Running Injuries: Shin Splints

December 17, 2015

The cause of shin splints, sometimes used as a “catch-all” term for anterior leg pain, most often can be summed up by this phrase: too much, too soon. Whether it’s a beginning runner adding mileage too quickly or a veteran runner rapidly increasing intensity or dramatically changing their workout routine, the large change in a short period of time does not allow the soft tissues in the anterior leg the appropriate amount of time to adapt to the new stresses and demands.

There are two main locations for shin splints and both will result in pain along the tibia bone itself:

1. Medial tibial stress syndrome (MTSS), which affects the posterior tibialis muscle

2. Anterior tibial stress syndrome (ATSS), which affects the anterior tibialis muscle.

The most common site for shin splints is the the inside of the shin or MTSS. Anterior shin splints (toward the outside of the leg) usually result from an imbalance between the flexor muscles of the calf and the extensor muscles in the front of your leg. Anterior shin splints often afflict beginning runners who have not adjusted to the stresses of running yet or are not properly stretching the lower leg muscles.

There are several theories on the tissue reactions to these increased stresses and muscle imbalances that include small tears in the muscle, an inflammation of the periosteum or the thin layer of connective tissue that wraps around the tibia, an inflammation of the muscle, or some combination of these.

Shin Splints Symptoms

Shin splints often feel worse in the morning or at the beginning of exercise because the soft tissue tightens overnight and at rest. Shin splints are also at their most painful when you dorsiflex your foot and ankle or point your toes toward your head.

Anterior shin pain can also be associated with a couple other, often more serious, injuries, such as a stress fracture in the tibia or compartment syndrome. Symptoms of a stress fracture differ from MTSS in that a stress fracture will typically feel better in the morning and become more painful as exercise continues. There will also typically be a definite point of sharp pain as you press along the tibia or shin bone. Compartment syndrome is a swelling of the anterior leg muscles within a closed compartment of connective tissue, which creates increased pressure in that compartment and compresses the nerves and blood vessels. The symptoms of compartment syndrome include leg pain, unusual nerve sensations, and eventually muscle weakness. Sometimes surgical “decompression” is required if symptoms become severe enough.

Prevention & Self Treatment

The best prevention strategies include a gradual increase in intensity and duration of exercise, wearing the appropriate shoes for your foot type, and proper stretching and foam rolling after exercise.

The standard self-treatment protocol is R.I.C.E (rest, ice, compression, and elevation) or M.I.C.E (movement -pain free range of motion such as light stretching, ice, compression, and elevation). Kinesiotaping can also be beneficial, just make sure you follow the appropriate instructions which can be found here: https://www.youtube.com/watch?v=xICBWe-UbTo

Medical Treatment

Be smart! If you aren’t getting better, get some help. I can’t tell you how many patients I get who wait months or even years before coming in for treatment. The longer you wait, the harder it is to get rid of your symptoms! Here are some tips for finding the right health care professional:

Find someone certified in soft tissue mobilization, whether it’s instrument assisted like Graston Technique or hands on like Active Release Technique (ART). This is where you need to do your homework to see who’s near you. Follow the links to those sites to search their provider lists and read up on what each is all about. Stress syndromes respond well to manual therapy or hands on/massage work. If this is something that’s been around for a while, exercise alone won’t work because the whole leg has learned to compensate and the neurological pain pathway has been well established.
Not every chiropractor or physical therapist is created equally. Some do very little soft tissue work and rely mostly on manipulations or exercise, others do not. We all specialize in our own little areas. This can seem frustrating, but most of us have websites to tell you what we are certified in. There’s nothing worse than wasting 8 insurance visits not getting better, only to switch places and have them fix it in two or three visits.

More About Graston Technique and Active Release Technique (ART)

The primary goals of a practitioner using Graston Technique and ART are to:

Aid in the disruption/breakdown of the adhesions
Increase normal tissue flexibility, movement and comfort
Aim to restore full flexibility, balance and stability

Treatment with Graston and ART techniques is often preceded by a light warm-up activity for the area and complemented with specific strengthening and stability exercises. Most patients report a positive response within 2-4 treatments.

This article is part of a series looking at common running injuries, how to prevent them, and how to treat them if they do occur. Read more about these other injuries as well:

References:

1. Reshef N, Guelich DR. Medial tibial stress syndrome. Clin Sports Med. 2012 Apr;31(2):273-90.

2. Hamstra-Wright KL, Bliven KC, Bay C. Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis. Br J Sports Med. 2015 Mar;49(6):362-369.

3. Plisky MS, Rauh MJ, Heiderscheit B, Underwood FB, Tank RT. Medial tibial stress syndrome in high school cross-country runners: incidence and risk factors. J Orthop Sports Phys Ther. 2007 Feb;37(2):40-7.

4. Griebert MC, Needle AR, McConnell J, Kaminski TW. Lower-leg Kinesio tape reduces rate of loading in participants with medial tibial stress syndrome. Phys Ther Sport. 2014 Jan 29.

5. Hammer, Warren. (2007). Functional Soft-Tissue Examination and Treatment by Manual Methods, 3rd edition. Jones and Bartlett Publishers, Inc, Sudbury, MA.

6. Michaud, Thomas C. (2011). Human Locomotion. Newton Biomechanics, Newton, MA.