This article was written by the late Marie-Catherine Bruno, Physiotherapist, Athlete, Colleague, and Pedorthist Extraordinaire.
What is a shin splint? This is a generic term to describe inflammation of either a muscle (the tibialis), a tendon, or of the bone’s outer membrane (periosteum) in your lower leg. The most common one is an inflammation of the tibia due to a constant pull from a certain muscle (the tibialis posterior), that is attached all along the tibia. Shin splints affect mostly runners, but it is not rare to see overweight people dealing with this issue as well.
Symptoms
There is a gradual onset of pain, usually starting after running for a while (anywhere from 10-15 minutes, sometimes up to 45 minutes). The pain will be dull and aching. It can be anywhere along your tibia, or sometimes around the inside of your ankle, just behind the ankle bone. The pain usually goes away when you stop running, but if you press hard on the area, you can reproduce the pain, even at rest. It takes a few days to go away, but the minute you go back for a run, it will come back. When really inflamed, it can even hurt when walking.
The Cause
There is a multitude of possible causes of shin splints. The key to healing such an injury is to, first of all, find out what the cause is; only then can you receive the appropriate treatment. Here are the common culprits…
- Falling arch (also mistakenly called flat foot). Do your feet seem to be flat? If so, do a quick test: lift up your foot and look if you see an arch. Then put it down on the ground, and gradually put all your weight on that leg. Is the arch still there or is your foot now flat on the ground? If the arch is still there, and as pronounced as it was up in the air, move down to the next cause! If, on the other hand, your arch seems to have flattened out (like 60% of the population), you have what we call pronated feet, meaning that the muscles and ligaments that should hold up your arch are not strong enough to do their job. This condition needs to be treated with either orthotics or by getting on a specific strengthening and stretching program by your physiotherapist. If you do not treat it, it changes the whole alignment of your body and creates abnormal wear and tear in your joints. In the short run, you will probably develop shin splints from your tibialis posterior (one of the muscles holding up your arch), that constantly pulls on the tibia bone on which it is attached because it is being constantly stretched.
- Old or inappropriate shoes. When you are running you increase the load on your joints by up to 80%. Therefore your body has to do a lot of shock absorption. Your shoes should act as good shock absorbers. Take a look at them; do you see creases on the sidewalls of the sole? If so, you need new ones. It means that you have a flat! And they cannot absorb much anymore, no matter how new the top still looks. Also, look at the sold and note what part of the heel is worn. It should be near the center, but a little bit more on the outer side. If you are wearing out the center or the inner part, you do not have the appropriate shoe for your foot. Shoes are designed for different types of feet: some of them are for pronators (pronated feet), some are for a normal, neutral foot, and a minority of shoes correct supination (the opposite of pronation). If you don’t have the right one, you are creating a new problem! So make sure you buy your shoes in a specialized shop. (The money you save on a bargain, you will be reinvesting it in anti-inflammatory drugs and physiotherapy!).
- Running with spike shoes. If you do a lot of track workouts and use spikes, you have to lift up the front of your foot higher in order to clear the ground. This requires a lot of work from the tibialis anterior, other leg muscles. Overworking this muscle will result in tendonitis. Advice: start with only one of those workouts a week for about a month. Then slowly progress to two, and then may three. But avoid running with spikes more than 3 times a week. Also, do your warm-up and cool down with regular running shoes.
- Working on a hard surface and/or being overweight. The harder the surface, the more your body has to absorb when you are walking. So you have to wear good shoes to work if you work on concrete floors. The ideal is a pair of walking shoes or even running shoes.
- Running on banked surfaces. Streets are slightly banked on the sides so that the water can drain from the center of the road faster. If you always run on the same side of the road, you are putting a lot of stress on your ankle, and therefore pulling some of the muscles in your leg. Running on indoor tracks (banked curves) also has the same effect. Advice: change direction once in a while! Try to run on bike or dirt paths instead of along the road sometimes.
The Treatment
The most important part of the treatment is to eliminate the cause. So you first have to figure out what caused it in the first place (and running itself cannot be blamed!). If you cannot find anything in the above list, see a physiotherapist. Then work on getting rid of the cause (buy new shoes, get orthotics, lose weight, and change your running route….) this alone will take care of most of the problem but you will still need some anti-inflammatory treatment to speed up the healing process. For some people, medications and ice alone will do the trick, but for more acute and stubborn shin splints, you will probably need to see a physiotherapist.
Then go back to your training program but be wise and go progressively. As you get better, you can increase the length and frequency of your runs and enjoy running pain free!
