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updated 5/26/10

Massage Therapy for Shin Splints

Perfect Spot No. 3, in the tibialis anterior muscle of the shin

by Paul Ingraham, Vancouver, Canada MORE

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Credentials and qualifications

I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.

For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.

Trigger points (TrPs), or muscle knots, are the world’s most common cause of aches and pains, and yet they are rarely diagnosed correctly. Having too many stubborn trigger points is called “myofascial pain syndrome” (MPS). The Perfect Spots series of articles highlights trigger points that are unusually common and yet relatively easy to treat yourself — the most satisfying and therapeutically significant places to apply pressure on the human body. For a complete, advanced tutorial that walks you through every possible self-treatment option for muscle pain, see Save Yourself from Trigger Points & Myofascial Pain Syndrome!

If you have shin splints — which is a painful, potentially serious condition — you may prefer to visit this detailed tutorial: Save Yourself from Shin Splints! This article summarizes the basics of self-massage for your shin musculature. Note that rapidly developing severe shin pain can be a medical emergency. If this is your situation, you are in the wrong place: don’t read this article, go to a hospital emergency room. I am not kidding.

Perfect Spot No. 3 is in the your shins — seemingly an unlikely place for muscle knots! But there is meat there, and if you’ve ever had shin splints then you know just how vulnerable that meat can be. Even if you’ve never suffered so painfully, your shins probably still suffer in silence — latent trigger points in the upper third of the shin that don’t cause symptoms, but are plenty sensitive if you press on them. They inevitably form here because you walk on two legs, and usually on hard surfaces.

Relieving tension in Spot No. 3 may also be helpful for plantar fasciitis, because the shin musculature is surprisingly important for arch support.

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The tibialis anterior muscle of the shin

Perfect Spot No. 3 is in the upper third of the muscle.

We usually think of the shin as a bony place, but in fact there is a good-sized muscle on the lateral face of the shin: the tibialis anterior muscle. The tibialis muscle works almost alone: it is the only muscle that strongly lifts the foot. Functionally, its major job is not to shorten, but to lengthen in a controlled way: to gently lower the forefoot after the heel strikes the ground. This requires an eccentric contraction — the muscle contracts while lengthening, as your biceps does when you lower a barbell.

Without the tibialis anterior’s powerful and well-coordinated eccentric contractions, your foot would slap ungracefully onto the ground with every step. On hard surfaces like concrete, the strain of preventing foot slapping is immense. For runners, that strain is often how shin splints usually begin, and is one of the main reasons to avoid hard-surface running. Eccentric contractions are known to cause additional muscle soreness after exercise, which is why the shin muscle tends to get really sore after running hard — and why the muscle tends to develop large, chronic trigger points.

Another situation where the tibialis anterior has to work especially hard and tends to get really sore is coming down a mountain: because of the downward slope, the foot must be lowered further with each step, which means more eccentric contraction.

Without the tibialis anterior, your foot would slap ungracefully onto the ground with every step.

If you feel the inside surface of your shin, you will find hard bone, covered only by skin. On the outside surface of the shin, however, there is a thick pad of muscle starting about two inches below the knee: that’s the tibialis anterior. The Perfect Spot here is actually a whole patch of common trigger points in the top third of the muscle (see attached diagram). They are not hard to find, and they are usually very potent.

Pressure on any of tibialis anterior’s key trigger points will likely cause an almost paralyzing “good pain” that radiates down the shin into the top of the foot and toes. You will probably be surprised by the amount of sensation flooding down the leg: the tibialis anterior is a Perfect Spot because it almost always produces so much more sensation than anyone expects. It’s one of those spots that makes my clients say things like, “Wow, did you know that was there?” Amaze your friends!

The tibialis anterior is a really tough muscle. Unless you actually have shin splints (see below), these spots will usually tolerate plenty of pressure. To treat someone else, you may find that your thumbs alone are not quite strong enough; using an elbow or the blade of your forearm will make things much easier. Start gently but work steadily up to a satisfying pressure, and hold it until the intensity of the sensation gradually fades.

You can also use some massage oil or lotion to slide the blade of your forearm or the heel of your hand up the length of the tibialis anterior. This is quite a satisfying variation, combining the pleasure of good old-fashioned Swedish massage with the unique sensation of a trigger point at the top of the stroke.

To treat yourself, lean your shin into something hard, like the edge of a park bench or a tennis ball: whatever’s handy. I had an old hot-water radiator once that was perfect!

What about shin splints?

If you have shin splints, or you are helping someone with shin splints, you should handle this Perfect Spot cautiously. It can be helpful, but you must also be careful not to make the condition worse.

There are different kinds of shin splints, such as tibial stress fractures and medial tibial stress syndrome, neither of which can be helped much by massaging the tibialis anterior.

But another common kind of shin splints, anterior compartment syndrome, may respond well to the right kind of massage. This condition is caused by swelling of the compartment (think “sausage wrapping”) that the tibialis anterior muscles lives in. If this problem develops quickly, it can be dangerous — it can actually destroy the muscle, and lead to potentially life-threatening infection. If you have severe, rapidly developing shin pain, please go to the emergency room!

Slower cases are not dangerous: they just cause chronic pain. And trigger point therapy may calm the tibialis anterior muscle down enough to help relieve the problem. The trick is to give the tibialis anterior some help without increasing the pressure in the muscle compartment any more than it already is. Traditional Swedish massage strokes are completely out of the question in this situation: strongly stroking up or down the length of the muscle with broad pressure will just increase the pressure, like rolling up a toothpaste tube without undoing the cap. The trick is to just use point pressure on the Perfect Spot itself: locate it and apply only moderate focussed pressure to the trigger point, and this may help the muscle without irritating the whole muscle.

This is just the briefest of introductions to shin pain. For (much) more information, see Save Yourself from Shin Splints!

What about plantar fasciitis?

Plantar fasciitis is a painful and often exasperatingly persistent condition of the arch of the foot. Although there are better ways of treating it, self-massage of the shin muscles may be helpful as well.

The foot’s arch is a little biomechanical marvel. It is held up by a fascinating combination of elastic and muscular support and “clever” skeletal arrangement, and it can take a lickin’ and keep on tickin’. But it does have limits, and when the muscles and connective tissues in the arch suffer excessive strain, they can really begin to burn. Once they start, it’s hard to stop, because your feet get used a lot.

The tendon of the tibialis anterior muscle passes underneath the foot, creating a kind of “stirrup” for the arch, helping to hold it up. To the extent that the tibialis anterior muscle fatigues and fails to support the arch, treating it may be very helpful for plantar fasciitis. A happier, more functional tibialis anterior means a happier, more functional arch!

For more information, see Save Yourself from Plantar Fasciitis!

What about Morton’s neuroma?

A Morton’s neuroma is a sensitive growth on a nerve between the bones of the foot which gets painfully pinched, especially when wearing shoes that constrict the forefoot.

Morton's neuromas occur in the referral zones for some of the lower leg musculature, most notably the tibialis anterior muscle. Tibialis anterior trigger points are potentially relevant to Morton’s neuroma therapy in two ways:

• they may sensitize the neuroma, making it feel worse than it would otherwise
• the presence of the neuroma in the tibialis anterior referral zone may aggravate tibialis anterior trigger points

So there is the potential for a vicious cycle ... but also the potential to relieve it and desensitize the neuroma by relieving the trigger point.

Further Reading

• SY Save Yourself from Shin Splints! — Causes and treatment options for shin splints explained and discussed in great detail, especially shin pain caused by myofascial trigger points, compartment syndrome, medial tibial stress syndrome, and stress fracture
• For more information about how hard-surface running affects your shins, see SY Always Running the Same Way — The trouble with running on concrete and asphalt.
• Is there anything you can do about that nasty soreness that crops in your shins after a downhill hike or a your first run in a while? Probably not. For the reasons why, see SY You Can’t Beat DOMS! — The myth of treatment for nature’s little tax on exercise, delayed onset muscle soreness (DOMS).

Appendix A: Is trigger point therapy too good to be true?

Trigger point therapy isn’t too good to be true: it’s just ordinary good. It can relieve some pain cheaply and safely in many cases. The existence of trigger points is not controversial. You can measure their electrical activity, take samples of their highly acidic tissue chemistry, and now a new MRI-like technology can now show them as well.

The Perfect Spots are based on a decade of my own clinical experience, and on the research and writing of Drs. Janet Travell and David Simons, pioneers of myofascial pain syndrome research. They produced “the Big Red Books” (a massive pair of texts).

Trigger points are clinically significant, but unfortunately obscure. As Dr. Simons wrote, “Muscle is an orphan organ. No medical speciality claims it.”

Want to know more? This is the tip of the iceberg. There’s a whole book …

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Not too good to be true.

Just ordinary good. Trigger point therapy isn’t a miracle cure, but it is a valuable life skill. Practically anyone can benefit at least a little, and many will experience significant relief from stubborn aches and pains. The first several sections are free.

Appendix C: Quick Reference Guide to the Perfect Spots

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