Shin Splints

Shin Splints

The full name for shin splints is 'Medial Tibial Stress Syndrome' which simply defines the condition as a syndrome in which stress, over time, has caused an injury to the medial (inside) part of the tibia (lower leg). It is very common in athletes who pound the legs - runners, sprinters, figure skaters, gymnasts, etc. It is a typical overuse injury. It does not occur over night but over a period of time during which the athlete has been pounding the legs. It is not the added force caused by weightbearing - for it is not common in weightlifters or other athletes that put a lot of force on their bones - but rather the impact force associated with running. This is one of he reasons why proper footwear is essential for anyone involved with running. Figure skaters, gymnasts, etc. don't have the luxury of choosing ideal footwear with adequate cushioning so, if you're a runner, exercise your ability to pick a good pair of shoes.

The Anatomy

The pain associated with shin splints is thought to correspond to the area where the soleus muscle of the calf attaches to the shin bone, or tibia. If you've ever whacked your shin, you know that there's not a lot of meat on the front of the tibia. It's really just skin over the bone. The majority of the muscles attach to the back of the tibia. If you put your fingers on the front of the tibia, right on the bony ridge where you don't have any padding, and then roll inwards and you'll be able to almost feel behind the tibia. There's a bit of a 'shelf' on the medial side of the tibia. This is where we usually find the sore spots associated with shin splints so if you poke around behind the ridge of the tibia you'd often hit some real hot spots.

It's important to understand that sometimes shin splints will present with the same signs and symptoms as a stress fracture in the tibia. It is also thought that shin splints can progress to stress fractures if not treated properly. So it is very important that if you think you have shin splints, and they are not responding to rest or treatment, you have a professional look at them because if you wind up with a stress fracture you're looking at a minimum of 6 weeks for it to heal.

Signs and Symptoms

Pain located on the medial (inside) part of the lower leg
Pain is often worse with running or other weight bearing exercise
Pain may be related to training on exceptionally hard surfaces (concrete, indoor tracks) or on tight turns (indoor tracks)
Pain may linger even after cessation of the offending activity
May be associated with tight calf muscles

What's Going On

The idea, as I outlined above, is that the soleus muscle is pulling really hard on the backside of the tibia, thereby causing pain. This causes inflammation in the outer layer of the bone, called the periosteum. It is directly related to the repetitive pounding forces associated with running, etc. The soleus muscle has to flex and pull in response to the pounding and this aggravates the periosteum.

What To Do About It

It should be obvious that if we can decrease the pounding forces through the leg we can decrease the likelihood of injury. Proper footwear is essential. Running in worn out shoes is often the triggering incident in runners. Make sure that the shoe you are wearing suits your foot type. Excessive pronation - collapsing of the arch - is one of the causes of shin splints. Also, choose your running surface carefully. Here are a few general rules of thumb:

The softer the better. Here is a list, from hardest to softest, of common running surfaces.
- Steel > Concrete > Asphalt > Packed Dirt > Grass > Treadmill > Bark Chips
- One other surface to consider is running tracks. Indoor tracks are the worst surface you can run on, not only because they are hard and unforgiving, but they are also short with tight turns and this adds to the stress on the shin. People who run regularly indoors will often have problems with their inside legs.
When recovering from shin splints, use this progression to returning to road running
- Water Running, then Cycling, then Stair Master, then Treadmill, then road running.

Here are a few other suggestions:

Address faulty foot mechanics - sometimes orthotics are beneficial
Check shoe mileage - you may be overdue for new shoes
Check your training log - have you doubled your mileage, added hills too quickly, rapidly increased training?
Ice, Ice, Ice. By far the best home treatment for shin splints
Stretch the Soleus and Gastroc muscles (see Stretching for more detail)
Massage is often useful
Taping the shins will often alleviate the pain dramatically. This is a useful strategy for aiding the healing process, but should not be relied upon as a crutch to continue training. Use it if you can't walk at work, for example, but don't use it so that you can get in another long run on injured legs.
- To tape your shin, buy some wide hockey or trainers tape, about 1½ inches wide. If your legs are hairy you'll need pre-wrap foam or shave your leg. You want to tape the lower part of your shin but not your calf muscle as this can cause cramping. Start just above the ankle bones. Your leg is shaped like a cone so you can't just wrap the tape around horizontally. You'll need to tape in an upside-down 'V' pattern. Wrap around the shin once and then tear. Repeat this for a total of 3-4 strips making sure each one overlaps. Then stand up, walk around a bit, as see if it's too tight. If it's too tight peel them off and start over. If it feels okay, repeat the process to reinforce the first layer. If your calf starts cramping or hurting, cut or tear a slit in the back of the top of the wrap to give your calf some room. Remove the tape when you're done the activity you were taping for.
Return to running gradually. Build up slowly to pre-injury training level. Use the progression outlined above if possible, spending 1-2 weeks at each level. Example - 2 weeks water running, then 2 weeks, cycling, etc.