Shin splints is common among runners and is characterised by crippling pain down the inner part of the shin – the front of the lower leg. Unfortunately there is some confusion as to the causes or even the definition of shin splints and pain in this area is not always due to shin splints.
What is shin splints and why does it occur?
The medical term for shin splints is medial tibial stress syndrome (MTSS). This refers to the fact that the pain of shin splints originates on the medial (inner) side of the tibia (shin bone). It is usually caused by inflammation in the connective tissue wrapped around the tibia, where the muscles of the lower leg (most notably tibialis posterior) attach to it. Damage to this connective tissue may be due to repeated trauma where there has been excessive strain or force placed on the area.
The most common cause of shin splints is through overuse, and is most often seen in patients who engage in running and jumping sports. Shin splints account for about 10 to 17% of injuries in runners, but dancers are among the worst affected and have shin splint rates of up to 22%. Shin splints can affect anyone engaging in high impact sports, such as football and basketball, and it can even develop in walkers, especially if they increase their speed or distance too quickly.
This injury is more likely to occur if the patient has poor biomechanics such as over-pronation (where the foot rolls in) and also if they wear poorly fitting and unsupportive footwear. Shin splint sufferers are often found to have tight calf muscles. In fact it is often found in people who have an anterior pelvic tilt – that is the top of the front of the pelvis tips forwards and the tailbone is tilted out at the back (see figure below). This posture causes an imbalance in the hip muscles which in turn leads to strain on the lower leg muscles and their attachments. As in any other area of the body, an osteopath will always check the patient’s pelvic alignment as this is so often an underlying cause.
However it is important to remember that as in any type of pain, there is always involvement of the brain. If you suffer from shin splints – or shall we simply say “pain in the leg”, and you stop exercising altogether, the problem will not go away and when you try to exercise again, you will find that as soon as you raise the intensity of your exercise the shin splints will be back. This is partly because stopping exercise results in deconditioning, which causes an increase in the pain you experience. But it is also because your brain has come to associate the intense exercise with pain and therefore is more likely to generate a pain experience when you resume this level of exercise.
Other causes of pain in the shin
It is important to ensure that you have the correct diagnosis, as there are other causes of lower leg pain, which may become serious if left untreated.
The most serious type of lower leg pain commences suddenly, is associated with rapidly increased swelling of the lower leg, and either heat or tingling and or loss of sensation. In this case don’t hesitate, seek medical assistance immediately as these are the symptoms of DVT (deep vein thrombosis).
Pain on the outer (lateral) part of the shin or in the calf may be due to compartment syndrome, which is also sometimes known as shin splints. Compartment syndrome occurs when the muscles of the lower leg swell and the fluid becomes trapped inside the connective tissue wrapping (or fascia) which envelopes the muscles. This is more serious than shin splints, as the connective tissue will have shortened and does not stretch as readily as muscle. In extreme cases it may be necessary to have it surgically released. However this would be the last resort, following more conservative treatment with osteopathy, sports therapy or physiotherapy.
Another cause of pain in the lower leg is stress fracture. This is also more serious than shin splints, and is common among young women athletes and dancers. Stress fractures are more likely to occur in very active women who are underweight and who therefore have a disrupted menstrual cycle. Normal menstruation is important for regulation of bone calcium and if this is disrupted, the bone weakens and is prone to stress fractures.
So before you conclude that pain in your lower leg is due to shin splints, make sure you have got the correct diagnosis.
What can I do about shin splints?
If you suspect you have shin splints, start by using ice and rest. In order to encourage healing you can take gentle exercise, but nothing too demanding. However if you do not address the causes of the shin splints, the problem will return. This means ensuring that you are wearing appropriate footwear and that you have addressed any foot pronation. Stretching is important and you may wish to get your lower limb mechanics looked over. If you do have an anterior pelvic tilt you may want to get treatment to help correct this and then Pilates will help to maintain proper pelvic alignment in the longer term.
It can also help to mobilise the nerves of the lower leg as well as stretching the muscles. See the video below for instructions on how to do this.
Sorrel Pindar, Registered Osteopath.
Image attribution for Muscles of the Lower Leg: By OpenStax [CC BY 4.0 (https://creativecommons.org/licenses/by/4.0)], via Wikimedia Commons