Have you ever felt pain in the front of your lower legs each time you run? You feel as though your legs are on fire! You have probably felt the pain of shin splints.
The name ‘shin splints’ is a description of pain felt over the front of the tibia bone – the front bone on the lower leg. The lower leg actually has two bones – the tibia and fibula. The tibia is the larger bone to the front of the leg. Shin splints describes pain along the front of that bone, usually located anywhere from 2 inches below the knee to 2 inches above the ankle. The origination of the pain is usually from inflammation along the tendon (posterior peroneal tendon) that runs along the front of the bone.
Shin splints are common in runners and aggressive walkers who enjoy their sport and train hard. However, there are other reasons for athletes to suffer from shin splints besides overuse. You can recognize the pain of shin splints because they are very apparent at the beginning of your run, ease up after you are warmed up and then reappear toward the end of the workout.
Causes of shin splints can be overuse but they are also common in runners who do an excessive amount of hill running, have tight calf muscles or tight Achilles tendons, running on uneven terrain, doing speed work, using worn out shoes without adequate support or in runners and walkers who have poor biomechanical structure to their foot. This means that runners who over pronate while running put an undue amount of stress to the tibial area and thus cause this overuse injury. So while shin splints may be an over use injury you must find the reason for the overuse so that you can make adjustments to your training or equipment to prevent further damage after recovery.
Shin splints are also common in athletes who enjoy other sports that require a great deal of running such as soccer, football and basketball.
Overpronation is one cause that requires the athlete to seek attention once the shin splints have healed. Without the proper equipment in their shoes these athletes will continue to suffer from shin splints to the point that training will come to a standstill several times each season. The athlete who overpronates will be able to decrease or eliminate the experience of shin splints by the addition well built orthotics to their shoes.
Pronation is the action of the foot once the foot hits the ground. In a normal stride the foot hits on the outside of the heel and the foot rolls approximately 4-6 degrees inward. If the foot is stiff, flat or has a high arch the twist to the tibia bone will be excessive and cause the pull and tears along the tendon, causing the shin splint. The overpronation can be corrected with orthotics and the right running/walking shoes.
When an athlete continues to train through the pain there is a high risk for developing stress fractures of the tibia bone. These fractures aren”t the same as breaking the bone in an accident. Instead of a clean break the bone actually splits apart in the middle when the tibia is twisting and the tendon is pulling on the bone.
To diagnose the athlete”s problem the doctor will take a thorough history and do a physical exam looking for point tenderness on the shin, abnormalities in gait and overpronation. If the physician feels its necessary an x-ray, MRI or bone scan maybe ordered. X-ray documentation of stress fractures lags behind the actual fracture by about 2 – 3 weeks. So the actual break won”t show for 2-3 weeks, until healing and new bone is being laid down.
The more conclusive test is the bone scan will show ‘hot spots’ in the bone that indicate the break from a stress fracture. But athletes with shin splints don”t necessarily suffer from stress fractures. When the condition is caught early, treated and preventative measures instituted the athlete can forego the long arduous recovery from a stress fracture.
Treatments and Recovery
Once your doctor has diagnosed shin splints he”ll prescribe a treatment plan to help you recover to your previous level of activity and prevent any further loss of training by preventing more shin splint. Treatment of shin splints starts with rest. This might be the hardest thing that an athlete has to do in the recovery and treatment of any injury. It can be frustrating and aggravating to watch conditioning and performance fall behind after weeks and months of hard work. But it doesn”t have to be that way and in the rehabilitation process there are things you can do to increase the likelihood you”ll return at a level close to where you left.
Once you”ve been convinced to rest the leg, so you don”t develop further injuries (stress fractures) or complications you can move on to finding why you developed the shin splints in the first place. Unless you determine the reason or cause you”ll be destined to repeat this process in a few short weeks or months from now.
The most common cause of shin splints is over use. But the underlying cause of the overuse is that the tibia has been placed under abnormal stress, often from a biomechanically incorrect stride and foot placement. Your physician will help with diagnosis and the start of treatment and rehabilitation from shin splints but you should include a visit to a podiatrist in your treatment plan to evaluate the mechanical placement of your foot during walking and running. This specialist can evaluate you walk and run and determine of over pronation or under pronation is causing a problem.
The issues of over or under pronation can be somewhat addressed through properly made shoes (for your particular situation) but also should be supported through the use of custom made orthotics. Orthotics are shoe inserts that take the place of the shoe insert that comes with your regular tennis shoes or running shoes. Although they can be pricey they also will decrease or eliminate the number of times you suffer from shin splints and potentially from stress fractures.
Important in the treatment of shin splints is rest and the proper shoes for your running form. A top end running store will have salespeople trained in the mechanics of running and will be able to steer you towards running shoes that will protect your legs as well as shoes can.
Ice or cold therapy is another aspect of your rehabilitation from shin splints. If you use ice directly on the skin you must keep the ice in constant motion, as with an ice cup. If the ice is left to sit on the skin you risk damage from frostbite. There are also ice packs made specifically for this process. Use ice or cold on the area for 15 minutes every hour for as many hours as you have available for the first week. This will help to decrease the inflammation and speed the healing.
In the first week of treatment you”ll also benefit from the use of anti-inflammatory medications such as ibuprofen. Follow the advice of your doctor or physical therapist to help decrease the inflammation and continue healing the tendons.
Once you are back to your physical activities (at least one week pain free) you should use good warm up and cool down practices to keep the tendons from becoming over stressed. Always warm up first, and then stretch slightly. You can also stretch well during your cool down process to increase the flexibility of the lower leg and the ability of the foot to work at its best.
Runners and walkers should attempt to exercise on soft even surfaces which help to absorb some of the impact of the lower leg. Once you are pain free and beginning back to your activity level you can also incorporate some strengthening exercises to help protect the foot and lower leg.
Some strengthening exercises that are good to do with both legs include:
- While barefoot use the big toe to draw the entire alphabet in the air
- While standing in supportive shoes raise up and down on your toes
- While standing raise to your toes on just one foot and hold for ten seconds.
- Walk on your toes and then your heels
- With your shoes and socks off place a towel on the floor and gather it up in your bare toes
Of course only perform these exercises if you are completely pain free. Your physical therapist can help you develop a more individualized plan for your specific situation.
During the period of time when you aren”t running or getting back to running slowly you can incorporate running in a pool to continue to improve your lower leg strength and cardiovascular strength. You will find that with good form in the pool and a strong workout you”ll return to running in better shape than when you left it. The pool will keep your body cooler, allowing you to work harder and the water adds resistance that increases the workload on the heart.
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