Shin Splints

The term “shin splints” is the general term used to describe any discomfort in the lower leg. There are however several varieties of “shin splint” and their diagnosis and treatment is dependent on the location of pain.
Shin splints can generally be categorized into the following:

Anterior compartment syndrome
Posterior compartment syndrome

Anterior compartment syndrome

If discomfort is felt during or after a run at the front (anterior) of the lower leg, it likely that you have anterior compartment syndrome. The muscles at the front of the shin can become tender to touch and especially sore when the feet are lifted upwards against resistance.

Symptoms

Soreness on the muscle situated immediately next to the shin bone.
Pain in the anterior muscles when running and when the feet are lifted upwards.
Weakness in the anterior muscles felt when trying to lift the feet up

Causes

A sudden increase in running intensity and a change in running surface are major contributors to anterior compartment syndrome. Switching from grass running to road running causes the muscles in the lower leg to be used slightly differently, leading to a fast rate of muscle swelling within the sheath of the lower leg. This swelling increases pressure within the anterior compartment of the lower leg and can cause significant discomfort.

Prevention

Along with ensuring that the correct footwear is being used and running frequency and intensity do not rise too sharply, thought must be given to a sudden change in running surface. Many new runners are concerned that excessive road running will inevitably lead to injury due to the shock that the hard surface inflicts on the joints. However, by performing the majority of training on soft surfaces such as grass and then suddenly introducing a distance run on the road, the chances of contracting anterior compartment syndrome are high. Alternating the surface that you run on is by no means off limits but a gradual transition is advised to allow the anterior shin muscles to adapt to the change in surface.

Treatment

RICE is the first course of action to reduce any muscle swelling and inflammation. Avoid running for a number of days or until pain has gone. If symptoms are recurrent, the advice of a professional is recommended so that a gait assessment can be carried out. Orthotics may need to be introduced into your shoes to correct an over-pronating running gait.

Posterior compartment syndrome and medial tibial stress syndrome.

Due to the number of muscles situated in the posterior (rear) compartment of the lower leg, diagnosing the exact cause of this particular form of shin splint can be difficult. Although pain experienced in the calf region of the lower leg can be classed as a form of posterior compartment syndrome, by far the most common form experienced by runners and the type to look at in more detail, is medial tibial stress syndrome.

Symptoms

Depending on the exact cause and structure affected, pain can be felt on the shin bone (tibia) or the muscles on the medial (inside) of it.

Pain on the tibia bone may indicate a stress fracture.
Pain on running which may dissipate after a while.
In the advanced stage, discomfort can be felt whilst walking and at rest.
Pain can be initiated by standing on tip toe.

Causes

Overtraining, too many high intensity runs and over-pronation can all be reasons for contracting any form of posterior compartment syndrome. Excessive running and sharp increases in weekly mileage can cause the muscles of the lower leg to pull on the fascia which connects the muscles to the bone. Overtime this can cause inflammation and chronic pain if running is continued. As with anterior compartment syndrome, a sudden swelling of the muscles within the posterior sheath can cause a build up of pressure and can contribute to lower leg pain.

Prevention

All normal injury prevention guidelines must be followed to avoid being inflicted with this debilitating condition. A sensible approach to training, wearing proper footwear and avoiding any sudden change in training patterns are essential to avoid your running programme being disrupted by lower leg pain.

Treatment

After the area has been treated with the RICE procedure, avoid running or any activity that induces pain. If symptoms continue, treatment by a professional will not cost you much and running with the possible aid of shoe orthotics you will be able to be resumed.

For more imforamtion about other running injuries and running training and nutrtion, you might be interested in buying my book "The Marathon and Half marathon: A Training Guide." Click on the book cover below for more information.