Shin Splints – A Pain in the Leg!

I remember them well-that dull ache at the front and side of my shins. I was 27 years old, in my prime and invincible! I’d always run pretty well and was doing 3 x 5k runs a week for health and Rugby fitness. At the time I was also a national surflifesaving champion and working as a PE teacher in Ipswich, Queensland.

I’d just heard about this new endurance event called an Aquathon – a 5k run followed immediately by an 800m swim. You run in your swim gear, kicked off your shoes and dived straight in for the swim! The national championships were being held at Oatley in Sydney. I had 3 weeks to get ready.

I’ll give that a go I thought! I’m already pretty fit. I know what I’ll do! I do interval training, everyone says it’s the way to get race fit fast!  Down to the local athletics track wearing  a pair of thin road racing shoes and into it. Warm-up with a lap easy, do some stretches and then 10 x 400m runs on 2 minutes then a lap warm-down and stretch again. Twice a week of intervals should do it on top of the normal 3 x 5k runs. And maybe a 10k run as well to get some endurance up!

Big mistake – shin splints big time! Never forgotten and never repeated! Young and dumb! So what does the research say about the causes, treatment and prevention of these very painful lower limb injuries.

Causes

Medically, shin splints are called Medial Tibial Stress Syndrome (MTSS). They are sometimes called “tibial stress syndrome”, “tibial fascitis”, or “anterior compartment syndrome”. Shin splints account for 10-15% of all running injuries and up to 60% of all the conditions that cause pain in athletes’ legs. Interestingly, women are three times more likely than men to get them, especially those who try and keep up with male training partners and have to work harder physiologically than the men at the same running speed.

While the cause of MTSS pain is unclear, most researchers agree the shin splints are related to either the covering (fascia) of the soleus muscle (see picture) connected to the covering of the tibia (shin bone) being damaged or the repetitive impact forces that fatigue the same muscle which create slight bending in the tibia bone and small microfractures in the bone.

Research has shown that there is no one cause but the proposed risk factors include: 

  1. Increased pronation of the foot
  2. “Tight” calf muscles that can lead to pronation
  3. Muscle strength imbalance between the front and rear of the lower limb with strong front of shin muscles compared to the calves
  4. Too big a jump in training intensity (in particular) or distance
  5. Training too much on hard surfaces
  6. Training too much on inclined surfaces such as hills, stairs or cambered roadsides
  7. Previous history of MTSS
  8. Genetic factors such as flat feet, high arches or leg length differences
  9. Inadequate calcium intake
  10. High body weight
  11. Having a training age of under 5 years – being relatively new to running
  12. Poor condition of shoes, especially poor shock absorption in the midsole

Looking at most of these risk factors, it becomes pretty obvious what we can do to misnimise the risk of getting shin splints.

Treatment

Rule number one, see a professional (e.g. physiotherapist or podiatrist). Ideally one that is a runner or works with athletes regularly. I’ve learnt over the years to see a podiatrist immediately I have any running issues. She is a runner herself and has videoed me side-on and from behind, looked at my foot and lower limb angles at rest, and looked at my (smelly!) shoes. She has identified some areas I need to work on to prevent any future injuries.

Non-steroidal anti-inflammatory drugs (Ibobrufen, Brufen, Nurofen, Naprosyn, Voltaren, Advil), rest, taping and ice can help the pain.

Below are some other treatment options:

  1. Decreasing run distance, frequency and duration
  2. Replacing road runs with water running or running on grass
  3. Increase the strength and endurance of the soleus muscle through heel raises on steps
  4. Replace those old shoes or get insole inserts
  5. Arch taping or taping around the area of pain
  6. Ice massage
  7. Control pronation through orthotics or new shoes suggested or designed by the podiatrist

My advice is to try these as soon as you get any pain in the the areas shown in the picture above. However, if pain persists, trot along to your runner-friendly podiatrist for professional diagnosis and treatment specific to your individual case.

Prevention

Research has shown that no single prevention method is consistently effective in managing shin splints. Interestingly, stretching of the lower legs has consistently been shown not to prevent MTSS. However, several methods have proven useful including:

  1. Shock-absorbing insoles
  2. Replacing running shoes every 400-800 km depending on body weight and training surface
  3. Pronation-controlling insoles
  4. Lose body weight
  5. A gradual and progressive increase in running intensity and volume or type (e.g. hills or intervals)
  6. Run on softer surfaces. Here is a suggested order going from softest to hardest (grass > bush trails > grass trails > cinders > synthetic tracks > treadmills > asphalt > concrete).

Listen to your body, wear well-cushoined shoes, stretch before and especially after all runs, run on flatter and maybe grassed surfaces or trails, warm-up and down well, and gradually increase the intensity, frequency and distance of your runs. If pain persists, get along to a professional – a podiatrist.

Sources:

  1. Craig, D. (2008). Medial tibial stress syndrome: evidence-based prevention. Journal of Athletic Training, 43(3): 316-318.
  2. Hubbard, T. and others (2009). Contributing factors to medial tibial stress syndrome: a prospective investigation. Medicine and Science in Sports and Exercise, 41(3): 490-496.
  3. Moen, M. and others (2009). Medial tibial stress syndrome: a critical review. Sports Medicine, 39(7): 523-546.