Shin Splints – more than just shin soreness

Shin splints refers to shin pain, most commonly with exercise, and can be due to bone, muscle/tendon or vascular issues.

It covers a number of pathologies and is not a specific medical diagnosis.

Under the term “shin splints”, there are a number of pathologies including Tibial Bone Stress, Tibial Periostitis and Chronic Exertional Compartment Syndrome.

Imaging, such as MRI, can identify some but not all conditions affecting the area.

For example, it will find bone stress or periosteal reaction. However it can’t detect compartment syndrome.

Each form of imaging has very specific properties and functions, so you should avoid routine screening scans (ie. “Not sure what it is, let’s start with an x-ray”).

Get a specific scan to confirm or exclude the most likely condition in your case AFTER a decent clinical assessment.

Imaging can also be helpful by finding associated injuries that may affect your biomechanics, such as bony spurs or tendon splits.

Stop shin splints from stopping you!

Identify the pathology

Identifying the specific pathology is vital as the management strategies and activity recommendations are very different.

This doesn’t necessarily mean you need to scan your leg.

A good clinical assessment can confirm the diagnosis by recognising common patterns as well as identifying causative or contributing factors behind your pain.

Shin splints pain patterns

If your shin splints pain warms up with activity and gets worse again as you cool down, it’s most likely to be Tibial Periostitis.

The most common description of Tibial Periostitis is “it hurts to start walking in the morning and for the first 500m of my run, but then it improves and almost goes away after 2km. But an hour after I finish my run, it’s back and feels worse. It even hurts to walk…”

Shin splints pain that builds with sustained activity and eases within minutes after stopping activity?

You could have Chronic Exertional Compartment Syndrome or CECS (NB. don’t get this mixed up with Acute Compartment Syndrome, which is a medical emergency and presents completely differently).

A common description of CECS is ” I seem to start fine but after a few hundred metres or a couple of kilometres, the pain builds up. It’s not just in one spot and it keeps getting worse until I need to stop. After sitting down, it eases pretty quickly. But soon after I start again, it gets worse and the cycle repeats”.

Shin splints symptoms that worsen with activity, then linger for days afterwards are more likely to be caused by Tibial Bone Stress.

A common description of a Tibial Bone Stress Injury (BSI) is “it feels like shin or calf pain but it’s hard to find the exact spot. It starts the run noticeable but not too bad, then it just gradually builds up. I can run with it but it hurts a lot. Once I stop, it just stays sore for the rest of the day and is still worse the next day. It even hurts when I’m laying in bed at night”.

Control the loading

You’ll need to reduce your exercise loading if the pain is worsening, BUT…avoid the temptation to stop altogether.

The underlying causes, such as weakness and stiffness, will worsen with too much time away from exercise.

Read more about how rest can make the problem worse and make it more likely to happen again.

Gradually reduce your activity each week until it’s at a level that allows your symptoms to improve steadily.

Pain while running

Aim for shorter strides with a faster cadence (steps per minute) to reduce the impact forces on the shin.

That’s not to say that your cadence or stride length were incorrect before.

It’s simply a matter of any reduction in stride length and increase in cadence is associated with reduced impact loading.

Dedicate one training session per week to technique training, to practice the updated running gait.

Manage the symptoms during and after a run to reduce their impact on your running technique.

You can do this with a handheld roller, heat cream or ice packs.

Common mistakes when treating shin splints

Fix any deficits identified if they fit with the causative biomechanics

If I had a dollar for everyone given random ankle strength exercises when there was never an ankle strength issue identified in the first place!

Find a cause that makes sense – it might be poor stability or poor technique.

Address that cause directly with an exercise that rehearses the muscle patterns required.

Ankle stability exercises - no more seated foot twists! Try these awesome exercises.

Avoid anti inflammatory meds!

They take away the pain in most cases but they only mask the symptoms while the condition worsens.

They also take away your primary gauge of treatment response.

How do you know an intervention is working if you’re masking the symptoms.

As unpleasant as pain is, it’s great at helping you work out your ideal training load and provides feedback on altered running techniques.

You don’t need to get orthotics or new shoes!!!

Don’t waste your money on new shoes and orthotics UNLESS there’s a proven deficit in your foot and ankle stability that’s contributing to your problem.

Low Dye taping is often used by clinicians to ascertain the effect on improved stability on your symptoms.

It can also be used to temporarily improve stability, if that’s a causative factor.

Here’s a quick video on a simplified Low Dye taping technique you can try at home.

Don’t treat the condition, treat the cause.

The condition is a result of an underlying cause or causes – as long as the cause remains, you’ll have an uphill battle to fix the condition.

Begin to isolate different contributing factors, such as stiffness and stability, so see if they’re contributing to your symptoms.

Don’t try to fix everything at once – it’s impossible to determine what impact a change is having if you’ve changed multiple things simultaneously.

Although it seems quicker to change everything, it’ll slow down your recovery as you don’t know what’s working.

What else could it be?

Conditions referred to as Shin Splints

Firstly, we need to cover what it might be under the generalised heading of Shin Splints:

The most common condition is Tibial Periostitis.

It warms up, even goes away, with exercise. However it worsens on cooling down and with inactivity.

Tibial bone stress injuries present as a bony ache with exercise.

They worsen during exercise and remain sore for days afterwards.

Chronic Exertional Compartment Syndrome is an increase pressure around the calf.

It causes a vague but strong pain in the calf and often has associated numbness or tingling in the foot.

Medial Tibial Stress Syndrome is really a medical name for Shin Splints.

It’s not a specific pathology but is often used to describe a generalised overload pattern of the Tibia as seen on imaging.

Conditions that cause similar symptoms to shin splints

Then there’s a list of conditions which can all cause shin pain but aren’t technically in the Shin Splints category.

Sciatica can cause vague nerve-related pain into the leg, including deep into the calf.

This is often mistaken for calf or shin pathologies as there is often concurrent local issues like sore muscles.

You can also get localised symptoms from a Calf Muscle Strain.

The Soleus muscle, the most commonly injured calf muscle, attaches to the back of the Tibia and can cause shin soreness.

Vascular issues includes inflamed blood vessels, such as Varicose Veins, or occluded blood vessels, such as Popliteal Artery Entrapment Syndrome.

Both types of conditions can cause vague pain into the shin.

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