Pain to the front of the shins or lower leg is usually shin splints, or Medial Tibial Stress Syndrome. Very common, particularly in runners and keen walkers. It can effect anyone, usually when someone has increased their training.
Shin Splints is classed as an ‘overuse injury’. This is because it builds up overtime to become chronic. It will start with an occasional achy pain, particularly going uphill, to eventually causing constant sharp pain.
SYMPTOMS
Shin Splints is very common and fairly unmistakable, but things to watch for include:
Pain felt down the shin, just off the inside edge of the bone.
Pain felt at the beginning of a run and then easing off.
Commonly, symptoms also tend to reduce a few minutes after a run.
As the injury gets worse the pain can be felt when walking and at rest.
Pain with direct pressure on the inside of the bone.
THEORIES
* What are Shin Splints?
* Where is the pain coming from?
CALF weakness
Weakness in the calf muscles is often associated with shin splints, it may be that the smaller muscles have to take over when running more. This leads to irritation in their attachment points on the inside of the shin (see below). Calf strength should always be factored in when preventing shin splints and ankle injury. See more about calf injury here.
Shin Muscles
The muscles of the calf and the smaller muscles of the ankle attach along the shin bone (Tibia). Specifically, the big soleus muscle, flexor digitorum and tibialis posterior are usually the culprits. There is also fibrous connective tissue (fascia) that is connected to these muscles and the tibia. If these muscles are weak or the ankle is a bit wobbly, the impact of running or walking can tug the attachment point away from the bone causing irritation.
Running gait
Running action and foot biomechanics causes repeated shin bone bend. As the ankle moves up and down and takes our weight, the shine bone slightly bends. As we run the tibia also slightly rotates inwards too, causing more stress on the inside soft tissues and muscles as mentioned above. This repeated bending is dictated by running form; where and how you strike the ground as you run.
The repetitive nature of running may also lead to micro-fractures in the shin bone, causing more pain if you continue to keep jogging with shin splints pain. If training is increased very gradually, the bone will adapt and get bigger to cope. If training is increased too quickly, the bone will not have time to adapt and will stress fracture.
TREATMENT
REST – until completely pain free – DO NOT RUN THROUGH PAIN
ICE – the shin area
NSAIDs – Ibuprofen may help reduce the inflammation
RUNNING RE-EDUCATION – see below
FOOTWEAR/GEL INSOLES
GRADUAL INCREASE OF LOAD – slowly build up to desired training level
PREVENTION
Gradual Training Increase
Cross Training
Strengthen Calves & Glutes
Flexibility Training
Good Footwear
Consider Running Surface
RUNNING RE-EDUCATION
Increase step width
Take your legs wider, imagine running either side of an imaginary line.
iNCREASE CADENCE
Take more, shorter, steps rather than big long strides. There is no need to aim for a specific number of steps per minutes, experiment with a comfortable pace.
If none of the below cues are working for you, then it may be time to book in with one of the Bristol Physio team for some advice.
Foot Strike/GROUND REACTION FORCE
Think about sweeping the foot underneath you – an ‘about-to-charge’ type action! Kick the leg back behind you, flicking the heel.
Strengthen the ANKLE
Wobble board work, calf strengthening, banded work – there’s loads on our exercise channel to help.
See about Knee Injuries here.
