This article written by Steph Davies at Sports Physio Hwb Lampeter aims to explain what predisposes you to getting shin pain when running, and her top 5 tips for getting it to go away.
Medial Tibial Stress Syndrome (MTSS) aka Shin Splints
The most common type of shin pain in runners is Medial Tibial Stress Syndrome (MTSS), which used to be known more commonly as 'shin splints'. This is typically pain that is felt on the inner surface of the shin bone, and usually along the lower third. With MTSS, pain is often there at the start of a run, seems to ease a bit as you 'warm up' but then aches again later in the day, usually after the run has finished. The pain is often felt in a line running a few inches down the shin bone as opposed to one single point, and is tender to poke at. Try to resist the temptation to poke at it!
There are other, and less common, causes of shin pain e.g. tibial stress fracture, nerve pain from the lumbar spine, compartment syndrome, bony cysts... so if you are not sure, please get it checked out by a sports physiotherapist or a qualified health professional experienced in treating sports injuries.
Assuming it does fit the picture for MTSS (aka shin splints), what causes it?
Like a lot of these 'overuse' type injuries that start in the absence of any trauma, they are a result of overload on the bone and soft tissue from a sudden change in volume, type, or intensity of activity. In the case of MTSS it can also be from a change in running footwear, or by certain biomechanics such as over-pronation at the feet, weak or tight calves, or poor muscle control at the hip and pelvis. All of these elements ought to be assessed and addressed in order to deal with grumbly shin pain. If left untreated and with continued aggravation, the shin pain can gradually worsen in intensity and severity, eventually leading to a tibial stress fracture.
What can be done about it?
1. OFFLOAD IT
The first stage is to stop irritating it so it has a chance to get better. Most cases of shin pain will settle down, given the chance. So if running makes it hurt (even if it 'warms up' during the run and only hurts after), you need to take a rest from running temporarily. The quicker you deal with it, the less time off running is required. It's an investment in time, because if you continue to train on it until it becomes a stress fracture - well that requires several months rather than weeks off running, so deal with it early and it is less of a problem.
If the thought of not running drives you crazy, contact our military instructor Paul on our Injured Fitness page and he will put you through your paces with a fitness programme that will look after your injury but keep you fit.
2. CONSIDER FOOTWEAR
As mentioned earlier, a change in footwear, or indeed worn out footwear, can be a part of the problem. If its time to replace your running shoes, replace them and sometimes this is all it needs. If you've recently spent a lot of money on a new pair of trainers, but this coincided with roughly when the shin pain started... you might need to test out running in either your old pair, or a different pair, once the pain has subsided to see it the new shoes were the culprit.
If you have particularly flat feet or high arched feet, and this is a recurring issue despite addressing the other points mentioned in this article, then you might benefit from seeing a good musculoskeletal podiatrist to try you out with either some off-the-shelf or customised orthotics (insoles) for your shoes. research has shown that poor arch height (known as navicular drop) can be a risk factor for developing MTSS.
3. ADDRESS BIOMECHANICS - STRENGTH
When your muscles are having to work hard due to a lack of strength, conditioning or endurance, it is easier for them to get tight. Sometimes a lack of calf muscle strength can result in tightness that pulls on the muscle attachment at the shin, causing the shin bone surface to become irritated. However, it might not be solely the calf muscles that are the problem - it might be that the calf muscles are overworking to compensate for a lack of strength or endurance further up the kinetic chain, like at the hip or pelvis, for example. Or the hamstrings, or the core / abdominal muscles. Having your biomechanics assessed by us can help identify where the weak link lies and we can give you an exercise programme to address this both for while you are offloading it, and then as a maintenance plan going forwards when you do return to training.
One of my previous jobs was working at the Royal Military Academy in Sandhurst, where new Army Officer recruits would be put through their paces and whipped into shape over the course of a tough year of training. When I first started there, MTSS and tibial stress fractures were pretty common. However, by the time I left, the Army had changed their physical training programme considerably to include more functional strength and conditioning, interval training and weights in the gym, and less over all running mileage. The rates of MTSS and tibial stress fracture plummeted. So train hard, but also train smart. Don't stack up the weekly mileage for the sake of it, and only do a volume that you genuinely have the strength and conditioning for.
4. ADDRESS BIOMECHANICS - MOBILITY
As eluded to in the previous point, muscle tightness can cause extra pulling on bony surfaces, particularly tightness in the soleus muscle (one of the deeper calf muscles). However, massaging and stretching aren't always the solution in the early stages of MTSS and may even make the irritation worse, so it's important to introduce stretching and massage at the right point during the injury's recovery.
Calf tightness and ankle stiffness are also sometimes an underlying reason for foot over-pronation as your foot tries to compensate for a lack of range of movement at the ankle.
5. GRADUATED RETURN TO LOAD
Finally, when you addressed all of the above, your symptoms have settled, and you are ready to return to running; resist the temptation to go hell for leather and make up for all that lost running time as that massively increases the risk of recurrence and the return of the shin pain that you spent all that time resting. A training / running build up should be planned, progressive, structured and incremental to allow all your joints and muscles the chance to recondition without being overloaded again. Be patient, be consistent, and you will get there in the end.
Hope that helps! Please get in touch if you have any questions, or would like some guidance or an individualised treatment and rehab / training programme, and we would be more than happy to help.
Steph Davies
Specialist MSK Physiotherapist
REFERENCES
Hamstra-Wright KL, Bliven KCH, Bay C
Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis
British Journal of Sports Medicine 2015;49:362-369
Burne SG, Khan KM, Boudville PB, et al
Risk factors associated with exertional medial tibial pain: a 12 month prospective clinical study
British Journal of Sports Medicine 2004;38:441-445.
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