Runners frequently develop shin pain during or after some sort of exercise or activity, which could be caused by several factors. Often referred to as “shin splints,” this term itself is not an injury, but is a collective term that refers to a few different injuries of the lower leg. Although runners are most typically affected by shin splint symptoms, those who participate in jumping sports such as basketball, dance, tennis, etc. are also at risk.
The most common types of shin injuries include:
- Medial tibial stress syndrome (MTSS) – Is the most common cause of leg pain in athletes. MTSS is an overuse injury which causes pain on the inner aspect of the shins. Pain usually runs along the length of the shin and may be present in one or both legs.
- Tibial stress fracture (TSF) – Pain is usually more point-specific and located directly over the bone in the shin. Pain is usually relieved when not bearing weight. Stress fractures that are relatively new (2-3 weeks) will most likely not show up on an x-ray, and won’t until the bone starts to heal itself. If a stress fracture is diagnosed, it may be recommended to wear a boot or not bear weight for a period of time.
- Anterior tibialis tendonitis – Pain is located along the outer border of the lower leg bone, where the anterior tibialis muscle is located. This muscle helps turn your foot inward and upward. Repetitive motion and increased strain on the muscle can cause inflammation in the tendon. Pain begins while running and may specifically be noticed after running hills or inclines.
Facts Related to Shin Splints:
- MTSS accounts for nearly 60% of all overuse injuries of the leg
- About 10-20% of runners will experience at least one bout of shin splints during their career
- TSFs account for 6-14% of running-related injuries
- TSFs seem to be more prevalent in females
There are numerous theories about the origin of shin splints, but the exact mechanism of injury is frequently unknown. Possible causes of shin splints include:
- Faulty biomechanics while running/jumping
- Anatomical abnormalities, e.g., flattened or high arches or position of knees
- Muscle weakness, e.g. quads or gluteal muscles
- Decreased flexibility, especially in the calf muscles
- Low bone mineral density
- Hormonal imbalances
- Type of surface on which activity is performed, e.g. hard surfaces like concrete sidewalks or roads
- Quality and condition of footwear, e.g. poor quality or worn out running shoes
- Training technique, e.g. too aggressive progression of training frequency and pace
Prevention and Treatment
Because the lower leg bone is chronically inflamed due to repetitive forces, running further aggravates shin splint symptoms and prevents the affected site from healing properly. Shin splint prevention and treatment strategies:
- Decrease the intensity and duration of activity
- Resting 7-10 days is recommended; try biking or swimming to continue cardio exercise
- Ice (20 min with bag OR 5 min with ice cup massage over area) and elevate often during the day
- Inserts, orthotics, and new shoes may be helpful to alter where stress is placed on the feet and up the legs
- Running mechanics may need to be altered if inconsistencies are noted
- Stretching and strengthening may help decrease pain and improve function
Technique: Hold each exercise 15-30 seconds in a gentle pain-free stretch. Do not bounce!
Frequency: 3-4 repetitions/exercise, 5-7 days per week*
* Recommendation: Begin stretches and exercises listed here (only if pain-free) until your appointment with the physical therapist or athletic trainer.
Frequency: 3 sets of 10 repetitions, 5-7 days per week*
References:Carr K, Sevetson E & Aukerman D. “Clinical Inquiries: How Can You Help Athletes Prevent and Treat Shin Splints?” The Journal of Family Practice 57.6 (2008): 406-8.
Hubbard TJ, Carpenter EM & Cordova ML. “Contributing Factors to Medial Tibial Stress Syndrome: A Prospective Investigation.” Medicine and Science in Sports and Exercise 41.3 (2009): 490-6.
Pohl MB, et al. “Biomechanical Predictors of Retrospective Tibial Stress Fractures in Runners.” Journal of Biomechanics 41.6 (2008):1160-5.