Shin Splints! This is likely the last thing that a runner wants to think about. It’s a potentially complex problem with relatively simple treatments that no one wants to do. With that cheery introduction let’s jump in. The medical term is Medial Tibial Stress Syndrome and it encompasses everything on the continuum from shin splints, to bone stress reaction (think of it as pre-stress fracture), to stress fracture. A variety of biomechanical forces can be at work here, but essentially it all comes down to too much, too soon. You push your lower leg muscles into doing something they are not ready to do.
First you notice a muscle ache along the shin bone (most often on the inside) that lasts longer or is more intense than regular pains after running. Later, this begins to be something that causes you to shorten or change your route. It is often associated with increasing mileage or advancing hills (especially downhill) too quickly.
Treatment is relative rest from running, but not necessarily rest from exercise. Cross-training is great and you really need to strengthen all the leg muscles, but especially those of the lower leg. These are the muscles that are responsible for ankle motion and some toe movements. I would like to refer you to a specific website that has a good combination of exercises, but I haven’t found one that I like yet (sounds like another project!). Don’t forget stretching, a loose muscle functions better. Ibuprofen in the early stages is helpful. Ice massage (see Initial Injury Treatment) is a great technique that can help with swelling and prevent scar tissue formation. When the pain has improved, a gradual increase of mileage and hills is essential to prevent re-injury. A good rule of thumb is only increasing weekly mileage by 10% each week.
There are a variety of braces and compression sleeves developed to help with shin splints. Taping has also been used. The idea is that compression will support the muscles and prevent some of the strain where they attach to the bone. Individually, some people have improvement with them, but there is no scientific evidence out there that they do anything. Arch supports may provide more support, especially in heel pronators or people with flat feet.
The MOST IMPORTANT thing with shin splints is DON’T IGNORE THEM! As I said before, this is an injury that lies somewhere on a continuum. By pushing through shin splints you can push yourself right into a stress fracture. Stress fractures can be more difficult to heal than regular, traumatic fractures. This can translate into months without running.
Matt Evans, MD