Shin Splints
"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. As always, Trust No One and 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 to the right.
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. Also, listen to the sound of your feet landing; if there is a slapping sound, this is a bad sign. The force that creates the slapping sound also creates a shock in the foot that travels up the body. Try to modify your running style to minimize the sound. Following the POSE method may help.
3.3 Option 3 - Excess Dorsiflexion
Dorsiflexion is the medical term for pulling your foot towards your shin. If you stand and rock back onto your heels, you are dorsiflexing your feet. It is possible that shin splints may be caused or aggravated by excessively dorsiflexing. This excess dorsiflexing occurs just before your foot lands, and may overwork the Tibialis Anterior muscle. One solution to this problem is to be aware and to relax your foot more. Another suggestion is to pre-exhaust the Tibialis Anterior muscle before you run. To do this, perform some shin raises.
- Shin Raises. Stand with your back to a wall, your heels about 12 inches (30 cm) from the wall. Lean back until your butt and shoulders are on the wall. Lift up your toes to bring your forefoot off the ground while leaving your heels down. Pull your toes as close to your shins as you can. Relax back down, but don't allow your forefoot to touch the ground. Repeat until your Tibialis Anterior feels tired.
3.4 Option 4 - 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. Using "compression socks" may help.
3.5 Option 5 - 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 Foot Strike is. If you try to heel strike 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.
3.6 Option 6 - Follow the POSE method
Try following the POSE method may give you a more bio-mechanically efficient stride that fixes the shin splint problem.
3.7 Option 7 - 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.
3.8 Option 8 - Bone Scan
Initially a stress fracture will not show up on an x-ray, though after a few weeks of healing, though there may be some evidence of that repair will visible. To diagnose a stress fracture, a more sophisticated technique is required, such as a CT scan, MRI, or bone scan. However even these techniques are not completely reliable. Another technique that was used on me is to apply ultrasound; if there is a stress fracture this will produce an intense pain.
