‘Shin splints’ is another one of those common medical terms that describes multiple medical conditions. Let’s make some sense of it all.
Shin splints.
Shin splints is that term that describes pain in the lower leg between the knee and the ankle. They usually occur as a result of increased intensity in running and jumping type activities. The most common and most fixable symptom is dull aching along the inner, lower two-thirds of the lower leg. They are the most common lower leg injury and affect a wide range of people: runners, dancers, teenagers and factory workers.
Confusion…
There is plenty of confusion about what shin splints are, what causes them, and how to treat them most effectively. A good part of that confusion is based on the fact that there are actually three conditions that are commonly called ‘shin splints’. They are:
- Stress fractures
- Compartment syndrome
- Periosteal irritation
Let me explain.
Now true shin splints are a periosteal irritation. Also called medial tibial stress syndrome. This means there is stress or irritation on the medial (inner) tibia (larger of the two lower leg bones) due to stress on that bone. The ‘stress’ is typically caused by of one of your calf muscles as it pulls on its insertion along the lower two thirds of the inner tibia.
This form of shin splints responds famously to the right type of treatment.
Let me explain the other types first:
Compartment syndrome.
This condition is often diagnosed as shin splints, but it isn’t. An anterior compartment syndrome causes pain along the full length of the outer shin bone. It is caused by the muscles in that ‘compartment’ at the front of the leg swelling with exercise and creating pressure. In this circumstance the harder you go with your exercise the worse it gets. To the point that you have to stop exercising.
A key difference between compartment syndrome and true shin splints is the location of the pain. A compartment syndrome will cause pain on the ‘outer edge’ of the tibia.
So feel your shin for a minute.
Feel the sharp line of bone running from knee to ankle. You know, the bit that got hit with the hockey stick in school and had you crying on the ground. Well that bone is your tibia. A compartment syndrome will give you pain along the line of this bone, but along the outer edge. So if you are feeling the right shin with your right hand, slide your fingers one centimetre to the right and you are on muscle. This is where your compartment syndrome pain will be.
Now slide your fingers left, over the bony edge to the inside of the lower leg. Now slide down to the lower half of the lower leg. Here is where true shin splint pain will occur.
Stress fracture.
This condition is often diagnosed as shin splints, but it isn’t. A stress fracture in the tibia is literally a fracture or weakness in the bone. This presents as a much more localised pain in one sharp little spot. As opposed to true shin splint pain that runs along the bone. Stress fractures will give more pain the more you exercise, require scans to confirm, and will only recover with rest. Often complete immobilisation of the limb is required for weeks or months for stress fractures to heal.
The good news.
The good news is – as I said near the start – the most common form of shin splints is the most fixable.
Periosteal irritation causes the pain. The periosteum is the ‘skin of the bone’. That is, it is the thin tough layer of ‘glad wrap’ on the outside of the bone that muscles attach to. Now the deeper of your two large calf muscles is called soleus. Soleus attaches to the lower two thirds of the inside of your tibia. And the ‘periosteum’ of the tibia, where the soleus attaches can get angry. It can get inflamed and irritated. So … periosteal irritation.
Can it be fixed?
Absolutely.
In most cases the soleus muscle has become somewhat dysfunctional or tight. So although your pain is along the bone, the cause is in the calf muscle behind your leg. This may have occurred as a result of overuse, like that new jumping program that was going to enable you to dunk the ball. Or it may be a result of poor foot biomechanics (which is an article for another day). Either way, the right treatment on the soleus will typically get good results.
What to do?
- For a while, reduce your weight bearing exercise. (This means reduce running, jumping, long walks.)
- Ice the location of the pain immediately after exercise, but not at other times. If the pain is present frequently then ice the pain. Do not ice the calf at the back, just the bony painful area for 10 minutes at a time.
- Heat and stretch. Okay after rest, when the pain is reduced – use heat. But not in the same place. Not on the bone! Use heat on the calf at the back. More specifically on the middle of the calf at the back for 10 minutes followed by stretch for 10 seconds, 10 times twice per day.
Which stretch?
Now a soleus stretch is a calf stretch with the knee bent. If you scroll back up to the picture of the girl in the feature image you will notice she is stretching. As she pushes the heel of her back leg into the ground with a straight knee she is stretching gastrocnemius, the most visible calf muscle. And she will feel the stretch behind the knee. This is a well-known calf stretch.
The more poorly known calf stretch is the soleus stretch. Look again at the girl in the picture. Her front leg is doing a stretch as well. It is basically the same stretch however her knee is bent. This stretch will be felt in the mid-lower portion of her calf. This is the soleus stretch. This is the stretch you need to be doing.
Where to from here?
I would recommend easing of your intense training and doing the heat and soleus stretch 10 times for 10 seconds, twice a day for 10 days. Then resume your training, starting with less duration and intensity and increasing gradually over four weeks. Continue with the Soleus stretching as part of your warm down. If you find the symptoms reoccur then give your Myotherapist a call. Usually a treatment or two on Soleus will resolve your complaint.
In other cases your footwear will need to be addressed. Don’t rush out and change your footwear until you have consulted a Myotherapist because a treatment or two is usually successful and cheaper than new footwear or even orthotic inserts. Footwear is the next step (excuse the pun) in a process of elimination to solve your complaint.
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Have a splendid week.
– Tim
