Shin Pain May Mean Hip Weakness

Brian Azinger, MA, LAT, Agnesian HealthCare Sports & Spine Center

It’s hard to be active without some level of ache or pain. A common pain I have seen as an athletic trainer is shin pain, commonly referred as shin splints or Medial Tibial Stress Syndrome. This condition is characterized by pain along the posterior medical boarder of the lower half of the tibia. The medial shin will be tender to touch over an extended area, pain with palpation over a 5 cm or greater area of the posterior-medial border of the tibia. Please take note that pain over an extended area implies that pain is not localized. Localized pain, or pain in one specific spot on the tibia, may be associated with a stress fracture and should be evaluated by a medical professional.

One possible cause for shin pain is weakness of the hip muscles, specifically the gluteus medius. This muscle is located in the lateral him and abducts and rotates the hip joint. When the gluteus medius muscle becomes weak, it results in a collapsing kinetic chain. This collapsing kinetic chain allows your thigh to rotate and pull inwards abnormally.

This internal rotation of the thigh and lower leg causes excessive pronation of the foot, resulting in the ankle and foot collapsing inward. This pronation of the foot places the posterior muscles of the tibia (soleus, flexor digitorum longus and tibialis posterior) at a lengthened position.

For my athletes who have shin pain associated with hip weakness, I start them with two easy to learn exercises.

Clam shells and hip abduction exercises are a good and easy way to start strengthening your gluteus medius muscle. I like my athletes to do three sets of 15 to 20 reps of each exercise, but they can also be done holding the position of 10 to 30 seconds, then repeating three times. Also when doing these exercises you do not want to body to rotate or turn when lifting the leg. To prevent this you may need to position yourself so your back and butt are against a wall when doing the exercises. This will prevent the body from rolling during the movement. Resistance can also be added to each movement with cuff weights or resistance tubing.

There are many exercises out there that can strengthen the muscles around the hip. These two are just a good place to start. When I have athletes do these exercises, it is my hope to strengthen the gluteus medius so the collapsing kinetic chain does not occur and shin pain lessens.

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