Who else wants to avoid the ‘shin splints’ injury?

The term ‘shin splints’ has become widely used in the running community to describe leg pain below the knee. The most common symptoms include a sharp pain that occurs in the lower two-thirds of the shin bone during exercise and often turns into a dull ache when resting or with light weight-bearing activity.

Did you know there are three different injuries that could be responsible for this pain? If you didn’t, then you are in the right place.

• chronic compartment syndrome
• tibial stress fracture
• medial tibial stress syndrome (MTSS)

This is why a correct assessment is essential to ensure the correct diagnosis and treatment of ‘shin splints’.
If left untreated, ‘shin splints’ will affect a runner’s performance and even prevent them from taking part in running events. In severe cases, surgical intervention might even be needed.

Injuries and symptoms causing the ‘shin splint’ syndrome

Chronic compartment syndrome

During physical exercise, commonly running or football, our muscles expand to allow for increased blood flow to supply the muscles with oxygen (Buerba et al., 2019). If the connective tissue (fascia) surrounding these muscles fails to expand too, then pressure builds up. Many find that symptoms rapidly improve with rest within minutes or hours of stopping the aggravating activity (Buerba et al., 2019).

If ignored, the pressure built-up pressure can compromise the muscle’s blood supply overtime, further increasing the intercompartmental pressure (McMillan et al., 2019).

Symptoms include

• Lower leg pain during and/or post-exercise
• Pins and needles
• Burning sensation
• Cramping that is relieved with rest

This type of injury is mostly caused by repetitive use of the calf muscles.

Tibial stress fracture

As a result of repetitive loading, the tibia bone can begin to fracture. This occurs when the body doesn’t receive adequate recovery-time from the trauma of physical activity (Milgrom et al., 2021).

Symptoms include

• Localised pain to small specific spots at the site of the fracture
• Tenderness on the tibia, which can be relieved with rest
• Deep throbbing pain whilst walking (if left untreated)

This type of injury can be easily distinguished from chronic compartment syndrome and medial tibial stress syndrome because the pain is localised to one specific area, rather than along much of the tibial bone and connecting muscle as found in MTSS (Milgrom et al., 2021).

Medial tibial stress syndrome

The cause of this type of injury has not been clarified yet, although some researchers suggest that periostitis (inflammation of the connective tissue surrounding bone) could be the trigger.

Symptoms include

• Pain ranging from a dull aching sensation to sharp pain along the inner side of the tibia bone on weight-bearing
• Pain during/after physical activity
• Increased pain on palpation of the tibia bone (particularly the mid-lower two thirds)

This injury is one of the most common amongst runners and symptoms gradually get worse overtime if left untreated (Menéndez et al., 2020).

How to effectively treat the ‘shin splints’

Here are some easy exercises and modification ideas that everyone can include in their schedule to either treat these injuries or help prevent them:

1. Decrease frequency and/or intensity. If you’re already struggling with symptoms of shin splints, by simply decreasing the frequency and/or the intensity of your running, the body will spend more time recovering rather than going through the same repeated trauma that caused the injury in the first place.
2. Assess the foot striking pattern during running. This can help distribute the load more efficiently and effectively through the foot and up into the leg, thus reducing such concentrated forces on the irritated area (Buerba et al., 2019).
3. Stretching/foam rolling the muscles that make up your calves will help relieve overly sensitised muscle tissue. Below are techniques to stretch both muscles within the calf complex:

Gastrocnemius– stand facing the wall with one foot in front of the other. Keep your back leg straight and feet facing forwards whilst transferring your weight into the front leg by bending your knee. Use the wall for support. You should feel a stretch in the gastrocnemius muscle of the back leg. Hold for 2 minutes and repeat two more times.

Soleus– stand facing the wall with one foot in front of the other. Keep your back leg bent and feet facing forwards whilst transferring your weight into the front leg by bending your knee. Use the wall for support. You should feel a stretch in the soleus muscle of the back leg. Hold for 2 minutes and repeat two more times.

3. Strength work is fundamental before and after an injury, as getting stronger muscles improves the muscles’ tolerance to load (Menéndez et al., 2020). The best strengthening exercises are those that better mimic the discipline the athlete is training for. For a runner, the closest movement that replicates the running movement is the lunge. Not only does this exercise work all the muscles predominantly used whilst running, but it will improve your single leg strength. This is essential to ensure pelvic stability when transitioning through each stride.

To perform a lunge

• Take a step forward with one leg
• Bend through the knee of the back leg until your knee touches the floor before pushing back with the front leg
• Ensure you keep an upright torso and maintain a stable base – imagine your feet are on train tracks rather than a tight rope

4. Increasing load gradually helps tackle and prevent shin splints. When training, increase distance and/or intensity gradually whilst still allowing time for recovery. Symptoms of discomfort should be mild and certainly not last until the next day. Remember to be patient with this process!
5. Decreasing the amount of impact by increasing cadence and avoiding hills minimising the amount of impact placed on the lower leg.
6. Go and see a professional. At Injury Active, we will carry out a full assessment to identify the cause of ‘shin splints’ (or any other injury). This entails a detailed subjective assessment including training schedule and historical injuries, followed by a full movement assessment as so many factors can trigger an injury (even something as minimal as the foot mechanics can cause shin pain).

Finally, we recommend a course of action that addresses the injury while keeping you active – we do our best to ensure that our clients can train while treating their injuries.

Summary & Conclusion

Shin splints is an injury that can be treated non-operatively but should not be overlooked. What is considered to be a non-serious injury can have debilitating effects when ignored. Please feel free to get in touch if you have any questions or think you may be suffering from shin splints.

REFERENCES

Buerba, R. A., Fretes, N. F., Devana, S. K., & Beck, J. J. (2019). Chronic exertional compartment syndrome: current management strategies. Open Access Journal of Sports Medicine, 10, 71.

McMillan, T. E., Gardner, W. T., Schmidt, A. H., & Johnstone, A. J. (2019). Diagnosing acute compartment syndrome—where have we got to? International Orthopaedics, 43(11), 2429-2435.

Milgrom, C., Zloczower, E., Fleischmann, C., Spitzer, E., Landau, R., Bader, T., & Finestone, A. S. (2021). Medial tibial stress fracture diagnosis and treatment guidelines. Journal of science and medicine in sport, 24(6), 526-530.

Menéndez, C., Batalla, L., Prieto, A., Rodríguez, M. Á., Crespo, I., & Olmedillas, H. (2020). Medial tibial stress syndrome in novice and recreational runners: a systematic review. International Journal of Environmental Research and Public Health, 17(20), 7457.