Shin Pain - Shin Splints

Shin Splints is a term most commonly used to describe most shin related pain. However, shin splints are only one of several conditions that affect the shin/Tibia region. The most common causes of Tibia related pain are:

• Shin Splints: two varieties - Posterior or Anterior Shin Splints.

• Stress Fractures.

• Compartment Syndrome.

 

 

♦ Posterior Shin Splints: This pain is felt along the inside (medial) border of the shin (Tibia). It is called Posterior Shin Splints as the condition involves the Tibialis Posterior muscle.

The cause may be due to large eccentric loading of the Tibialis Posterior muscle. Eccentric loading means that the muscle is placed under stress whilst at the same time elongating. In this case the eccentric loading is due to excess out of phase pronation of feet - this may also contribute to excess medial rotation of the lower limb. This coupled with the sudden increase in activity with unconditioned muscles is the likely cause of the problem.

 

♦ Anterior Shin Splints: This pain is felt more along the front (anterior) border of the shin. It is called Anterior Shin Splints as the condition involves the Tibialis Anterior muscle.

A Possible cause of this condition may also be due to adverse eccentric loading but of the Tibialis Anterior muscle. Particularly for heavy heel strikers as the Tibialis Anterior muscle has to control the rate of descent of the forefoot (after heel strike) as it travels to the ground (otherwise the forefoot would just slap onto the ground). Once again, the muscle is having to elongate whilst under stress and this is referred to eccentric loading - which would be exacerbated further if the runner was also striking the ground too far ahead of body (i.e. over striding).

 

This condition could also be the result of a muscle imbalance i.e. difference in strength and/or flexibility between the posterior muscle group (i.e. Calf muscle) and anterior muscle group (i.e. Tibialis Anterior) of the lower leg.

Both conditions can also related to a sudden increase in training volumes as well as a sudden increase in hill running in the training program.

One may need orthotics to resolve the possible pronation problem thus resolving excess stress directed to the soft tissues and joints. However it would help if you started rehab. via stretching the calf muscles as well as the lower leg anterior muscle group. To stretch the anterior muscle group you will need to kneel down and gently sit on one heel (with top of foot lying flush to floor) at a time with the shin area lying flush to the floor and with opposite leg bent - hold for about 1-2 min. then change sides. You should feel a stretch along the front part of the shin.

Another exercise you can do is strengthening the anterior muscle group. There are various ways to do this via placing resistance to the foot as you move foot up and down via the ankle joint. One example is sitting in a place where your leg/foot is over hanging in air and with a weight of some sort (i.e. bucket with a small weight inside) on your foot. Move your foot up and down until you start to feel a slight ache/burning sensation in the shin region - rest - then do it again or swap sides.

Massaging the medial aspect of shins at a later date will help in breaking down the scar tissue.

 

♦ Stress Fractures:

Stress fractures can be localised tenderness on a bone. They usually hurt if you tap on the area. These are also caused by adverse forces from either ground reaction forces of forces place by a particular muscle.

Shin Splints (i.e. Posterior Shin Splints - otherwise known as Medial Tibial Stress Syndrome) tends to ease in severity after the region has warmed up, thus pain will generally be felt during the run up to this point - then lessen somewhat. However, the pain associated with stress fractures does tend to increase as the run progresses.

An X-ray is of little to no use in the early stages as they may only reveal a stress fracture after 3-4 weeks from time of injury (once the fracture starts to heal a ridge can be seen on the film). A MRI or bone scan (as seen below) is the only definitive exams to reveal the stress fracture in the early stages. 

 

• Stress fracture found as dark spot on left Tibia.

 

♦ Treatment: may consist of ice massaging and rest. A vitamin D supplement may also be beneficial to aid in healing and bone strength. A bone scan would be needed to confirm a stress fracture, however I personally don't feel it necessary for bone scans unless there is a long unresolved problem of the region (i.e. longer than 6-8 weeks). If a stress fracture is present, then rest from heavy weight bearing exercise is the only solution till the bone heals which is about 6-8 weeks. Stress fractures will heal in their own time but there are other non-weight bearing activities to help one stay conditioned i.e. pool running, cycling.