Shin pain explained
With the running season and warmer weather just around the corner, many of us may be slipping on our trainers to get out there and exercise. Be cautious! Have you suddenly increased our walking and running intensities to risk injury? A sudden increase in the levels of our exercise may cause overuse injuries, especially in our legs. This is particularly so for hips, knees, feet and everything in between.
There are many factors that predispose each of us to such injuries, but typically poor mechanics or weaknesses are the culprits. Other causes can include:
- excessive training or activity
- poor foot posture (especially flat feet or extremely high arches)
- inappropriate footwear
- inadequate warm up
- training on hard or inappropriate surfaces
- muscle weakness
- tightness in specific muscles and joints, such as the calf, quads or buttock muscles
- poor training technique or methods
- leg length differences
- poor balance
- being overweight or generally deconditioned.
Let's explore shin pain in more detail, as this is a very common complaint and diagnosis is often mistaken.
What causes shin pain?
There are several causes of shin pain, but the most common is shin splints. Shin splint pain is felt down the inside edge of the tibia (shin bone) and is due to an inflammation to stresses too heavy in the deep muscles of the calf. These deep calf muscles include tibialis posterior (the muscle supporting the arch of our foot), flexor digitorum longus (the muscle that curls or flexes our toes), flexor hallicus longus (the muscle that flexes our big toe) and soleus and attach to the inner border of the tibia. The connective tissue responsible for attaching these muscles to the tibia is known as the tenoperiosteum. Every time the calf contracts, it pulls on this tissue and if too forceful or repetitive, damage, inflammation and pain can occur.
Typically, the pain occurs with exercise and eases with rest. There is sometimes a rest at ache such as on the evenings after exercise.
This type of shin pain can sometimes occur with another cause of shin pain, compartment syndrome. Compartment syndrome occurs again in the calf and most frequently in the deep calf muscles we have mentioned above. These are closest to and just in behind the shin bone (as with shin splints). These deep muscles are encased in thin tissue called fascia, thereby creating a 'compartment' of muscle. When there is activity requiring repeated use of muscles within the deep muscular compartment (such as walking, running, dancing or jumping), there is a local increase in blood flow, causing the muscles to swell. Subsequently, the pressure within the compartment increases excessively (unable to escape) during activity. From this there can be symptoms such as muscular tightness, shin and calf pain, weakness, pins and needles or numbness.
The third common cause of shin pain is the one we hear of and fear the most – stress fractures. Being a physio who treats clients with shin pain, it is often thought by my patients that stress fractures are the cause of their pain. But this is rarely the case, thank goodness. Tibial stress fractures are very small incomplete fissures or cracks in the shin bone. They are due to compressive forces in the tibia being much greater than the bone can handle. This could be due to an inappropriate or sudden increase in training, training surfaces being too hard or uneven, or foot and shoe mechanics not being supportive enough. Most patients will recover with 8-12 weeks of appropriate rest and structured and gradual pain free return to exercise, although some will require up to 6 months.
With any person presenting with shin pain due to exercise, treating physios should always keep in mind the need for further investigative scanning if reduction in shin pain is not seen. Bone scans, MRIs, crutches, and bracing may be required to ensure correct diagnosis and if exhibiting stress fractures, allow for healing to occur with enough rest.
So, how do I know what is the cause of my shin pain?
Your friendly physio or podiatrist should be able to assess and get a really good idea of the sort of shin pain you have. By asking you about your exercise levels, looking at footwear, assessing your muscle strength, length and control about the hips knees and lower leg, having a good feel and poke around – we will get a great idea. Keeping in the back of our minds, the possibilities of referring for bone scans or MRIs ( to confirm our diagnosis) will be part of our thinking too.
Management of these injuries will really depend on what is causing the shin pain – massage and stretch work through tight muscles and structures of the leg such as the hip flexors and calves, muscle strengthening and stability work for weakened regions, advice on pacing plans to return to exercise without injury re-aggravation and of course, working with a podiatrist to improve foot mechanics, forces, orthotic prescription and shoe advice right for your foot and sport.
And how to I prevent all of this from happening in the first place?
Well we all know that prevention is better then cure, which again screams true. After all, the last thing you want is to be told you cannot exercise for 6 weeks or more – just as you are getting into your fitness regime beautifully and feeling the rewards.
So, to keep it simple:
- Be sensible. Don't jump from doing a little to climbing Mt Everest! Have an idea of the way in which you will slowly build your training up towards that goal.
- Vary your training. Why not mix it up? Cross training days away from your running, or running and walking on differing surfaces such as the road, grass, or sand. By varying your training you have a better and more varied loading through your muscles and bones to prevent over stressing.
- Have rest days. Most of us would have no problem here! But if you are really hard core with your exercise, your body needs days to recover, so give it that.
- Happy feet. Make sure your shoes are doing their job. They need to be supportive, cushioned and not thread or sole bare. Seek advice from a podiatrist if your foot is really flat and shoes seem to not control over-pronation or excessive rolling inwards. Orthotics or even advice on shoes to support better will do you the world of good and prevent injury not only in your legs, but backs too.
- Stretch and relax. Stretches particularly of the calf and lower leg are essential if you're out there on your feet all day or for regular hitouts. Try out our calf slider for improving muscle length and strength.
So, no excuses to get out there and get a little fitter. See you on the starting line!