Treating and Avoiding Shin Splints
One common running injury is “shin splints”, a phrase that really tells you nothing. As with most body pain, inflammation is involved and needs to be minimized. In the case of shin splints, inflammation is occurring in a muscle compartment that has little room for expansion, and it is occurring right where your muscle attaches to the leg bone (the tibia). Bones don’t have nerves in them to sense pain, but they are covered in a fibrous membrane called the periosteum, which is rich in nerve fibres. It is at the periosteum that the pain and the injury begin. This pain is quite intense, but runners love pain and their heads are a bit thick, so some choose to push through the pain of shin splints and take them to a new level… stress fractures, and compartment syndrome! Understanding the circumstances that lead to these injuries is the key to preventing them.
The recurring theme that leads to most running injuries is excess training and inadequate recovery. Admittedly there is a design problem as well. The Original Designer gave us all massive muscles on the back of our leg to push off with, but we all have tiny muscles on the front of our lower leg, the largest of which is Tibialis Anterior. With every step that you take, this muscle works very hard to let front of your foot land gently. If you suddenly increase your walking distance, or power walk, or run, this muscle is worked progressively harder, trying to prevent your forefoot from slapping on the ground.
Also if the running surface becomes harder, there is more stress transferred to your leg. Concrete is very hard on the body and training on this surface should always be avoided. High quality running shoes are specifically designed to provide padding and support for running. Conversely, worn out shoes should be replaced early because of their reduced shock-absorbing capacity. Runners with high rigid arches tend to experience greater pounding shock, whereas those with flat feet tend to experience greater fatigue of the muscles that support the foot — and push-off. Both however tend to develop shin splints
In the early stage a runner will feel a noticeable pain right at the bone when they first begin, but then disappears as running continues. The pain will often return after exercise or the following morning (as the area becomes inflamed). As the injury progresses the athlete will experience more time with the pain, and less time without it. Eventually, if ignored and training continued, the pain may become quite sharp and become focused on a very small area of the bone. If this happens a stress fracture should be considered. As well, continued inflammation in muscle compartment can lead to compartment syndrome, which is potentially a very serious condition.
The classic treatment for shin splints is rest. This should be done until day-to-day activities are pain free. Massage will speed recovery, but I must warn you right now that massage for this condition, while effective, is quite painful. When running is resumed it must be approached cautiously, substituting cross-training activities for running to help increase the interval between running days. The most important preventive strategy is not to repeat the mistakes that lead to the injury. Examine all the training variables – surface, shoes, training volume, intensity, workout type, hills and if there is any recurrence seek help from a qualified trainer.
It should also be noted that shin splints can occur in the posterior (back) compartment of the leg as well. Posterior shin splints can be caused by a multitude of impact activities such as running, jumping, dancing, step classes aerobics, etc.
Shin Splints at a Glance
- Inadequate rest time (over-training)
- Rapid increase in speed or distance
- Bad running mechanics
- Running on a hard surface or uneven ground
- Improper or worn out footwear
Signs and Symptoms
- Pain located on the near the bone on the lower leg (see picture)
- Pain is often noted at the early portion of the workout, and then lessens only to reappear near the end of the training session.
- Pain may linger even after cessation of the offending activity
- Shin splint discomfort is often described as dull at first. However, with continuing trauma, the pain may become so extreme as to cause the athlete to stop workouts altogether.
- Ice 10-15 minutes 2-3 times per day.
- Anti-inflammatory medication (speak to your doctor or pharmacist).
- Deep tissue followed with lighter massage to flush the leg.
- Begin running on a softer surface. Here is a list, from hardest to softest- Concrete > Asphalt > Packed Dirt > Grass > Treadmill > Bark Chips
- When recovering from shin splints, consider this progression to returning to road running- water running, then cycling, then Stairmaster, then treadmill, then road running.
- Address faulty foot mechanics – sometimes orthotics are beneficial
- Check shoe mileage – you may be overdue for new shoes
- Never increase your training by more than 10% a week. If you happen to feel like you can conquer the world that day, only do it by 10%.
- Taping the shins reduce the pain dramatically. This is a useful strategy for aiding the healing process, but should not be relied upon as a crutch to continue training. Use it if you can’t walk at work, for example, but don’t use it so that you can get in another long run on injured legs. One source for leg taping is The Sports Injury Clinic website.
- Return to running gradually. Build up slowly to pre-injury training level. Use the progression outlined above if possible, spending 1-2 weeks at each level. Example – 2 weeks water running, then 2 weeks, cycling, etc.
- Avoid hills (at least for a while).
For more information on shin splints check out the following websites. Some of these are excellent running sites.