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Posted by Jacqueline Carpenter on 8th Feb 2017

The Pain of Shin Splints

The Pain of Shin Splints

Any repetitive activity can wear on the body and anytime a body endures too much activity before the body is truly ready for it, injury occurs. Runners experience the most overuse injuries of their lower body than any other athlete. Sprains and strains are typical overuse injuries and any other micro-trauma to the muscles and bones. 80% of runners’ injuries occur at or below the knee (Ferber, 2009), including plantar fasciitis, patella tendonitis, and medial tibial stress syndrome, or shin splints. Medial tibial stress syndrome refers to an irritation or degeneration of the shin bone, or the soft tissue which surrounds it. However, the term “shin splints” often refers to any pain felt on the inside edge of your tibia (shinbone, AAOS, figure), and it was believed that medial tibial stress syndrome was the only thing characterized as shin splints.

Shin splint pain is typically (AAOS, 2016):

  • Sharp and razor-like or dull and throbbing
  • Occurs during and after exercise
  • Can be aggravated when pressure is applied to the area, upon touching the shin

It would seem there are three major types or causes of shin pain, compartment syndrome, medial tibial stress syndrome, and tibial stress fractures (Ingraham, 2016).

Compartment Syndrome: Compartment syndrome refers to an increase in pressure within one of the body’s fascial compartments, usually the arm or leg. A compartment is a section that contains muscles and nerves, surrounded by a supportive connective tissue, the fascia. The fascia is very thick in the leg due to the increase in pressure of the blood being pumped throughout the legs. The thickness allows very little room for the leg to expand into and if the pressure from inflammation, like from an injury, becomes too great, blood supply to the muscle can be blocked. Severe damage to the nerve and blood supply to the leg can be compromised and can cause the muscle to die. This is a much less common ailment in the shins, but if not taken seriously can cause a lot of problems. Pain can occur on either side of the shin and it is important to speak with a doctor if chronic, prolonged, pain occurs in the shin. 

Medial Tibial Stress Syndrome:The medial part of your lower leg refers to the inner part of your shin. Medial tibial stress syndrome (traditional shin splints) exhibits pain in the middle and lower shin on the medial side of the tibia. The pain is typically due to repeated trauma to the connective tissue surrounding the tibia. It can also be stress caused by an imbalance of muscle strength around the tibia. It is important that you work the shin muscle (tibialis anterior, Wikipedia) as well as the calf muscle (gastrocnemius) when performing strength exercises to help equalize the pull of these muscles on the bone. High impact activities contribute to the progression of medial tibial stress syndrome and can be treated fairly easily.

Medial Tibal Stress Fractures (Patel, 2011):Stress fractures are common impact-related injuries that begin with repetitive activity. Repetitive force to a bone can produce micro-fractures, and if the stress continues while the bone is still attempting to remodel the bone, small fractures can occur. The tibia accounts for almost a quarter of the stress fracture locations. Localized pain to the tibia with edema, or swelling, at the injury site is a common indicator of a possible stress fracture. Typically an X-ray or a bone scan is necessary for a doctor to diagnose stress fractures and differentiate from medial tibial stress syndrome. While an MRI is not useful in detecting medial tibial stress syndrome, it is possible to detect symptoms of a stress fracture using an MRI (Ohnishi, 2015), but it can be costly. The figure below shows the results of an MRI with an apparent stress fracture at the top of the tibia; indicated with the arrows (Patel, 2011). For severe stress fractures it is recommended to limit the amount of weight applied to the leg and may require the use of crutches, walking cast, or brace.

As noted previously, shin pain often occurs after sudden changes in physical activity including changes in frequency, duration or intensity. Having flat feet is a risk factor to developing shin splints as it typically causes over-pronation of the ankle, or the flattening or “rolling in” of the foot. In any weight-bearing activity there is a relationship between the degree of pronation of the foot and ankle and internal tibial rotation. The tibia naturally rotates within the ankle joint to allow a greater range of motion within the foot. But, when the foot rolls inward (Sports Injury Clinic, 2016) and causes the ankle to become destabilized, this adds more stress to the muscles and tendons within the foot, ankle and tibia.

 

Exercising with improper or worn out footwear will also increase the risk of injury to the shin and it is important to use the proper shoes or orthotic inserts to help stabilize the arch of the foot and prevent over-pronation.

Non-surgical treatment for non-severe shin splints includes:

This information is provided as an educational service and is not intended to serve as medical advice. It is important to seek advice from a physician if you have concerns about your chronic leg pain or experience many of the symptoms listed above. Do not begin an extensive treatment plan without speaking with a physician first.

Sources:

  • AAOS. (2016). Shin Splints. http://orthoinfo.aaos.org/topic.cfm?topic=a00407
  • Ferber, et. al. (2009). Suspected mechanisms in the cause of overuse running injuries: a clinical review. Sports Health: A Multidisciplinary Approach. 1(3): 242-246. DOI: 10.1177/1941738109334272.
  • Ingraham, P. (2016). Save yourself from shin splints. https://www.painscience.com/tutorials/shin-splints.php.
  • Ohnishi, J. (2015). Differentiating tibial stress fracture from shin splints by using MRI. Sports orthopaedics and traumatology. 31: 188-194. http://dx.doi.org/10.1016/j.orthtr.2015.06.007
  • Patel, et. al. (2011). Stress fractures: diagnosis, treatment, and prevention. American Academy of Family Physicians. 83(1): 39-46. PMID: 21888126
  • Read, H.K. (1996). Shin splints. The Foot. 6(2): 82-85. http://dx.doi.org/10.1016/S0958-2592(96)90043-7.
  • Sports Injury Clinic (2016). What is overpronation? http://www.sportsinjuryclinic.net/sport-injuries/foot-heel-pain/overpronation.