Shin Splints

The term "shin splints" is a generic term used to describe pain usually felt along the inside (medial) border of the shin (tibia). It is most commonly suffered by sportspeople in codes where there is a major weight bearing component performed on hard surfaces, such as football, rugby, and particularly running.

The pain is most commonly felt on the inner border of the tibia as shown, but can also be felt on the lateral (outside) side of the tibia as well. Every time your foot hits the ground, a certain amount of very minor damage or "microtrauma" occurs to your bones, muscles and joints.  This is quite normal.  However, by definition, a "gradual onset injury" occurs when this trauma exceeds the body's ability to heal.  This is what is occurring when you develop shin pain from running.

Shin pain can be broken down into the following three categories

• Bone Stress - This can range from an irritation of the bone surface (cortex) causing a "stress reaction", right through to stress fractures.
• Inflammation - This develops at the insertion of the muscles, where they join in to the medial tibial border. Small bumps and tender areas are common.
• Compartment Syndrome - This is where the muscle expands and becomes too large for the "compartment" it sits in as a result of overuse, causing it to become painful from compression of nerves and blood vessels.

Each of these three categories has it's own particular signs and symptoms, although there can often be an element of all three in a painful shin.

Cause: One of the major causes of all three injuries is abnormal biomechanics (i.e. an abnormal walking/running pattern) During walking and running, the usual pattern of movement is:

• Foot strike/Heel strike
• Loading Phase
• Toe Off

Each foot strike delivers a shockwave that travels up the leg. This energy must then be absorbed by the rest of your body. The structure of your foot has the biggest bearing on how your body achieves this. Some people have a high arch and relatively rigid foot, which has limited shock attenuation. Other people have low arches or pronated feet, which causes excessive muscle activity and early muscle fatigue, which in turn leads to shin pain. These physical attributes can be compensated for, to a large extent, by selecting the correct footwear, and carrying out an appropriate stretching program as discussed later in the article.

Symptoms: In the early stage of shin splints an athlete will describe a pain that is present when exercise first begins, but then disappears as they continue. The pain will often return after exercise or the following morning. As the injury gets worse, the athlete will experience pain of greater intensity, which will be easier to aggravate, and take longer to settle again. Eventually, if the pain is ignored and training continues, there can be a constant pain, which is also present at rest. At this stage it is quite possible that a stress fracture has developed.

Treatment:

The treatment of Shin Splints depends upon which of the three categories your particular circumstances fall into, there are however a number of areas which will need to be addressed.

• Rest - Preferably seek a professional medical opinion (e.g. a sports physiotherapist) before resuming your training, but at least stop running until your symptoms have significantly decreased and you have had at least a week of stretching and strengthening.
• Ice - The best way to do this is actually massage a single ice cube up and down the painful area of your shin for up to 20 minutes at a time, and at regular intervals throughout the day
• Stretches
  • Calf muscle
  • Achilles
  • Your lumbar spine, gluteal muscles, hip muscles, quadriceps and hamstrings will probably also be having an influence on your pain and should also be addressed.
• Strengthening
  • A number of strengthening exercises for your calves, the intrinsic muscles of your feet and the stability muscles of your hip and pelvis can also play a vital roll in preventing the return of the pain.
• Type of Shoes
  • Good running shoes are specifically designed to provide padding and support for the biomechanics of running. They help absorb shock and facilitate efficient energy (motion) transfer. It is vital to get a running shoe which matches your specific biomechanics. A proper fit is also important.
• Orthotics
  • An analysis by a podiatrist can also be very useful, both for the correct selection of running shoes, and also to analyse your gait pattern and determine whether orthotic devices (specifically designed inlays which support the contour of your foot) would be beneficial.

Summary: In summary, if you are experiencing shin pain or "shin splints" you should seek appropriate medical advice. This will enable you to determine and treat the actual cause of the problem, rather than simply waiting for the symptoms to disappear.