Ever had shin splints? No you haven’t! Often patients come to me having already dignosed themselves from Dr google or from seeing a different physiotherapist for the same issue several months prior, only for the issue to come back again.
What has become a household term for runners isn’t really a clinical diagnosis - at least not in the way you might think.
Anterior shin pain (as a general term) could cover a few different injuries and we’ll expand on those here.
Medial tibial stress syndrome - The major load baring bone of the shin is the tibia. This bone takes the brunt of our landing forces, especially if we don’t run with great technique. The bone surface called the periosteum can become inflamed due to overload which over time can become chronically painful and lead to what is commonly known as 'shin splints' - a stress fracture.
Compartment syndrome - As it sounds, this condition is an issue between compartments in the lower limb where restricted muscles and fascia swell to create painful areas up the shins.
Muscle strains and soreness - Anywhere we have muscles and tendons we can unfortunately get muscle strains or tendon injuries. Poor technique and/or lack of strength can lead to these overuse type injuries in the general shin area or front of the ankle. Often a muscle is sore from a novel bout of exercise but recovers fairly quickly. In cases where the recovery is suboptimal or the training volume is excessive this damage can become an injury.
The good news is that they’re all treatable and somewhat preventable injuries BUT each needs to be identified and dealt with slightly differently.
If bone is damaged we must first understand the cause. Overload causes the mechanisms of bone recovery to become disrupted and the area inflamed. It is normally described as 'point tenderness' by a therapist and pain is local to this area. Malnutrition and poor recovery can be a factor in bone adaptation so we must address this alongside a temporary break in running. The repetitive impact from running on damaged bones could worsen any fractures so this is one instance we recommend taking some time off the pavement in favour of lower impact activity such as swimming or cycling. Reintroducing running must be done sensibly and gradually, using discomfort as a guide. In the meantime we can use resistance training to regain bone density in the injured area. It should go without saying that a Physio should diagnose and oversee this whole process!
Compartment syndrome is often peoples first assumption but is in actual fact extremely rare. It can be equally if not more painful than bone injuries, causing vascular and neural problems in the lower leg. It can literally feel like things are swelling and trying to burst out of our legs! The treatment usually involves a combination of manual physical therapy, stretching and strength work. In very extreme cases surgery is required but this is very rare.
Band toe raises
Fold the theraband in half so it stays in place over the base of your toes
Use as much range as possible but be sure to keep your knee(s) straight
Move slowly and keep control
Keep the foot vertical
The most common and arguably easiest to fix issue is muscle strain/soreness. The large muscle on the front/outside of our shins is the tibialis anterior and is primarily responsible for lifting our foot with each stride. It’s easy to see how this would be taxed quickly when running new distances, paces or up/down hill more than normal. As stated above, a little soreness post training can be an entirely normal process, however if that pain is consistent, worsening or becoming chronic then it’s a sign of an overuse injury. You may need to relook at your training programming, adjust volume increases more carefully and even add strength work for the muscles concerned. Our favourites include toe taps and heel walks (click on exercises to view demonstration videos). Furthermore, band toe raises (shown above) or dumbbell toe raises (seen below) are very effective too.
Dumbbell toe raises
Hold the dumbbell securely between the feet
Use as much range as possible while keeping knees straight
Focus on controlled movement and full contraction
Our overwhelming advice is that no-one should suffer from chronic pain. If you think your shin pain could be more than just normal temporary muscle soreness, we highly recommend that you visit a Physio as soon as possible.
By Tessa Williams