Shin Soreness & Shin Splints

Shin soreness and shin splints are terms used to refer to pain in the front lower leg. It could be because of:

The muscles on the front and the leg's outer part are strained or partially torn by a sudden awkward movement and are technically known as medial tibial stress syndrome.
A direct blow to the tibia (shin bone).
Stress fracture.
Swelling of the Posterior or Anterior Tibial muscles within their containing sheath. (Compartment Syndrome).

Causes

While there are many causes of shin splints, they can all be categorized into two main groups: Overload (or training errors) and Biomechanical Inefficiencies. Weak or inhibited gluteal muscles can cause shin splints.

Overload (or training errors)

Shin splints are commonly associated with sports that require a lot of running. 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 absorb the damaging shock force.

Other overload causes include:

Exercising on hard surfaces, like concrete.
Exercising on uneven ground.
Beginning an exercise program after a long layoff period.
Increasing exercise intensity or duration too quickly.
Exercising in worn-out or ill-fitting outdoor shoes - read more from this article.
Excessive uphill or downhill running.
Return following injury without adequate build-up.

Biomechanical Inefficiencies

The significant biomechanical inefficiency contributing to shin splints is that of flat feet. Flat feet lead to a second biomechanical inefficiency called overpronation. Pronation occurs just after the heel strikes the ground. The foot flattens out and then continues to roll inward. Overpronation occurs when the foot and ankle continue to roll excessively inward. This excessive inward rolling causes the tibia to twist, which overstretches the lower leg muscles.

Other biomechanical causes include:

Poor running mechanics.
Tight, stiff muscles in the lower leg.
Running with excessive forward lean.
Running with excessive backwards lean.
Landing on the balls of your foot.
Running with your toes pointed outwards.

Strain, tear or fracture

A muscle strain or tear - you would feel the pain immediately whenever you contract or stretch the muscle.
Stress fracture - requires a specialist diagnosis. As the tibial tendons lie close to the shinbone, it is often difficult to distinguish between posterior tibial tendon strain and a tibial stress fracture.

The two problems can also co-exist as the stress fracture is caused by the excessive pull from the tendons against the bone, and tendon tightness and pain may be a protective spasm around a fracture area.

A tear in the enclosed muscles can cause compartment syndrome, so the two problems co-exist.

Compartment Syndrome

Muscles are enclosed by a containing sheath, which is inelastic. The muscles tend to swell due to injury or overuse, so each time you use them, they swell further and create extra pressure on the sheath. With compartment syndrome pain, you usually only feel these pains when running or walking for long enough to bring muscle swelling. You feel pain when exercising, but it eases when you stop, and the muscle swelling reduces. The pain may be felt in the following:

Posterior tibial muscle - behind the inner side of the shin, mainly in its central and upper part.
Anterior tibial muscle - the upper outer part of the shin.

Telling one from the other

A stress fracture tends to have pain that runs up and down a region of the lower leg near the tibia, and if you tap the tibia, some discomfort may be felt. If you have numbness in the lower leg, this is generally associated with compartment syndrome.

In Athletics Weekly^[1], Daniel Lawrence reported that the three most common causes of shin splints are Stress Fractures, Medial Tibial Traction Periostitis and Compartment Syndrome. These injuries are caused by repetitive strain or overuse and are linked to common biomechanical faults of the feet, with both high and low arches increasing the risk of shin pain. The following table provides an overview of each condition.

Condition	Pain Location	Result of Exercise	Special Tests
Medial Tibial Traction Periostitis	Diffuse pain in the inner shin	Pain reduces during exercise	Worse in the morning
Stress Fracture	Focused pain on the inner lower third of the shin	Made worse by exercise and impact activities	Vibration Ultra Sound
Compartment Syndrome	Outer shin pain and tightness	increases after a short period of exercise	Muscle Weakness, possible altered sensation

How to Treat Shin Splints

The essential treatment for shin splints is no different to most other soft tissue injuries. It involves Rest, Ice, Compression, Elevation, and Referral to an appropriate professional for an accurate diagnosis. Immediately following the onset of any shin pain, the R.I.C.E.R. regime should be applied.

Stop the activity.
Apply ice wrapped in a damp towel for 10 minutes every 2 hours.
Apply a compression bandage to help minimise the swelling of the tissues.
- Compression is not advisable for compartment syndrome as it may increase pressure and cause further damage.
Elevate your legs to help limit blood flow and prevent the use of the muscles.
Rest the injured part as much as possible to allow the healing of damaged tissues.
Refer to an appropriate professional for an accurate diagnosis.

The R.I.C.E. regime must be implemented for at least the first 48 to 72 hours. Doing this will give you the best possible chance of a full recovery.

The next phase of treatment (after the first 48 to 72 hours) involves some physiotherapy techniques. Applying heat and massage is one of the most effective treatments for speeding up the healing process of the muscles and tendons.

Determine if the shin splints are due to a biomechanical or overload problem and take appropriate steps to remove the cause.

References

LAWRENCE, D. (2012) Shun Shin Problems. Athletics Weekly, 15th March 2012, p. 60

Page Reference

If you quote information from this page in your work, then the reference for this page is:

MACKENZIE, B. (2000) Shin Soreness and Shin Splints [WWW] Available from: https://www.brianmac.co.uk/shin.htm [Accessed