Pain in the Shin
Brad Walker explains the signs and symptoms of shin splints, the preventative action you can take to reduce the chances of experiencing the injury, and how to treat shin splints.
Shin splints are a term used to describe lower leg pain. However, shin splints are only one of several conditions that affect the lower leg. The most common causes of lower leg pain are general shin soreness; shin splints; and stress fractures. For this article, I will only be addressing the first two. I will save the topic of stress fractures for another issue. Before I move on to shin splints, I want to cover the case of general shin soreness quickly. Shin soreness is a muscular overuse problem. Using the R.I.C.E.R. regime, you will be able to overcome 95% of all general shin soreness within about 72 hours. For lower leg pain that goes beyond general shin soreness, a more aggressive approach must be taken. Let us now have a look at shin splints in a little more detail.
What are Shin Splints?
Although the term shin splints are often used to describe various lower leg problems, it refers specifically to a condition called Medial Tibial Stress Syndrome (MTSS). To better understand shin splints or MTSS, let us look at the muscles, tendons, and bones involved. As you can see from the diagram below, many muscles and tendons make up the lower leg or calf region. It is quite a complex formation of inter-weaving and over-crossing muscles and tendons.
The main components of the lower leg that are affected by the pain associated with shin splints are:
Specifically, the pain associated with shin splints results from fatigue and trauma to the muscle's tendons, where they attach themselves to the tibia. To keep the foot, ankle, and lower leg stable, the muscles exert a significant force on the tibia. This excessive force can result in the tendons being partially torn away from the bone.
What Causes Shin Splints?
While there are many causes of shin splints, they can all be categorized into two main groups - overload (or training errors) and biomechanical inefficiencies.
Overload (or training errors)
Shin splints are associated with sports that require a lot of running or weight-bearing activity. However, it is not necessarily the added weight or force applied to the lower leg muscles and tendons, but the impact force associated with running and weight-bearing activities.
In other words, it is not the running itself, but the sudden shock force of repeated landings and change of direction that causes the problem. When the muscles and tendons become fatigued and overloaded, they lose their ability to absorb the damaging shock force.
Other overload causes include:
The significant biomechanical inefficiency contributing to shin splints is that of flat feet. Flat feet lead to a second biomechanical inefficiency called over-pronation. Pronation occurs just after the heel strikes the ground. The foot flattens out and then continues to roll inward. Over-pronation occurs when the foot and ankle continue to roll excessively inward. This excessive inward rolling causes the tibia to twist, which in turn, overstretches the muscles of the lower leg.
Other biomechanical causes include:
How to Prevent Shin Splints!
Prevention, rather than cure, should always be your first aim. I was amazed when researching this topic at the number of articles that neglected any mention of preventative measures. They all talked of treatment and cure, but only one out of twenty took the time to address the issue of prevention in any detail. Even before any sign of shin soreness appears several simple preventative measures can be easily implemented. Since about half of all lower leg problems are caused by biomechanics inefficiencies, it makes sense to get the right footwear advice. Your feet are the one area you should not "skimp" on. The best advice I can give you concerning footwear is to see a qualified podiatrist for a complete foot-strike, or gait analysis. They will tell you if there are any concerns regarding the way your foot-strike or gait is functioning.
After your footstrike has been analysed, have your podiatrist, or competent sports footwear salesperson recommend several shoes that suit your requirements. Good quality footwear will go a long way in helping to prevent many lower leg problems. Apart from good footwear, what else can you do? I believe the following three preventative measures are not only very useful but crucial.
Firstly, a thorough and correct warm-up will help to prepare the muscles and tendons for any activity to come. Without a proper warm-up, the muscles and tendons will be tight and stiff. There will be limited blood flow to the lower legs, which will result in a lack of oxygen and nutrients for those muscles. Before any activity, be sure to thoroughly warm up all the muscles and tendons that will be used during your sport or activity.
Secondly, flexible muscles are essential in the prevention of lower leg injuries. When muscles and tendons are flexible and supple, they can move and perform without being overstretched. If however, your muscles and tendons are tight and stiff, it is relatively easy for those muscles and tendons to be pushed beyond their natural range of movement. To keep your muscles and tendons flexible and supple, it is crucial to undertake a structured stretching routine.
Third, strengthening and conditioning the lower leg muscles will also help prevent shin splints. There are several specific strengthening exercises you can do for these muscles, but instead of going into the details here, I have found another website that has already done all the hard work. It explains several exercises you can do for preventing shin splints.
How to Treat Shin Splints!
Firstly, be sure to remove the cause of the problem. Whether it is a biomechanical problem or an overload problem, make sure steps are taken to remove the reason. The primary treatment for shin splints is no different from most other soft tissue injuries. Immediately following the onset of any shin pain, the R.I.C.E.R. regime should be applied. This involves Rest, Ice, Compression, Elevation, and Referral to an appropriate professional for an accurate diagnosis. The R.I.C.E.R. regime must be implemented for at least the first 48 to 72 hours. Doing this will give you the best possible chance of a full recovery. The next phase of treatment (after the first 48 to 72 hours) involves several physiotherapy techniques. The application of heat and massage is one of the most effective treatments for speeding up the healing process of the muscles and tendons.
I have found both from personal experience and from working with many clients, that this form of treatment is the most effective. The application of heat and deep tissue massage to the affected area seems to bring the best results. If you suffer from shin splints, be sure to spend at least a few minutes massaging the affected area both before and after you exercise.
Once most of the pain has been reduced, it is time to move on to your treatment's rehabilitation phase. This phase aims to regain the strength, power, endurance, and flexibility of the muscle and tendons that have been injured.
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About the Author
Brad Walker is a prominent Australian sports trainer with more than 15 years of experience in the health and fitness industry. Brad is a Health Science graduate of the University of New England and has postgraduate accreditations in athletics, swimming, and triathlon coaching. He also works with elite level and world champion athletes and lectures for Sports Medicine Australia on injury prevention.