Shin splints are one of the most common running injuries, but also one of the most poorly understood. The term ‘shin splints’ is actually more of an umbrella term for shin pain, rather than a diagnosis, and it is this lack of understanding that often causes trouble for runners.
Shin pain that is related to the bone is more commonly referred to as medial tibial stress syndrome, and this is the most common type of pain. It typically presents as pain along the inner shin bone (tibia) during exercise and afterwards, and when you touch it.
Muscular shin pain is much less common and is experienced as a more vague tightening pain in the muscular part of the shin, most commonly down the front
It is important to make sure you have a proper diagnosis from a physiotherapist or sports doctor to determine if the pain is bone-related or muscular.
Bone-related
Bone-related medial tibial stress syndrome is caused by stress on the inside part of your tibia bone, which causes the bone to swell inside. If irritated for long enough, it can lead to a tibial stress fracture. This is when the bone starts to crack, and swell.
Pain can also occur along the front part of the tibia (the tibial spine), which is a more serious type of shin pain. It’s where the tibia bone flexes, or bows, upon landing, which causes it to widen, and this can quickly turn into a stress fracture. It is harder to treat than medial tibial stress syndrome. You should consult your doctor/physio if you suspect you have this.
Under the medial tibial stress syndrome umbrella you also have periostitis – inflammation and irritation of the outer lining of the bone. The periosteum is the connective tissue that forms a layer around bones and acts as a point of attachment for muscles, among other things. Irritation and inflammation of this often occurs in the early stages of medial tibial stress syndrome and can cause soreness along the inner border of the shin bone. It often presents as a bone stress injury, however, with periostitis, symptoms often occur over a slightly larger area than with, say, a true stress reaction or stress fracture.
Muscular
Muscular shin pain, which is far less common, is characterised by a tightening in the shin that worsens during exercise – some patients report that their legs feel so tight they might explode. As the muscles expand during exercise, the fascia (which the muscles sit inside) gets squeezed and this causes a tightening sensation.
This condition is called chronic exertional compartment syndrome (CECS), and in 80% of cases, is in the front part of the shin. The leg is normally pain-free except during activity. Neurological type symptoms can sometimes occur in these cases – tingling, numbness or weakness in the foot may sometimes present.
Is it a stress fracture?
Stress fractures will continue to even get more painful during a run. And if you press your fingertips along your shin and can identify a definite spot of sharp pain, this is a common symptom of a stress fracture.
Stress fractures often feel better in the morning too because the bone has rested all night, whereas shin splints often feel worse in the morning because the soft tissue tightens overnight.
Pain from medial stress syndrome is usually most severe at the start of the run, but often lessens and can even go away completely during a run, once the muscles are loosened up.
This is an easy way to distinguish between shin splints and a stress fracture of the shin bone.
How are shin splints caused?
The most common causes of medial tibial stress syndrome are:
- Poor biomechanics, including poor hip rotation, over pronation of the foot, flat feet or dropped arches, though high arches can also cause shin splints.
- Increasing volume of, or intensity of, running too quickly.
- A low bone density, which is more common in women. Softer bones bend more easily, which causes strain and microdamage to the bone.
- Poorly cushioned or worn-out trainers, which don’t provide the necessary cushioning and support to absorb impact from the pavement.
In most cases, shin splints are an overuse injury. Beginners are more susceptible as their leg muscles haven’t been used or stressed in the same way before, but equally, runners returning from injury can be at risk if they increase their mileage too quickly.
What do shin splints feel like?
Medial tibial stress syndrome presents as pain in the bony part of the shin, while exertional compartment syndrome (ECS) is experienced as a tightening pain in the soft, outside, muscular part of the shin.
As a rule, shin splints feel like a nagging pain, concentrated in the inner border of your tibia, typically. As mentioned, with bone-related shin pain (medial tibial stress syndrome), you will feel pain in the bony part of the shin, during and after exercise, and when you press on the area, while with muscular-related shin pain, pain is experienced as a tightening pain in the soft, outside, muscular part of the shin.
What’s the best treatment for shin splints?
Medial tibial stress syndrome (or shin splints) tends to not respond well to continuing to run. Whereas with tendon injuries, we tend to allow running with some soreness and awareness in the area (3/10 level of pain) typically running with this level of discomfort for medial tibial stress syndrome prolongs the issue. Rest is the first course of action unfortunately. And this does not mean going out for a ‘test run’ every few days. Rest means rest. Give it an initial two weeks to let things settle.
- Take anti-inflammatories like ibuprofen (though always consult a doctor first if you have existing health conditions) but do not take in order to run pain free, as this will make the problem worse.
- Try running in a pair of good running trainers
- If you have been diagnosed with exertional compartment syndrome (ECS), loosening up the muscles in your leg will help. as mentioned, part of the problem is due to a tight fascia, the tough material that wraps our muscles. Run your shins and calves over with a foam roller to help loosen it. Massage can help too.
Here at SSP WE CAN rule out other causes. We can also help you work on any weaknesses that have caused the problem so that it doesn’t reoccur.