Do you run? If so, you’re at higher risk of a common condition called shin splints. If you’ve experienced it before, you know how they can be a persistent and pesky problem that makes even a short run unpleasant. Shin splints come from repeated trauma and “wear and tear” to the muscles and tendons that surround the tibia bone, the larger bone in the lower leg.
Surprisingly, experts aren’t sure exactly what causes shin splints, whether they’re due to trauma to the periosteum, the sheath that surrounds the tibia, or inflammation and trauma to the tendons or muscles in the area of the shin. What’s clear is that they’re typically brought on by overuse. Shin splints are also called medial tibial stress syndrome, an appropriate name considering they come from repeated stress on the tissues around the tibia. You don’t have to run to develop shin splints. If you do any type of vigorous, high-impact exercise, you’re at risk. However, shin splints are most common in runners.
You’re more likely to develop shin splints if you increase your running mileage too quickly or tackle a new exercise program too aggressively. In general, you shouldn’t increase the distance that you run by more than 10% per week. This gives your muscles and tendons a chance to adapt to going longer distances. Shin splints are also more common when first starting an exercise or running program or if you try to tackle a longer distance than you’re accustomed to. It can also happen if you suddenly increase the frequency with which you work out.
Signs and Symptoms
The most common symptom of shin splints is pain along the tibial bone. Since the bone is toward the medial side of your lower leg, you’ll typically feel it along the inside of your calf and it can be sharp and stabbing or more of a dull ache made worse by movement. You’ll usually feel the discomfort most when exercising and it usually subsides with rest, although in severe cases, you can have it even after you’ve recovered. If you press the medial side of your calf, you might feel pain or slight swelling even at rest.
Know What You’re Dealing With
Before treating shin splints, make sure that’s what you have. It’s important to distinguish this malady from a more serious condition called compartment syndrome. Acute compartment syndrome is a condition where fluid builds up in a compartment, or fascia, in the leg and becomes trapped. Normally, the fascia expands as blood flow increases. When the fascia doesn’t expand quickly enough fluid becomes trapped.
When acute, compartment syndrome can severely damage the lower leg due to a reduction in blood flow. A classic sign is severe pain in the calves made worse by running. Most acute cases of acute compartment syndrome occur after an injury, although you can also develop it from strenuous exercise. Acute compartment syndrome is a medical emergency that usually requires surgical decompression to avoid permanent damage to the leg.
Less commonly, compartment syndrome is chronic. With this variation, you typically experience milder pain and swelling in the calves when you walk or run. Symptoms include pain in the lower legs with exertion, swelling, tightness, and, sometimes, tingling or weakness in the lower legs. The symptoms usually worsen with exercise and resolve with 15 minutes after stopping. Again, you have to worry about fluid building up in the leg and compromising blood supply, although the chronic form of compartment syndrome doesn’t usually require emergency surgery and can sometimes be treated conservatively. That’s why it’s a good idea to get a proper diagnosis.
Compartment syndrome is something you don’t want to ignore. The risk factors for compartment syndrome are similar to those for shin splints – high-impact exercise and increasing the frequency or intensity of workouts too quickly. Other conditions that can mimic shin splints is a stress fracture of the tibia. Typically, with a stress factor, the pain is better in the morning and worsens as the day goes on. If you press on a discrete area and it feels tender to the touch, be suspicious of a stress fracture.
Treating Shin Splints
Depending on the degree of pain, you may want to stop high-impact exercise, like running, until your symptoms have improved. If not, drastically reduce your mileage or the amount of high-impact exercise you do and focus on other modes of training, like strength training. You can get a cardiovascular workout safely on an exercise bike. After every workout and 6 or more times a day, apply ice packs to your shins. You can also submerge the affected leg in a very cold water bath and leave it for 10 to 15 seconds at a time. Be patient. It may take up to 6 weeks for the symptoms to completely go away.
Preventing Them in the Future
Once your legs feel better, take steps to avoid further problems with shin splints. How can you do this? Don’t increase the intensity or duration of high-impact exercise, particularly running, too quickly. Wear supportive shoes and avoid running or exercising on hard surfaces such as concrete or asphalt. These surfaces place excessive impact on your feet since these don’t have enough give.
If you have repeated problems with shin splint, you may overpronate your feet when you run. Overpronation means your feet roll too much inward when running. This is a common problem in people who have flat feet. A sports medicine doc or podiatrist can evaluate your feet and fit you with an orthotic you place in your shoe to reduce pronation. Motion control shoes are also available if you overpronate but it’s best to get evaluated by a professional.
Always warm up and do dynamic stretches before doing high-impact exercise. Even after your shin splints heal, continue to do calf stretches to lengthen the muscles in your calves. Another way to reduce your risk of shin splints is to cross train so that you’re not doing the same repetitive movements, like running, over and over again. Be sure to correct any muscle imbalances as well. Overly tight calves increase the risk of developing shin splints.
The Bottom Line
Shin splints are common, especially among runners. If you run, cross-train so that you take some of the impact off of your legs and feet. Be sure you’re strength training to strengthen the muscles and ligaments and make them less susceptible to injury.
References:
Mayo Clinic. “Chronic Exertional Compartment Syndrome”
WebMD. “Shin Splints”
OrthoInfo. “Shin Splints”
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