Shin splints is the generic name given to a number of different clinical conditions that cause pain in the shin. There are many different types of shin splints; periostitis, stress fracture, tendonitis and compartment syndrome being among the most common
What are shin splints?
Periostitis concerns the inflammation of the periosteum - the sheath surrounding a bone. It generally occurs in weight-bearing joints, following excessive activity. It's common in the tibia (shin bone) and foot.
A stress fracture is a common overuse injury, often seen in athletes, and occurs with lower forces that happen repetitively over a long period of time. Also known as a 'fatigue fracture' they can occur in any bone. That being said, they are usually seen in the foot and tibia, since these bones support the body's weight.
A tendon is the structure that connects the muscles to bones. Tendons endure high loads when undergoing ballistic activities, like running. Tendonitis happens when the tendon becomes inflamed. Using the associated muscle generates sufficient force to become painful, particularly when running.
Compartment syndrome on the other hand typically arises from extensive muscle use. Pressure from an inflamed muscle builds up within the muscle sheath and causes pain. It is quite hard to diagnose, but can be extremely painful and will prevent even the most resilient athlete from training. Potential causes are linked to incorrectly progressed training. Regimes which fail to allow the body time to adapt to increasing loads are usually the culprit. This is especially true with beginners, but can also be seen in seasoned athletes.
Symptoms of shin splints - how it feels
The variety of different types of shin splints are matched by a variety of different symptoms. The most common though is tenderness on the front/inside of the shin (tibia). This area is usually hot and inflamed, with swelling sometimes too. You will often find that the pain settles after exercise, but recurs when training resumes.
How shin splints occur
There are many different causes of shin splints. These causes can be separated into extrinsic and intrinsic factors:
Extrinsic factors causing shin splints
Extrinsic causes are forces from outside the body that overload the tibia, it's surrounding muscles and tendons. They commonly relate to running on surfaces that are too hard or too soft. Even training on a slope or camber might cause them. Wearing inappropriate or worn-out shoes, running downhill or with poor basic technique are also common factors. These potential causes are also linked with incorrectly progressed training that fails to allow the body to adapt to increasing loads.
Intrinsic causes of shin splint
Intrinsic causes arise from forces within the body. They commonly result from excessive or rapid over-pronation (flattening) of the foot. This exerts unaccustomed force through the bone and associated muscles. Additionally, insufficient pronation (called supination), prevents the foot from absorbing shock and can exert excessive forces. Other common, but less well recognises causes include factors that affect the amount of pronation. Things like abnormal pelvic biomechanics, leg length discrepancies, tight calves and even spinal problems.
Usually, it's a combination of both the intrinsic and extrinsic causes that produce symptoms. For example, an inexperienced runner who increases mileage too quickly, but also has over-pronating feet, will be especially susceptible. Similarly, an experienced runner who progresses hill training too enthusiastically and unknowingly has a pelvic rotation that causes a leg length discrepancy would have some form of reaction too.
Treatment for shin splints
Self-help is critical when managing any injury and shin splints are no exception. So the R.I.C.E. principles apply here:
Obviously avoid the activities that cause you pain, until it has subsided. Normally, you can continue some form of training to prevent going stir crazy. Exercises like cycling, rowing, swimming or running in water might be possible.
Ice will help reduce swelling and inflammation. There are different ideas on how long to apply it and how. Generally speaking, you should be icing for 10 to 20 minutes, applied 3-5 times per day. Reuseable ice packs are very handy and easy to apply.
If the shin is swollen, then compressive support can be helpful. Especially when used along with an ice pack. Although if you have compartment syndrome, compression will probably not help.
When swollen, elevating the shin can certainly help.
Additionally, anti-inflammatory drugs and pain killers can sometimes help you over the worst of the pain. It may be worth discussing with your GP to see what options are available.
Shin splints exercises
Lower leg stretches can help to alleviate the symptoms. Try kneeling on the floor, then point your toes out behind you. Slowly sit back on your heels, pressing the top of your feet towards the floor. You may need a yoga mat or a couple of towels on the floor for comfort. This will help stretch the anterior tibial muscle on the front of your shins.
Also, stand at arms' length from a wall. Put your hands on the wall, then place one foot a stride-length in front of the other. Keep your back leg straight and your heel on the floor. Lean forward to stretch your calf, turning your heel out slightly.
Finally, stand in the same position, with feet flat, one leg in front of the other. Instead of leaning forward, bend your knee to feel the stretch lower down towards the Achilles tendon. This will target your soleus muscle.
How to prevent shin splints
As always, prevention is better than cure. Do check the causes outlined above and try and avoid them wherever possible. Think about the extrinsic factors that could contribute to shin pain. Take the logical steps to avoid them, like wearing the correct shoes for your foot type.
When prescribed correctly, orthotics can also help correct your foot biomechanics. Exercises to help any pelvic or spinal problems that may be causing shin splints can be useful too. If you are a supinator and do not pronate sufficiently to absorb impact, then shock-absorbing insoles can be very useful too. As well as being effective at preventing shin splints, these measures will also reduce the pressure on your shins if you already suffer from them.