The last few week, lots of patients have been coming into my office saying, "My shins are killing me after running." This is a common complaint of new runners or runners increasing their mileage or intensity. It has been estimated that "shin splints" account for approximately 15% of all running injuries and may account for up to 60% of leg pain in runners. Many terms have been used to describe exercise-induced leg pain, including shin splints, medial stress syndrome, tibial stress syndrome, recurrent exercise-induced ischemia, and chronic exertional compartment syndrome. "Shin splints" has been commonly used as an all-encompassing term for many disorders causing lower-leg pain so that’s how I’ll refer to it during this discussion.
So what is a "shin splint"? Shin splints are pain in the lower leg usually caused by a variety of overuse or chronic stress related fatigue syndromes. The root cause of most shin splints is chronic biomechanical imbalances of the lower leg and feet. What does that mean? Bad feet, muscle imbalance, bad shoes, or improper training. In my daughter's case, she was running too much, too soon, too fast like many new runners and needed better stretching and arch supports.
What can a "shin splint" represent? The underlying pathology of a shin splint can be a fatigue injury of almost ever tissue seen in the lower leg. This can include:
- Stress Fractures
- Periostitis (irritation of the covering of the bone also known as medial stress syndrome)
- Muscle fatigue or fascial herniation (compartment syndrome)
- Peroneal Nerve Entrapment
- Popliteal Artery Entrapment or Intermittent Claudication (decrease blood flow)
- Spinal Radiculopathy (spinal nerve compression causing referred pain)
Wow! That’s a lot of things that can cause shin splints!
While every shin splint injury has its own specific biomechanical causes, most are rooted in tight calf muscles and relative weakness in the front leg muscles. What's going on is that your tight calves are pulling up on your heel, which in turn pulls the front of your foot down. This puts strain on the muscles in the front of your leg, which unfortunately are not strong enough to resist the pulling. This causes a big pain in the leg! This is very, very common in runners, since running tends to exercise the calf muscles more than those in the front. But fear not, a little rest and a lot of stretching and strengthening will fix you up and possibly make you a better runner, too.
How do we treat them? Early on in the syndrome, shin splints are treated with ice, relative rest (slow down and get off the hills and uneven surfaces), anti-inflammatory like ibuprofen, stretching, and arch supports. Take a good look at your shoes. These often need to be replaced or upgraded to a better pair for your foot type. (More discussion on that topic in a future article).
After we address your shoes and overpronation or underpronation (your foot rolling in or out excessively when you run), then we move on to the muscle imbalances in your lower leg. Your calf muscles are too strong and tight, while your front leg muscles (anterior compartment) are too weak. This is easy to remedy but won’t happen overnight. Stretching your calf muscles with a simple wall stretch for your Achilles tendon many times a day( how many?) will help. Strengthening the front of your leg can be done by actually putting a small weight (or an athletic sock full of sand) on your foot and lifting it towards your shin. Hold that for a count of ten then relax. Repeat twenty five times. You will be amazed how tired those muscles are!
If your pain persists after two weeks of these simple solutions or is at any time pinpoint or severe in nature, call you podiatrist or sports medicine physician. Stress fractures can creep up on the overzealous new runner and can take 8 to 10 weeks of no running to heal!
Shin splints are common in today's active population. It is important to keep in mind that shin splints, like most running injuries, are basically an overuse injury. Listen to your body and back off when you begin to feel pain.
These are just a few tips to get you on the road to recovery! Run Happy!