What are shin splints?
Shin splints, the catch-all term for lower leg pain that occurs below the knee either on the front outside part of the leg (anterior shin splints) or the inside of the leg (medial shin splints), are the bane of many athletes. They often plague beginning runners who do not build their mileage gradually enough or seasoned runners who abruptly change their workout regimen, adding a sudden increase in the frequency, duration and/or intensity of activity, or switching from running on flat surfaces to hills. Runners with flat feet and those running in poor shoes or with poor form are also more likely to develop shin splints, otherwise known as Medial Tibial Stress Syndrome.
However shin pain doesn't always mean you have shin splints. It might be a sign of some other problem.
Two conditions that are sometimes mistakenly diagnosed as shin splints are:
Compartment Syndrome. Swelling or hypertrophy of muscles within a closed compartment creates pressure and is characterised by pain on the anterior (outside) part of the lower leg. To diagnose this condition, special techniques are used to measure the amount of pressure. Sometimes surgical "decompression" is required. The symptoms of compartment syndrome include leg pain, unusual nerve sensations, and eventually muscle weakness.
Stress Fractures. This is an incomplete crack in the bone, and is a far more serious injury than shin splints, but may also accompany them. The pain of shin splints is more generalized than that of a stress fracture. Press your fingertips along your shin, and if you can find a definite spot of sharp pain, it's a sign of a stress fracture. Additionally, stress fractures often feel better in the morning because the bone has rested all night whereas shin splints often feel worse in the morning because the soft tissue tightens overnight. Shin splints are also irritated when you flex your ankle up or down, depending on which muscles are aggravated. A bone scan or MRI is the definitive tool for diagnosing a stress fracture. However, there are clues you can look for that will signal whether or not you should get further imaging and your Osteopath can help with this diagnosis.
What are the causes?
The cause of shin splints can be summarised as “too much, too soon”. MTSS most often occurs in athletes who increase their mileage too quickly, the intensity or duration of their training; or change their running surface too dramatically and/or too abruptly.
Other common causes are worn-out footwear, running on hard or uneven surfaces, and even excessive stress placed on one side of the body from running on cambered roads or always in the same direction on a track.
Tight and/or weak calves leads to premature muscle fatigue resulting in altered running mechanics, as does inflexibility and imbalance of the quadriceps and hamstring muscles. Strong ‘core’ muscles and good pelvic stability are important for maintaining proper mechanics between the spine, hips and legs. Being ‘knock-kneed’ or ‘bow-legged’, having flat or over-pronated feet and leg-length discrepancies can also increase the likelihood of TSS. All these biomechanical causes and more, can be evaluated and treated by your Osteopath.
What can I do to prevent them?
Getting help and guidance before embarking on a new training regime is always helpful. A detailed examination and evaluation by your Osteopath before you change your routine or start something new, is always a good idea. But here are a few things that can help along the way.
Choose the right shoes. Wear footwear that suits your sport. If you’re a runner, replace your shoes about every 400 to 600 kilometers. Get fitted by trained fitters like those found at Complete Feet and Active Feet. Preferred brands are Asics, Brooks and New Balance.
Consider arch supports. Arch supports can help prevent the pain of shin splints, especially if you have flat arches.
Lessen the impact. But this doesn’t necessarily mean softer ground. Cross-train with a sport that places less impact on your shins, such as swimming, walking or cycling. Your legs will adapt to the surface you’re running on - softer ground means stiffer legs! In fact, there is even some evidence that running in thinner shoes on a harder surface might be a better idea.
Be sure to warm up. A gentle warm up before activity will allow the muscles to move and adapt more freely to the stresses you’re placing on them. Be careful not to overstretch. Over-stretching before exercise takes the “creep” out of muscles and actually makes them more prone to injury.
Add flexibility and strength training to your workout. A strong core, gluts,calves and shins will all help stabilise your body and allow you to run more efficiently with less strain on your shins. You must remember to stretch after every strengthening workout - this is how muscles repair and get stronger.
STRETCH stretch after activity. This is paramount. The general rule of thumb is ‘the larger the muscle - the longer the stretch’. The largest muscles in your body require a good 30-40secs each to achieve optimal stretch. The smallest muscles about 10-15secs. Your calves sit in about the middle.
Check your running form. Pay attention to how your foot hits the ground - you want to aim for a mid-foot landing, not a heavy heel-strike. You can inspect your footwear and look for how it wears to get an indication as to whether you hit the ground hard with your heel, or even if you tend to be an over-pronator. Increasing your stride frequency (aim for about 180 steps or more per minute) will markedly decrease the amount of force your tibia has to absorb when you hit the ground.
But how do I get rid of my pain?!
The basic treatment for shin splints is no different from most other soft-tissue injuries - RICER!
R: Rest is first and foremost the best way to overcome the initial pain of shin splints. Complete rest should be considered for two weeks, before returning to your training regime at the 50% intensity for the next four. This can be "relative rest" - meaning that you can substitute other non-impact exercises like swimming and biking instead of your running.
I: Ice should be applied along the area of most pain. Usually either the front, outside (lateral) or inside (medial) aspects of the shin. Never apply ice directly to bare skin (ice burns do exist!) and leave it for 10-15mins before giving the area a break. Reapply for another 10-15mins. This on/off/on application can be continued as long as comfortable.
C: Compression has shown to be of some benefit to improve blood flow to the lower leg and so compression socks, bandages or sleeves may be of some help. If you choose to try some, be sure to pick compression equalling no more than 30mmHg. 20mmHg seems to be the "sweet spot". Graduated compression socks are even more beneficial.
E: Elevation is less critical in shin splints, although if compartment syndrome is suspected, this is definitely going to help reduce the pressure in the lower leg.
R: Referral to a manual therapist for an accurate diagnosis and appropriate treatment should be your next port of call.
For shin splints in particular, stretching is the next very important step. Releasing off the calf and shin muscles is vital to take the irritation off the tibia. Once the calf muscles have lengthened sufficiently, you should begin to strengthen your ankles, calves, gluteal muscles and core.
See below for six easy stretches that will be a great start to your recovery.
Watch the video below to see how effective this stretch on the foam roller can be.
Stay tuned for a free downloadable guide on rehabilitating your shin splints - and a very special gift!