Shin Splints

Shin Splints

Shin Splints is an umbrella term referring to pain in the front of the shin area or shin bone (tibia). It is not a specific diagnosis.

We need to consider the 3 causes of shin pain when you present with any type of pain in this area. The link between pain and exercise will tell us what is causing your shin pain and this diagnosis is vital to successful treatment.

Q: What is causing my shin pain?

A: Typically shin pain is an injury that people dismiss and try to run through. As it gets worse the pain remains during running and in severe cases walking and stairs become painful to attempt.

  • Shin bone injury (tibial stress fracture) results in localised pain, usually quite sharp that gets worse when you put weight on it or with impact like jumping, hopping and running. It is usually painful at night and when you stand on it in the morning.
  • Shin pain of muscular origin (medial tibial stress syndrome) is the most common type and starts at the bottom part of the shin. This pain along the inside of the shin bone begins gradually and will ease as you warm up. It comes back though once you stop running and the morning after. If you run through it, the pain will keep getting worse and worse.
  • A compartment syndrome feels more achey and tight and gets much worse with exercise. However this pain eases off quickly once you rest from running. If you have a severe compartment syndrome there may be pins and needles and weakness in the affected muscles. This is more serious and needs immediate attention.

Q: What causes shin pain?

  • Alignment of the legs and feet need to be considered as both extreme foot types can cause shin pain symptoms
  • Weak calf, peroneals (outside of the lower leg) and extensor compartment muscles (front of shin that lifts up the ankle and toes)
  • Tight calf muscles limit ankle movement and increase the risk of malalignment
  • Novice runner suddenly increasing their mileage
  • Running on a sloped surface or a hard surface such as concrete or even astro

Q: How can I treat shin pain?

A: Treatment depends on whether the bone, muscle or compartment is the cause of pain. Not everyone will need orthotics but a biomechanical assessment must be done on any runner presenting with shin pain. A rigid, high arched foot that cannot absorb shock or an overpronating foot producing muscle fatigue are both very different situations that can each result in shin pain.

Rest is the most important thing, regardless of the reason for your pain. Many runners try to continue their training as they get their shin pain treated. This is not wise and will prolong your recovery. But rest alone won’t solve it either. You need regular, deep (and painful…sorry!) soft tissue release where the muscles attach to the shin bone. We will correct biomechanical issues if they are there with insoles or orthotics and then work hard to build up your leg muscle strength.

Q: Can I return to running if I have suffered a stress fracture?

A: Yes but when will depend on your symptoms! An x-ray will not show a tibial stress fracture in the early stages and the gold standard for diagnosis is a bone scan or an MRI.
We also need to determine what the cause of the stress fracture is, to prevent another one in the future. Nutrition and diet, hormone levels and bone mineral density levels should be checked even though excessive training and malalignment are the usual causes. Stress fracture treatment will involve rest from running and maybe even crutches for pain relief.

A gradual rehabilitation programme begins once walking is painfree and there is no bony tenderness to the touch. Typically it may take up to 12 weeks to return to running, depending on how quickly the diagnosis was made and how much stress the bone had to withstand before rest began.

Verdict on Shin Pain:

If you have shin pain when you hop, do not run. Do not ignore shin pain as it will get worse. Call us on 01-2137000 and we can help!