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.
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.