Shin Splints: All You Need To Know
What Are Shin Splints?
“Shin splints” is a nondescript reference to leg pain (below the knee and above the ankle) commonly affecting runners, however you don’t need to a runner to suffer from shin pain. It is one of the most common overuse issues in runners and the community, affecting almost 35% of the athletic population. The term “shin splints” could be classed as an umbrella diagnosis, so more accurate and specific diagnoses should be made through effective history taking and assessment.
Having said this, the most commonly referred to pathology for shin splints is medial tibial traction periostitis (MTTP), otherwise known as medial tibial stress syndrome (MTSS). This, and other potential diagnoses will be covered in this blog.
Why Do They Happen?
Shin splints can occur for a multitude of reasons. Main causes and risk factors include:
- Biomechanics – walking and/or running action, foot type (e.g. flat feet), posture.
- Incorrect training load
- Unsuitable footwear
- Training surface/terrain
- Fatigue
The diagnostic words of “stress syndrome” and “tibial traction” give some clues as to mechanism of injury, with repetitive stress & traction (or pulling) on your shin. This typically causes periostisis, which is inflammation to the fibrous outer layer of the tibia. The site of pain usually correlates with tendinous attachments of the soleus, flexor digitorum longus and posterior tibialis muscles. The belief is the repetitive traction of these muscles may be the underlying cause of the microtrauma to the bone.
Biomechanics? Tell me more!
Biomechanical anomalies are one of the most commonly reported intrinsic variables with regards to shin splints. When presenting to a qualified podiatrist or allied health professional, it is imperative that an appropriate biomechanical assessment is carried out to identify such anomalies, including but not limited to:
- Leg length difference
- Excessive pronation or supination
- Arch deformities
- Strength limitations
- Restrictions to joint range of motion
- Abnormalities to walking & running gait
When you view the body as a complex system, full of moving parts, you can appreciate that there IS an ideal way for each person to move in their most efficient way. Each and every walking or running stride involves hundreds of moving parts, all of which have a specific job to do at a specific time, but can be negatively affected by the points listed above. With that in mind, here are some thoughts to ponder:
- If the timing of a singular action – no matter how small – is out, what are the repercussions on the system as a whole?
- Are your muscles & tendons, or the bones they’re attached to, conditioned to cope with the range and force they’re exposed to?
- Considering your body requires time to adapt to load, how will soft tissues or bones react if training load is increased too quickly?
Symptoms & Differential Diagnoses
With regards to shin splints (MTSS/MTTP), the most common site of pain is the posteromedial border of the tibia, which is the inside border of the shin bone, particularly along the lower third. Pain will be felt over a diffuse area, rather than a pinpoint location.
Individuals with shin splints will typically feel the pain at the start of exercise, which will then slowly diminish through activity as they warm up. Pain may return after exercise and the next day.
As I mentioned at the beginning of this blog, “shin splints” (although classically referring to MTSS/MTTP), is an umbrella term covering all shin pain. It is important to see a qualified health professional for thorough assessment as there are other diagnoses which can present similarly, such as:
- Tibial stress reaction or stress fracture
- Chronic exertional compartment syndrome
- Popliteal artery entrapment
- Other muscle & tendon injuries
Treatment
Treatment for shin splints will depend on a multitude of factors, determined by thorough assessment of the individual and their subsequent diagnosis. For medial tibial stress syndrome/medial tibial traction periostitis, common treatments include:
- Rest, ice, and analgesia if required
- Activity modification (activity type and/or dosage)
- Shock absorbing insoles
- Corrective insoles (foot orthotics)
- Gait coaching
Matt from Keen Podiatry is a highly experienced musculoskeletal podiatrist who can properly assess and treat shin splints in Milton, Paddington, Toowong, Taringa, Red Hill, Bardon, and surrounding areas. If you have a history of shin splints or are currently experiencing shin pain, book here to see Matt at his Milton podiatry clinic.
References
- Brukner, P., Khan, K. M., Bahr, R., Blair, S., Cook, J. L., Crossley, K., McConnell, J., McCrory, P. R., & Noakes, T. (2012). Brukner & Khan’s Clinical Sports Medicine. (Fourth Edition ed.) McGraw-Hill Education.
- Deshmukh NS, Phansopkar P. Medial Tibial Stress Syndrome: A Review Article. Cureus. 2022 Jul 7;14(7):e26641. doi: 10.7759/cureus.26641. PMID: 35949792; PMCID: PMC9356648.
- Moen, M.H., Holtslag, L., Bakker, E. et al. The treatment of medial tibial stress syndrome in athletes; a randomized clinical trial. BMC Sports Sci Med Rehabil 4, 12 (2012). https://doi.org/10.1186/1758-2555-4-12