As a Sports Podiatrist and runner, shin pain is one of the most common conditions I see, especially in beginner triathletes and runners. There are many causes of shin pain and it is important to distinguish the cause of the pain before commencing an appropriate treatment program. Unfortunately, there is a common misconception out there that the cause of all shin pain is due to a condition called 'shin splints'. 'Shin splints' is actually what we call an 'umbrella' terminology for a very specific injury which is the underlying cause of pain. So, in short, the term 'shin splints' should never be used as it doesn't actually describe what is wrong with your shins!
Shin pain can be caused by any, but not limited, to any of the following conditions:
- Medial Tibial Stress Syndrome (MTSS)
- Tibial Stress Fracture
- Tibialias Posterior Tendinopathy
- Nerve Impingement
- Compartment Syndrome
Some common causes of the above conditions can include:
- Poor footwear (sorry girls...but you know my thoughts on choosing shoes based on pretty colours over actual important functional benefits)
- Weak calf muscles
- Tight calf muscles
- Training surfaces
- Hormonal imbalances as a result of an abnormal menstrual cycle causing a decrease in bone density
- Frequency of training-most shin injuries are a classic case of 'too much too soon'
- Inadequate nutrition or recovery from training
- Poor foot biomechanics
- Poor running technique, especially under fatigue
So how do I go about finding out what the cause of my shin pain actually is and more importantly, how do I go about fixing it?
It is important to have a thorough examination to establish what structure is responsible for the shin pain, what has caused it to occur and the best way to manage it.
MTSS – What is it?
One of the more common causes of shin pain is Medial Tibial Stress Syndrome (MTSS). This is by far the most common cause of shin pain that I see amongst female runners. MTSS is classified as inflammation of the connective tissue (the periosteum) that surrounds the outside surface of the tibia and the outside of the muscles running along the tibial bone. Pain caused by MTSS is specifically located in the middle to lower thirds of the inside of the tibia. If left untreated and training doesn't decrease, this condition can develop into a stress fracture of the tibia very quickly.
- Pain in the front or inside part of the middle to lower section of the shin
- Sore to touch or palpate in these areas
- Pain at the start of running, which can ease off after a few minutes
- Pain towards the end of a run or longer session
- Possibly some minor swelling in the region where the pain is present
- Pain can either be a deep, dull ache or a sharp, stabbing pain
MTSS can be caused by multiple factors, so it is important to have a thorough assessment by a Sports Podiatrist to establish the real cause of your pain. The most common factors for developing MTSS are having weak and tight calf muscles. When the calf muscles fatigue, the muscles lying on the inside aspect of the shin bone (the tibia) try to 'take over the load' that the calf muscles can't handle any more. These muscles aren't designed to deal with this kind of load or force, so they can become overworked and inflamed very quickly (remember the definition of MTSS-see above!). The other factors mentioned earlier can also play a key role in the development of MTSS.
Treatment for MTSS needs to be individually tailored to each person, depending on the underlying factors, but some general pointers include:
Reduction in running load
Improve the strength and flexibility of the calf muscles
Correcting abnormal biomechanics through rehab exercises, proper footwear choices, taping and orthotics
Icing after activity if sore
Returning to running properly after injury lay off- there is a huge re-occurrence rate for this type of injury!
Ryan Twist is a Sports Podiatrist practising out of Bayswater Foot and Ankle Clinic in Melbourne's outer east. He founded the clinic 5 years ago after returning home from working at Sports Podiatry Clinic in Canberra, where he gained valuable experience working with athletes at the Australian Institute of Sport. He has a passion for triathlons having competed in 7 Ironman’s and 10 Half Ironman’s - and qualifying for the World Ironman Championships in Hawaii. Some may say he is crazy, but let's not tell him that!
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