My shins are hurting: Can I call it Shin Splints?

By: Mujuthaba

Usually the term referred to anterior lower leg pain (shin pain) by physical trainers (PTs) is 'Shin Splints'. Is this an appropriate term to refer to shin pain, or is this term collective?

I personally have experienced 'shin splints' in the days I did my running. There were times when I had to stop running after 3-kms in a 10km run, just because of the stinging pain in the shins. Although after a minute or two of walking phased out the pain. I knew something was going on in my shins, and it was not pleasant. During my days as a PT for MNDF, 'Shin Splints' was the major cause of unpleasantness and injury for the servicemen I trained. Since this is such a common injury in recreational and competitive runners, I thought it would be a good to share the causes of the collective term 'Shin Splints'.

Shin pain in runners is mainly caused by three major factors:

1- Stress Fractures: This is caused due to over-training, in which case applying a lot of stress on the bone. The strain on the bone causes stress fractures, which gives rise to extreme pain, normally in the most anterior bone of the lower leg, the tibia. To avoid stress fractures, it is best not to over-train and to avoid running on hard surfaces.
Diagnosis &Treatment: Increased pain while jumping action or continuous pain at night and while at rest are symptoms of stress fracture. Rest is the best treatment. You can still exercise by means of swimming, cycling or water running. Stress fractures are usually microscopic, and may not show on normal x-rays. Generally they are visible on MRI and CT scans.

2- Inflammation: This could either be the inflammation at the insertions (to the bone) of the lower leg muscles, or inflammation of the outer-most layer of the lower leg bones (periostitis). Again, avoid over-training, running on hard surfaces and also use an appropriate shoe for running.
Diagnosis & Treatment: If shin pain subsides after a warm up or after five minutes into your 5km run, then the pain is probably due to periostitis. Ice therapy, appropriate rest, deep massage therapy and an anti-inflammatory drug to deviate inflammation may help. Visible on MRI scans.

3- Compartment Syndrome: A very complicated issue for runners. There are ten muscles that cover around the two bones of the lower leg. These muscles are grouped into four muscle compartments, where each is surrounded by a sheath or fascia. Compartment syndrome is caused when this fascia looses its ability to stretch with the muscle/s it surround. This applies a lot of pressure on the fascia (which doesn't stretch), causing pain, numbness at the feet and sometimes lower leg hernias. Main cause of the fibrosis (hardening) of the fascia is from over-use followed by inflammation. The affected compartment to this syndrome is normally subject to the form in which the runner uses his/her foot (biomechanics).
Diagnosis & Treatment: If compartment syndrome is present, the pain during running would not subside, but it will get worse. This pain will disappear only after a couple of minutes rest. Treatment is usually by means of training reduction and deep massage therapy. If this treatment fails, surgery could be the only option (fasciotomy).

I hope this helps you to categorize the type of ‘Shin Splints’ you are associated with currently. It may not be that you have just one cause listed above; there could be two or all three present.

As you can see, it is extremely important to avoid over-training your legs (or any body part for that matter) as this is the main reason for the three causes of lower leg pain.

Bibliography:

Brukner, P. & Khan, K. (2005) Clinical Sports Medicine (2^nd Ed.) McGraw-Hill, NY.