Shin Splints

I remember hearing the term shin splints in high school as I sat in the athletic training room surrounded by what seemed like the entire cross country team just two weeks into the fall season. Needless to say, ice cups were everywhere. Lower leg aches and pains, or “shin splints” as they are often called, are one of the most frequent complaints of runners whether veteran or beginner. In fact, they are so common that they are often considered almost a rite of passage that every runner must endure at some point in his career. While shin splints is an umbrella term used to describe pain that occurs below the knee and above the foot, it is not an appropriate diagnosis; rather, shin splints are the end product of an underlying condition. To effectively recover, an accurate diagnosis must be made and correctly applied treatment ad- ministered.

A common shin splint presentation starts like this: calf muscle tightness or scar tissue forces muscles on the front of the leg to work more, resulting in pain and swelling (aka shin splints). In this situation, if treatment were only directed at the painful muscles on the front of the shin, the underlying cause would be missed. Appropriate treatment would be to break up scar tissue in the entire lower leg, thus, decreasing the added tension on the muscles of the shin.The three most common causes for shin splints are overuse, improper footwear, and bone damage.

Overuse

As I have touched on before, overuse occurs when load exceeds capacity. If one’s training load exceeds one’s body’s capability to provide adequate recovery, an overuse injury will result. Scar tissue, our body’s Band-Aid, will start to accumulate in the muscles on the front of the shin and deep in the calf. Accrued scar tissue can cause shin pain as well as lead to muscle imbalances, over-pronation, or other biomechanical problems.

One must examine all viable training variables: running surface, intensity, workout variations, hills, weather conditions, everything. For example, the surface on which one runs creates different levels of stress on the body and especially the lower leg that absorbs a large percentage of that shock. Running on cement with worn out shoes creates more stress on your body than running on a dirt road with newer shoes. The repeated foot strike of the running cycle results in muscle fatigue and overuse, which leads to greater forces directed to the leg’s muscles and bones.

Improper footwear

Whenever, I treat someone with lower leg pain, the first questions I ask are the following:

• Which running shoes do you wear?
• Were you fitted for the shoes at a running store?
• Was there a recent change in shoes that preceded the current injury?

Shoes are probably the number one cause of lower leg pain. The muscles of the lower leg are the primary stabilizers of the ankle. If the amount of support is too much, too little, or suddenly changed, those muscles will be working overtime to control the amount of pronation in the foot and ankle. Making sure you are in the “right shoe for you” is crucial to preventing shin splints from occurring in the first place.

Bone Damage

As we examined in the last issue of Level Renner, bone damage is a common and often misdiagnosed condition of the main bone of the lower leg, the tibia. Shin splints can be confused with stress fractures or reactions (types of bone damage) be- cause pain is often in the same location. Stress fractures occur when the load placed on the bone causes it to break down faster than it can rebuild. This usually happens with sudden in- creases in mileage or intensity. Stress fractures can also be caused by existing problems such as dietary deficiencies and metabolic disorders even in low mileage situations. While one of the most common running injuries, “shin splints” represent a variety of different injuries of the lower leg. Similarly, there are many potential causes that can lead runners to be sidelined for weeks to months. As with all running related injuries, a proper diagnosis is key to a speedy recovery.

As always, if you have any questions regarding injuries or would like to have your own condition assessed, please do not hesitate to contact me at, dr.andrewschupp@gmail.com or call 608-244-7447.