‘Shin splints’ pain is a common cry from many a runner, from your novice to your elite. It is not so much a diagnosis, but rather a general term or the region of the pain. Causes can vary across all tissues in the lower leg - the muscles ( medial aspect), the bone (tibia), the blood vessels (compartment syndrome) or nerves.
This is the most common and is often due to the 'too much, too soon' effect of training, or an imbalance caused by weakness and tightness of the lower leg. The tibialis posterior muscle running down the length and attaching to the back of your shin/tibia can become inflamed due to over loading, causing a pulling on the bone. The tibial bone can feel bruised, and the muscle will feel sorest typically at the lower half of your shin. This pain, initially sore when you begin a run, will usually get better with distance.
What's really going on? Poor biomechanics is the culprit here, whether it be from your foot over-pronation, ankle and calf stiffness, to unsupportive footwear, or an internal torsion of your upper leg due to hip imbalanced weakness. The right targeted and individualised progfam of strength and mobility to correct ans control these forces will get you back on track.
Bone bruising and stress fractures scare the daylights out of most runners. This occurs when the level of stress being placed through them is greater than the rate at which the bone cells adapt and strengthen. An area of bone weakness can occur and become microscopic cracks if training were to continue. This pain is exquisite and very focal. A stretch of 1-2cm of the tibia or shin would be extremely tender. This pain gets worse with activity and can even ache at rest and through the night.
Whats' really going on? As with the muscular issues, biomechanics and over training increase the risk of stress fractures. Ignoring the warning signs such as tender bone, aches at night can lead to a stress fracture. Running surfaces such as running on concrete, running on a camber, or running around a track can also over load the tibia. Unfortunately, up to 12 weeks rest from running, a strength and mobility program to target imbalances and a graduated return via the Nordic anti-g trainer will see a runner put in the hard yards to get back.
- Nerve and vascular causes.
Irritated and compressed nerves and blood engorgement issues i the calf and lower leg can also cause shin pain. These should be excluded if the presentation is not typical for the more common muscular and bone causes. Further testing, investigations and scans are often warranted here, and your amazing physio would be able to advise you if they feel this is necessary after assessing you.
With any of your running niggles, whether it be your back, pelvis, hip, knee or lower leg, insist your physio assesses you thoroughly. A holistic assessment of your posture, strength, running biomechanics and training plans will help you to get back to what you love and with reduced risk of re-injury.
