With just two months to go to the London marathon, and plenty of other marathons approaching, the running blog is kicking off a series that will cover some of the most common running injuries. First up: shin splints.
So what are shin splints?
Shin splints is actually a bit of a misnomer and should really be referred to as “exercise-induced leg pain”, as I will explain. The most common type of exercise-induced leg pain is medial tibial (shin bone) stress syndrome (MTSS) which doesn’t exactly role off the tongue, but is a more accurate term. The other two main types are a stress fracture or compartment syndrome.
MTSS occurs when the muscle that inserts just behind the shin starts to pull away from the bone. There is a sheath around the bone called the periosteum, and this can get inflamed as a result of the pulling away, and cause pain. If this inflammation of the periosteum persists, because someone continues to run without attempting to treat it, then it may go on to cause a stress fracture. A stress fracture is not like a traumatic fracture that occurs suddenly. It is a continuum. So it may start with a worsening of the inflammation around the periosteum, and then slowly go into the bone itself.
The good thing about this is if it is caught early enough, it is possible to prevent a full-blown stress fracture. And this is definitely something you want, because a stress fracture can mean being put in a boot and no running for around 12 weeks.
Compartment syndrome literally means that the different muscles that make up the calf – which are split into compartments – get too big for the muscle sheath they are in and can cause quite severe pressure pain.
What causes it?
All three types of exercise-induced leg pain come under the category of “overuse injuries” (which are the most common types of running injury) as opposed to trauma. Biomechanics (how our movement is controlled in relation to our joints and muscles), training or the environment (running surface and footwear), or a combination of all these, can make someone vulnerable to developing an overuse injury.
MTSS results from a repetitive overload and the pelvis, and all the joints from the hip down to the foot may potentially contribute to the onset of symptoms.
One of the most common causes of MTSS is excessive or poorly controlled pronation (flattening of the foot). Pronation is a normal movement that occurs in the foot to help with shock absorption. Efficiency during running relies on achieving the right amount of pronation and supination. Things like fatigue, tight calves and gluteal (bottom muscle) activation can have an effect on the control of the foot as it hits the floor. Footwear and the surface that you are running on are also important factors.
Most patients that come in with MTSS describe an increase in their training volume/intensity or new footwear leading up to their symptoms. As a stress fracture can occur with untreated MTSS, many of the causes are the same.
Compartment syndrome is often related to a sudden change in training or load and can also occur with tight calves. The pain from compartment syndrome is not something you can run through and patients will describe their calves as feeling hard, and a sense of pressure building up in them.
How do I treat it?
There are effectively three different types of exercise-induced leg pain, and each has quite different treatment.
MTSS, which is probably the most common, would involve:
• Correct training errors – this may relate to volume/intensity or lack of recovery
• Checking footwear is appropriate
• Correcting biomechanical problems – the pelvis and all of the joints in the leg have the potential to contribute to MTSS and each patient will present slightly differently and will need to be thoroughly examined.
Some patients may need to be referred to a podiatrist. Correcting timing and control issues with certain muscles groups, and restoring appropriate flexibility to the joints and muscles of the lower limb may also be part of the treatment.
Clearly because exercise-induced leg pain is a type of overuse injury, there is usually some need to temporarily alter training. With the right treatment, your time away from running will be kept to a minimum and you will be advised to cross-train to maintain as much of your fitness as possible. We want to get you back running as soon as possible!
Being injured is always tough, but with the correct treatment you will learn more about yourself and what type of training is best for you. Shin splints isn’t a good term because it is too simplistic, and does not convey the serious problems that lurk behind it.
• Rebecca Christenson is a physiotherapist at Pure Sports Medicine. To get in touch, please visit www.puresportsmed.com or follow her on @rebchristenson
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