Shin Splints

[Incomplete - work in progress] "Shin splints" is not a specific problem, but a symptom - pain in the shins. This article gives a brief description and some possible courses of action. Note that I am not medically trained, so take this advice as a starting point for your research.

1 Description

"Shin Splints" is a non-medical term that refers to a general pain in the shin (the lower front part of the leg, between the knee and the ankle). The pain can be in the bone (tibia) or in the muscle (Tibialis Anterior) - see image at the end of this article

2 Underlying Cause

The Tibialis Anterior is the main muscle in the shin area. If you press on this muscle, you can feel it tighten as you pull your toes up towards you knee. This muscle is used to raise the toes or to push down with the heel of the foot. If you stand with your feet flat on the floor, and raise yourself up on your heels, you are using the Tibialis Anterior.

In running, the Tibialis Anterior is used if you land on your heels, to absorb the landing impact. Landing on your heels is relatively common in runners shod in modern running shoes. I believe that this heel strike it the cause of much of the shin splints that occur in runners.

Another possible source of shin splints is the bone (tibia). Excessive impact from landing could cause stress that leads to problems in the tibia. Diagnosing bone problems is difficult, even with a bone scan. However, if you suspect you have a stress fracture, seek medical advice.

A number of medical articles suggest that shin splints are caused by under or over pronation. Pronation is the roll of the foot during landing from the outside edge to the inside edge. This explanation does not seem reasonable to me, as the muscles in the shin are not directly used in the pronation movement.

3 Possible treatment

Below are a number of options that you could consider for treating shin splints, in roughly the priority order.

3.1 Option 1 - Check for Compartment Syndrome

Compartment Syndrome is caused by swelling in the front of the lower leg, which reduces blood flow. Compartment Syndrome is a dangerous condition, as it cuts of the blood to the lower leg and foot. If you have tingling or numbness in your feet, you may have Compartment Syndrome. If the shin splints get worse during exercise, rather than improving slightly as things warm up, this may be a symptom of Compartment Syndrome. If the area with the shin splint pain is tender when pressed immediately after exercise, but recovers quickly, this is also symptomatic of Compartment Syndrome. If you suspect you have Compartment Syndrome, I would suggest seeking qualified medical advice.

3.2 Option 2 - Use cadence to limit heel strike

If the symptoms are too severe for you to run, go to option #3, then try this option as part of your recovery. By following the advice on the Cadence page you can reduce the impact of landing and reduce the heel strike. Try to be aware of your foot strike and modify to avoid landing on your heels. You should be landing with the foot reasonably flat, or on the forefoot. Avoid reaching forward with the foot in an attempt to lengthen your stride. Your foot should land under the hip, not ahead of it.

3.3 Option 3 - Treat conservatively

You should reduce the amount of running you are doing, but I think that cutting out all running is not ideal, as some level of training stress can help the body heal correctly. Running a fraction of your normal mileage every other day should provide the body with the rest to recover. Avoid downhill running if possible until the symptoms disappear, as downhill running makes heel strike more likely. Ice will help with the healing - Cryotherapy - Ice for Healing. Stretching, massaging and icing the calf muscles may help, as tightness in the calf may put added stress on the Tibialis Anterior. You can strengthen the Tibialis Anterior by sitting on a chair and scrunching up a towel using your barefoot, grasping the towel between your toes, lifting it off the ground, releasing, then repeating.

3.4 Option 4 - Barefoot drills

Shin splints only appear to be an issue with runners who use modern running shoes. Many runners, myself included, report that they land with a very different foot strike when not wearing modern running shoes. If you try landing on your heels when barefoot, or wearing minimalist footwear, it is immediately painful. This pain produces an adaptation to land more naturally, on the midfoot or forefoot. Modern running shoes allow a style of running that puts a lot of stress on the Tibialis Anterior. Studies have also shown that the modern running shoes cause more stress on the body from landing than barefoot, and the more padded the running shoe, the greater the impact.

Doing a little barefoot running on a soft surface (grass, track, treadmill) should show you how different the footstrike is. If you try to heelstrike barefoot, the discomfort should cause you to adapt. Running barefoot is likely to cause you to experiment with different landing styles, and you should find a pain free and comfortable stride. I would suggest running for short distances, 100-400 yards at a time, quite slowly. These drills should teach you how your feet should land, which you may be able to reset your stride for your other running.

3.5 Option 5 - Go barefoot/minimalist

I put this option as the last alternative, as it is not trivial to move from running in a modern running shoe to minimalist running. The move requires relearning how to run, a time consuming process. However, it you cannot modify your foot strike using cadence, conscious modification or barefoot drills, this is your next step. The majority of barefoot runners I have come across move to barefoot/minimalist running because they become desperate to overcome a chronic injury.