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We often see athletes arrive to our clinic with complaints of inside ankle pain or shin pain. Often this gets mistaken as “shin splints” and the prescription is just rest and ice. In reality, “shin splints” is a catchall term that doesn’t really mean much of anything. It can refer to front shin pain, middle shin pain, or lower leg pain. If it can mean anything it means nothing! But, in the case of medial shin pain (on the inside of the leg) or medial ankle pain, we should look to posterior tibialis.
Before we go any further, however, I should point out that this is prime territory for stress fractures. Your PT will be able to help you decide which you are suffering from, but it is important to keep this in mind. Stress fractures always mean an immediate cessation of activity and likely non-weightbearing status for it to heal. If this injury isn’t improving or is highly limiting (you can't walk on it or really struggle), you need to seek additional medical care to rule out a stress injury!
So how does posterior tibialis get so upset? Well, the primary role of this muscle is to avoid pronation, or the collapse of your arch. This collapse will then cause your knee to cave in and can cause problems there and up at the hip as well. If posterior tibialis is not strong enough to withstand the forces we are placing upon it, then it will become inflamed, develop trigger points, ad potentially inflame the tendon itself. When it does this, we get pain on the inside of the shin or down near the ankle behind the bone (malleolus). You may even have some swelling, burning, or a “squeaky” feeling when the tendon moves. If you are having more acute pain that is really irritable and you're having trouble walking, it may be time to take a break and rest. If this has been happening for a while, rest is likely the last thing you need!
I often see this muscle get angry alongside a sudden increase in mileage or intensity in your training plan – typically around the beginning of race season or when you are approaching the end of a training program. Sometimes just increasing your long run by a mile or two can cause this issue. When it happens, it can be a real challenge to calm it down! Often, we need to reduce the mileage/intensity, first (but don’t stop running!). Then, we need to calm the muscle down with manual therapy (you can even do this yourself in most cases) in order to build it back up to a strong and functioning member of your muscle society.
What exercises are helpful for this? Well, let me show you where we would start:
Inversion
This exercise is important to help isolate posterior tibialis. The MOST important part of this is to make sure it is incredibly slow and controlled. If you perform this exercise fast, it will NOT work.
Pass arounds
Strengthening the foot and lower leg is particularly important, and pass arounds can be a great challenge. Make sure you are barefoot! Balance on one foot while you pass a small weight around your body clockwise then counterclockwise.
Heel Tap
Heel taps are a challenging exercise, but also bring in the gluteals. Make sure your main movement is hips BACK! Really poke your butt out.
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As someone who has experienced both acute and chronic posterior tibailis irritation, I know how debilitating this can be. But don't be discouraged! This can be fixed and it often does not involve much PT to get it moving in the right direction. Treating it yourself can be highly effective as long as you have proper guidance. Have questions or need help? Reach out to us today to get started on your path to recovery.
Thanks for reading,
Ryan