Pain in the Shin
Brad Walker explains the signs and symptoms of shin splints, the preventative action you can take to reduce the chances of experiencing the injury and how to treat shin splints
Shin splints are a term commonly used to describe lower leg pain. However, shin splints are only one of several conditions that affect the lower leg. The most common causes of lower leg pain are: general shin soreness; shin splints; and stress fractures. For the purpose of this article, I will only be addressing the first two. I will save the topic of stress fractures for another issue. Before I move onto shin splints, I want to quickly cover the topic of general shin soreness. Shin soreness is simply a muscular overuse problem. By using the R.I.C.E.R. regime you will be able to overcome 95% of all general shin soreness within about 72 hours. For lower leg pain that goes beyond general shin soreness, a more aggressive approach must be taken. Let us now have a look at shin splints in a little more detail.
What are Shin Splints?
Although the term shin splints is often used to describe a variety of lower leg problems, it actually refers specifically to a condition called Medial Tibial Stress Syndrome (MTSS). To better understand shin splints, or MTSS, let us have a look at the muscles, tendons and bones involved. As you can see from the diagram below, there are many muscles and tendons that make up the lower leg, or calf region. It is quite a complex formation of inter-weaving and over-crossing muscles and tendons.
The main components of the lower leg that are affected by the pain associated with shin splints are:
Specifically, the pain associated with shin splints is a result of fatigue and trauma to the muscle's tendons where they attach themselves to the tibia. In an effort to keep the foot, ankle and lower leg stable, the muscles exert a great force on the tibia. This excessive force can result in the tendons being partially torn away from the bone.
What Causes Shin Splints?
While there are many causes of shin splints, they can all be categorized into two main groups - overload (or training errors) and biomechanical inefficiencies.
Overload (or training errors)
Shin splints are commonly associated with sports that require a lot of running or weight bearing activity. However, it is not necessarily the added weight or force applied to the muscles and tendons of the lower leg, but rather the impact force associated with running and weight bearing activities.
In other words, it is not the running itself, but the sudden shock force of repeated landings and change of direction that causes the problem. When the muscles and tendons become fatigued and overloaded, they lose their ability to adequately absorb the damaging shock force.
Other overload causes include:
The major biomechanical inefficiency contributing to shin splints is that of flat feet. Flat feet lead to a second biomechanical inefficiency called over-pronation. Pronation occurs just after the heal strikes the ground. The foot flattens out, and then continues to roll inward. Over-pronation occurs when the foot and ankle continue to roll excessively inward. This excessive inward rolling causes the tibia to twist, which in-turn, over stretches the muscles of the lower leg.
Other biomechanical causes include:
How to Prevent Shin Splints!
Prevention, rather than cure, should always be your first aim. I was very surprised when researching this topic at the number of articles that totally neglected any mention of preventative measures. They all talked of treatment and cure, but only one out of twenty took the time to address the issue of prevention in any detail. Even before any sign of shin soreness appears there are a number of simple preventative measures that can be easily implemented. Since about half of all lower leg problems are caused by biomechanics inefficiencies, it makes sense to get the right advice on footwear. Your feet are the one area you should not "skimp" on. The best advice I can give you concerning footwear is to go and see a qualified podiatrist for a complete foot-strike, or gait analysis. They will be able to tell you if there are any concerns regarding the way your foot-strike or gait is functioning.
After your foot-strike has been analysed, have your podiatrist, or competent sports footwear sales person recommend a number of shoes that suit your requirements. Good quality footwear will go a long way in helping to prevent many lower leg problems. Apart from good footwear, what else can you do? I believe the following three preventative measures are not only very effective, but crucial.
Firstly, a thorough and correct warm up will help to prepare the muscles and tendons for any activity to come. Without a proper warm up the muscles and tendons will be tight and stiff. There will be limited blood flow to the lower legs, which will result in a lack of oxygen and nutrients for those muscles. Before any activity be sure to thoroughly warm up all the muscles and tendons that will be used during your sport or activity.
Secondly, flexible muscles are extremely important in the prevention of lower leg injuries. When muscles and tendons are flexible and supple, they are able to move and perform without being over stretched. If however, your muscles and tendons are tight and stiff, it is quite easy for those muscles and tendons to be pushed beyond their natural range of movement. To keep your muscles and tendons flexible and supple, it is important to undertake a structured stretching routine.
And thirdly, strengthening and conditioning the muscles of the lower leg will also help to prevent shin splints. There are a number of specific strengthening exercises you can do for these muscles, but instead of me going into the details here, I have simply found another website that has already done all the hard work. It explains a number of exercises you can do for preventing shin splints.
How to Treat Shin Splints!
Firstly, be sure to remove the cause of the problem. Whether it is a biomechanical problem, or an overload problem, make sure steps are taken to remove the cause. The basic treatment for shin splints is no different to most other soft tissue injuries. Immediately following the onset of any shin pain, the R.I.C.E.R. regime should be applied. This involves Rest, Ice, Compression, Elevation, and Referral to an appropriate professional for an accurate diagnosis. It is critical that the R.I.C.E.R. regime be implemented for at least the first 48 to 72 hours. Doing this will give you the best possible chance of a complete and full recovery. The next phase of treatment (after the first 48 to 72 hours) involves a number of physiotherapy techniques. The application of heat and massage is one of the most effective treatments for speeding up the healing process of the muscles and tendons.
I have found both from personal experience and from working with many clients, that this form of treatment is the most effective. The application of heat and deep tissue massage on the effected area seems to bring the best results. If you suffer from shin splints, be sure to spend at least a few minutes massaging the effected area both before and after you exercise.
Once most of the pain has been reduced, it is time to move onto the rehabilitation phase of your treatment. The main aims of this phase it to regain the strength, power, endurance and flexibility of the muscle and tendons that have been injured.
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About the Author
Brad Walker is a prominent Australian sports trainer with more than 15 years experience in the health and fitness industry. Brad is a Health Science graduate of the University of New England and has postgraduate accreditations in athletics, swimming and triathlon coaching. He also works with elite level and world champion athletes and lectures for Sports Medicine Australia on injury prevention. Brad can be contacted via his website at injuryfix.com
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