I’ve been told my running pain is “Shin Splints”. What does that mean…?

Daniel Graham

Podiatrist at Podiatry First

What are “Shin Splints”?

Shin splints are an overuse or repetitive-stress injury characterised by inflammation of the muscle, tendon and bone tissue near the tibia bone in the lower leg. Known as medial tibial stress syndrome (MTSS), shin splints often occur in runners or athletes who dramatically increase their amount, or intensity of exercise. MTSS can be quite disabling and progress to more serious complications if not treated properly. Often, the cause of MTSS is multi-factorial and involves training errors and various biomechanical abnormalities.

What causes it?

Commonly it is subsequent to abnormal forces and function of the lower limb. A little bit broad? Okay, MTSS is associated with biomechanical abnormalities of the lower extremity. These may include knee abnormalities, abnormal forces going through the tibia, abnormal development of the femur (femoral anteversion), limb-length discrepancies and/or foot and ankle abnormalities.

Hyperpronation of the subtalar joint is one of the most common and well-documented risk factors for MTSS.

Risk factors for developing MTSS include:

• Excessive pronation at the subtalar joint

• Excessively tight calf muscles

• Excessive loading of the inside shin muscle

• Undertaking high-impact exercises on hard, non-compliant surfaces (running on asphalt or concrete)

• Poor footwear

• Smoking and low fitness level

So what is actually happening?

Dysfunction of the tibialis posterior, tibialis anterior, and soleus muscles, alterations in tibial loading, and chronic repetitive loads cause abnormal strain and bending of the tibia.

In laman’s terms…

“There is an overloading of the muscles connected to the tibia and the tibia itself.”

A number of tibial stress injuries are thought to be involved including: tendinopathy, periostitis, periosteal remodelling and stress reactions of the tibia.

How do I know if this is what is happening to me?

The most common complaint of patients with MTSS is vague, diffuse pain of the lower extremity, along the middle-lower half of the tibia associated with exertion. In the early course of MTSS, pain is worse at the beginning of exercise and gradually subsides during training, and within minutes of cessation of exercise. As the injury progresses, pain presents with less activity and may also occur at rest.

If left untreated MTSS may become permanent, with constant and consistent debilitating pain during any exertion. Other complications include stress fractures of the tibia, compartment syndrome and complete tearing of the involved muscle, possibly away from the tibia bone. These are all very serious complications requiring surgical intervention, with some possibly becoming life-threatening. Best to have it dealt with well before it gets to this stage!

How to treat MTSS?

Researchers have concluded that there are essentially 7 stages that need to be covered to effectively rehabilitate these injuries and prevent recurrence.

• Early injury protection: pain relief & anti-inflammatory tips

• Regain full range of motion

• Restore foot and ankle control

• Restore normal lower-limb function

• Restore lower-limb strength

• Restore high speed, power, proprioception & agility

• Return to pre-injury activities

Personally, I work with patients to develop an appropriate rehabilitation plan. Cases vary between patients, sometimes it is as simple as changing footwear. Other times treatment may require orthotic intervention and stretching regimes. In more severe cases we need to place emphasis on proper technique, gait retraining, and return to activity in a step-wise fashion.

Caught early MTSS can have a “quick fix”, whereas, in more severe cases results may take longer. In severe cases, over a period of weeks, with clinical guidance, patients will slowly increase activity intensity and duration, and add sport-specific activities and exercises to their rehabilitation program; as long as they remain pain-free. Patients should scale back any exercises that exacerbate their symptoms or cause pain.

If you feel like this is happening to you, have yourself checked out. No one should be running through pain!

Call (02) 9387 1545 or CLICK HERE to make an appointment!

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