Shin Soreness and Shin Splints

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

The muscles on the front, the outer part of the leg being strained, or partially torn, by a sudden awkward movement. 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.

Biomechanical Inefficiencies

The significant 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 heel 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, overstretches the muscles of the lower leg.

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 the area of a fracture.

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

Compartment Syndrome

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

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, then this is generally associated with compartment syndrome.

Daniel Lawrence, in Athletics Weekly^[1], reported that the three most common causes of shin splints are Stress Fractures, Medial Tibial Traction Periostitis and Compartment Syndrome. The following table provides an overview of each condition. All of 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.

How to Treat Shin Splints

The essential 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.

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 the 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. The application of 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 problem, or an overload problem and take appropriate steps to remove the cause.

References

Related References

The following references provide additional information on this topic:

BREWER, R. B. and GREGORY, A. J. (2012) Chronic Lower Leg Pain in Athletes A Guide for the Differential Diagnosis, Evaluation, and Treatment. Sports Health: A Multidisciplinary Approach, 4 (2), p. 121-127
MUBARK, S. J. et al. (1982) The medial tibial stress syndrome a cause of shin splints. The American journal of sports medicine, 10 (4), p. 201-205
VTASALO, J. T. and KVIST, M. (1983) Some biomechanical aspects of the foot and ankle in athletes with and without shin splints. The American journal of sports medicine, 11 (3), p. 125-130

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Shin Soreness & Shin Splints