Injuries 101 - Shin Splints
What Is Shin Splints?
Shin Splints is an umbrella term for any pain in the shin area. There are two main common affected areas; pain on the front of the shin or pain on the inside of the lower leg on the tibia, I will refer to this version as medial tibial stress syndrome (MTSS). The pain you experience will depend on the severity of the condition
- Tenderness and inflammation on the inside or front of the shin bone
- A dull ache when you start or finish running
Often times pain will lessen a few miles into your run so a lot of people will try run through the condition however I speak from personal experience that shin splints, especially MTSS, can very quickly turn into a stress fracture at which point you are looking at 6 months off and possibly crutches for a few weeks. When palpating along the shin bone, front or inside; tenderness, swelling, lumps, and bumps may be felt, particularly in more chronic cases. This is because new bone growth has occurred in response to repeated trauma. Occasionally in severe cases, reddening of the skin over the inside of the leg from acute inflammation may be seen.
Could it be a Stress Fracture?
A Stress Fracture or Tibial Stress Fracture are similar to MTSS, however pain is acute or sharp especially on the inside of the shin bone and stays the same or gets worse with exercise. Again, it will be very tender when pressing along the inside of the shin bone. To be certain that you have a stress fracture, you will need a bone scan and it will only show up as the bone starts to recover.
Chronic Compartment Syndrome - A compartment syndrome occurs when the muscle becomes too large for the sheath that surrounds it causing increased pressure and pain. Typically symptoms will include pain at rest; an aching type pain gradually that gets worse with exercise. Pain comes on at a specific point in the run and is only relieved with rest. There will be little or no tenderness at rest unless it affects the large muscle on the outside of the shin.
The tibia or shin bone bears the body’s weight when running and jumping so all these large forces are transmitted through the bone and the soft tissues attached to it. The tibia bone has a thin sheath on the outside of the bone called the periosteum. MTSS and Shins Splints occur when the soft tissues (muscles and tendons) pull on the periosteum or sheath surrounding the shin bone causing pain and inflammation
Causes of Shin Splints:
1- Shin splints is an overuse injury, it tends to happen most to those who have just started running or have increased training dramatically. Simply put, the lower leg isn’t strong enough yet to take the stress of all the weight and pressure being put through the lower leg.
2- You have just started doing speed sessions or have changed footwear or the surface that you run on. Very similar to number 1, running fast increases the load in the lower legs due to having to push off and land not just more times in a shorter period but also your power demand is much higher than when say just recovery jogging. Footwear can be a factor if you go from a shoe with lots of extra support to a lighter flatter racing shoe - your ligaments and muscles have to adapt to more demand placed on them. This is always a factor when first starting out with a lighter shoe with less drop, you have less weight to lift which is good but you also have less cushioning to dissipate the landing pressure, so you’ll get a more powerful push off the floor but your shin bones and calf muscles may not have adapted fully when you first start.
3- Links exactly with the above, if you are using cushioned shoes and the cushioning starts to wear out as they get older suddenly you find yourself putting more pressure through the ground as you run and again poor shins and ankles.
4- An increase in running downhill, instead of just skipping off the surface there is more downwards weight and pressure especially if you are breaking to slow down, hence why the best technique for downhill’s is just to glide and go.
5- Finally the last factor is tight muscles that aren’t contracting properly - the less flexible and pliable the muscles are at the front and back of the shin the more stress you put through the bone when you land and push off. You can see how this then links back to point 1, an increase in training means you’re asking more of muscles which may then become tight or weak from overuse and are now not able to handle the demands placed upon them and so you put too much stress through the bone which then begins to hurt as it’s not being protected properly.
Shin Splints Treatment:
Treating shin splints involves reducing pain and inflammation, identifying and correcting training errors and biomechanical problems and restoring muscles to their original condition through stretching, exercises, and massage. The full rehabilitation process may take anywhere from 3 weeks to 12 weeks.
Self Help Treatment to Reduce Pain and Discomfort:
Protection – Wear compression socks or a shin splint sleeve or if you do not have these, long socks can be an alternative and avoid any activities. This will help keep the muscles warm and supple as well as providing support to the inflamed tissues. Wearing shock absorbing insoles in shoes particularly if you run or walk on hard surfaces in poorly cushioned shoes will help reduce the shock on the lower leg. Also it’s worth switching to wearing softer training shoes rather than hard leather work shoes if possible until symptoms go.
Rest – The bone needs to heal, so increase your vitamin D and Vitamin C and rest up. Very severe shin splints may require complete rest for a few days to a few weeks but you should aim to maintain an exercise routine by switching to swimming, cycling, cross trainer, rowing machines, step machines and other nonimpact equipment.
Ice – Using Ice is a good tool if you find the leg is swollen and painful as it will reduce the pain as it blocks it out and help you move the leg. However it’s always worth considering that the body swells an area to increase the blood supply to an area and protect it, so sometimes swelling is actually quite a good thing.
Elevation – This is to be done in the early stages the first 48 hours, elevating the injured limb in this case the leg will increase blood flow to the area which will help it heal.
Sports Massage, Myofascial Release & Taping:
After three days have passed since you noticed the injury or you decided that it’s too bad to carry on training and having done the above PRICE protocol. This is when it may be a good idea to come to see someone like myself who is trained in sports therapy or sports massage, who can then help you with the next stage or recovery.
Stretching & Massage – With a professional’s help or if you are very confident in what you are doing, and the area is now not too painful, stretch and massage the muscles of the lower leg, in particular calf stretching to release tension in the calf and perennial muscles which may be causing traction on the bone. Remember you are trying to loosen the muscles to take away the stress on the bone and trying to increase blood flow to aid the healing process but it will still be weakened, so don’t mistake this for a quick fix to get back to running. Also it should be very light and aim to avoid the inflamed periosteum close to the bone, gradually over subsequent treatments the deeper tissues worked through as pain eases.
The Fix & How to Prevent the Problem:
1 – Allow the bone to actually heal - It is a common complaint that athletes will rest until their shin pain goes or do the stretching or massage above, only for the pain to return once training resumes again. The stretching and massage reduces the recovery time as there is now less stress on the bone and is important as if you try run again with tight and inflexible muscles the same outcome will happen, undue stress put through the bone. However the number one reason pain comes back sometimes very quickly is that the bone simply hasn’t healed from the initial injury. This goes for pretty much every injury you cannot rush healing.
2 – Another reason that the pain may return is that nothing has changed since you initially got the injury so you may want to try figure out or work with someone like myself to find out what the root cause was. For example getting a biomechanical assessment to identify any problems with the feet or hips which may be contributing and make sure you have the right shoes and that they are in good condition.
3 - As you do resume training know it has to be slow and steady to allow for healing and strengthening to take place equally, it’s worthwhile to keep a training diary so you can look back and assess if the training load is or was too high before the injury and also help you build slowly. If your legs are feeling heavy take some time off, do a different from of training like cycling or swimming which doesn’t put so much stress through the legs. Train on softer ground so your doing less pounding (just bounce a golf ball on grass and then on concrete) the grass is going to soak up a lot of the downward force the concrete will literally rattle through your bone and leg. It’s harder to go faster on grass just as it is in a thicker cushioned shoe for this reason, but it’s a way to stay safer to begin with.
4 – Bones get stronger as an adaptation to stress, (not mental stress unfortunately); the most common cause of osteoporosis in older people is that they haven’t put enough stress through there bones, so they aren’t strong enough. The good news is as long as we take regular breaks to allow for healing to occur our bones will actual recruit more minerals calcium etc into the marrow matrix and make that bone thicker and stronger. This is called bone remodelling; it’s why I always recommend Calcium, Vitamin D and Iron to runners as they help this process so lots of milk, dark leafy veg and red meat or supplement if you don’t get enough in your diet naturally.
5 – A couple of good stretches and fixes - number one if you run on your toes and are always pushing off from the toes it makes sense that we want to counter this movement as all muscles work in pairs, so the key areas to focus on are stretching the calf specifically the soleus and posterior tibialis and strengthening the anterior tibialis which is a very small section of muscle which is interwoven into the bone along the front of the shin. If you are a heal striker then you would want to do the opposite.
6 – Finally compression socks can help to give a bit more support to the lower leg area as a whole and the tight nature of the socks/sleeves increases blood supply to the lower leg.
Further Help and Rehabilitation:
To get you back to full strength after the injury and prevent it happening again I recommend as well as follow all the above guidance and now knowing more about your injury that you also follow a good rehabilitation plan. This will involve strength and mobilising exercises specific to the injury but also specific to any particular needs which become evident after a full biomechanical assessment.
I have provided strength and mobilising videos and worksheets for all the common injuries as well as videos on taping and self-massage techniques; these are available in the member’s area for a small one off fee. Clients who have been to see me or used the clinic will have free access to this area and will have some tailored exercises based on any individual assessments done.