunction or imbalance issues. In these cases contacting a physio and undertaking a properly prescribed stretching/strengthening programme may be necessary. Ankle strengthening exercises are frequently utilized in MTSS rehabilitation, working through a full range of movements with resistance usually provided by some kind of light elasticated tubing. There is also some evidence to suggest a properly focused flexibility training programme targeting the shin area plus the hamstring muscle group and major muscles that make up the calf (the gastrocnemius and soleus), can help in rehabilitation and prevention of recurrence. Indiscriminate stretching can potentially do more harm than good here however, so it’s best to get guidance from a properly qualified physio.
Custom shoe orthotics can also be of benefit to some sufferers, as both excessively high and excessively low arches have been suggested to play a role in MTSS for some sufferers. Correct training shoes and orthotic inserts can reduce the stresses on the muscles and joints, and offer physical support to help improve mechanics – orthopaedic physicians or podiatrists can examine and scan feet to build custom orthotics and determine what kind of shoe is best. Some over-the-counter generic orthotics and shock-absorbing insoles have also been shown to be effective for relief in many sufferers. ‘Sorbothane’ is one such insole brand that can be useful for squash players, for help in alleviating the discomfort associated with certain generalised lower limb issues.
Shin pain can be an exasperating and debilitating issue for the squash player to deal with. Diligent rest and strengthening/mobilising the affected structures, along with taking time to properly identify and address the underlying issue(s) however, means the problem can be effectively dealt with and prevented from re-occurring – it can be very difficult to stay away from the court for a lot of players, but with shin pain a couple of weeks rest and recovery in the short term, can save a significantly longer period of pain and frustration in the future.
You can see more squash-specific injury/rehab guidance on the site here.
Make sure to also check out our video on general injury advice for squash players.
Gary Nisbet - B.Sc.(Hons), CSCS, NSCA-CPT, Dip. FTST
Squashskills Fitness & Performance Director
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