Mention the term “shin splints” and almost every runner recalls
experiencing pain in the lower leg associated with running. The term itself is non-specific and is what
we call a “waste basket” term. Pain in
the lower leg usually can be identified as Medial Tibial Stress Syndrome
(MTSS), stress fractures and exertional compartment syndrome.
MTSS occurs on the inside edge of the lower leg bone (tibia). It is usually tender to touch mid-way between
the knee and ankle or in the lower 1/3 of the leg. This injury usually occurs with runners new
to the sport, running on hard surfaces, training errors—doing too much too soon
or increasing distances too rapidly, muscle imbalances or biomechanical faults
especially excessive pronation. The
source of the pain is usually either inflammation of the tissue that lines the
bone called the periosteum, or the posterior tibialis tendon that runs along
the inside of the bone to the foot.
Left untreated or pushing through this injury can lead to a stress
fracture of the tibia, a small crack in the bone. X-rays are usually not necessary and the
stress fracture doesn’t usually show up for 2-3 weeks and either an MRI or bone
scan is needed to find it. Women are 2-3
times more likely to experience this problem than men and should be certain
that their vitamin D and calcium intake is sufficient. If stress fractures are recurrent, a full
medical work up is necessary to rule out other potential causes.
MTSS often develops when the Achilles tendon and Soleus muscle are
tight and or weak. Performing stretching
and strengthening exercises to correct that problem often eliminates the
problem. Most runners know how to
stretch the Achilles tendon but often are unfamiliar with stretching the
soleus.
If the lower leg pain is on the top or outside of the bone, the
anterior tibialis muscle may be the culprit.
If the pain worsens during the run and the foot gets numb and the ankle
gets weak, so weak that it is difficult to lift the toes up with the heel on
the ground, exertional compartment syndrome may be the problem. The muscles, nerves and blood vessels are
grouped in what is known as a compartment.
If the pressure builds in the compartment the muscle can swell and the
nerves and blood vessels become compressed to the point the ankle loses
function. Usually only present during
running and resolves shortly after stopping, but left unchecked may require
surgery to relieve the pressure.
Follow these tips at the first sign of lower leg problems:
- Ice the area after running.
- Stretch the Achilles and soleus.
- Strengthen the lower leg muscles, core and hips.
- Run on softer surfaces like a trail or track.
- Correct excessive pronation with an arch support.
- Replace shoes if worn excessively.
- Cross train in pool or elliptical until pain lessens.
- Still a problem after 2 weeks? See a Physical Therapist or Sports MD.
Watch the video for a 3 exercises to help you recover from shin splints…
Blog post by Joe Carroll.
About
Joe Carroll PT DPT SCS
Joe is a Doctor of Physical Therapy and
co-owns Cape Cod Rehab with his wife, Kathy. One of the first PT’s in the state
to be certified as a Sports Clinical Specialist (SCS), Joe is also a Master
Instructor in the Burdenko Method. He continues to run and support local road
races every year and knows what it takes to help athletes get to the level they
desire. Joe is a 5-time Boston Marathon finisher and ran his 7th marathon on
April 18, 2016 at the Boston Marathon raising money for Boston Children’s
Hospital.
