Shin Splints

Runner's shins can be susceptible to injury so this month's bulletin is on shin splints, what they are & what to do if you get them.

Welcome back to the Running Bug’s Sports Injury Bulletin. Hopefully you are perusing this article for prevention rather than cure! This month’s topic is shin-splints.

What are shin splints?

Shin splints is not a diagnosis in itself but is instead an ‘umbrella’ term covering several specific injuries.

These include stress fractures, periostitis, compartment syndrome, and tendonitis.

These conditions are commonly grouped together under the heading of shin splints due to their common presentation of pain at the front or inner part of the lower leg (shin).

The lower leg is a complex structure of two long bones – the tibia and fibula, and a multitude of muscle packed into four compartments – the medial, lateral, deep posterior, and superficial posterior compartments.

These structures are easier to visualise in cross-section, as depicted below:

All of these structures are susceptible to injury and rely on each other to be in peak health to off-load the poundage of running – whether elite or recreational, there can be over 7 times your body weight being transmitted through these structures!

Compression through the shin bone (tibia) and traction forces on the muscle compartments and their bony attachments lead to the following problems.

1) Tibial stress fracture

The cause is simple – the rate of stress on the bone exceeds the rate of repair.

The symptoms are pain along the bony part of the shin, initially after running, but as the conditions progresses you may feel it whilst running.

Do not push through it – listen to your body. The solution is therefore pretty obvious and involves rest.

This should be relative rest – continue to use other forms of training to keep you physically and mentally alert, such as cycling, swimming and cross-trainer.

The use of strength and stability exercises in the lower limbs will condition the muscles to better absorb the forces when you return to running.

Timescales will differ depending on severity. See a Chartered Physiotherapist or suitable medical professional early on to avoid months out of training.

2) Tibial stress syndrome

Medial tibial stress syndrome presents as a dull aching pain on the inner side of the tibia (shin bone). The area is often tender to touch and there is pain on resisted calf raises.

The condition is due to a deep posterior compartment muscle pulling at its attachment to the bone. These leads to inflammation of the bone’s outer lining, called periostitis.

Relative rest, lower leg strength and stretching exercises, and possibly arch-supporting insoles or trainers will assist in a speedy return to training. The latter solution may help as the Tibialis Posterior muscle has a role in supporting the inner arch of the foot.

3) Compartment Syndrome

The anterior (front) compartment includes 3 muscles packed into a tight space.

Rapid increases in training (the overzealous New Year’s Resolution?!) lead to rapid swelling in the compartment with increased pressure on the muscles, nerve and blood vessels contained within.

Immediate modification of training, ice, shin muscle stretches, and suitable rest should settle this within a month.

Be warned – running through this one can lead to surgical intervention to relieve dangerously high pressure in this compartment.

Anti inflammatory drugs along with rest and ice can help reduce inflammation, particularly in the early stages. Seek advice from your doctor before taking any medications.

In the long term, keep yourself strong and flexible in the legs, progress training demands steadily, never train when fatigued, and regularly replace your (suitable) footwear.

If problems persist, you may require biomechanical analysis as performed by Sports Injury Physiotherapists or Biomechanists such as the Sports Science Faculty at the University of Lincoln.

Until next time, keep healthy and enjoy your running!

Ross

Ross Clifford MCSP SOM is a practising Physiotherapist with a specialist interest in sport and exercise Physiotherapy. He also holds a Sport and Exercise Science degree and has taught in the area of Sports Injuries. He is a keen runner and cyclist.