Shin Pain (MTSS)

Shin splints are estimated to affect up to 35% of runners at some point in their lives, though you don’t need to be a runner to develop this pain. While shin splints are best known as the pain that comes on at the front and insides of the shins during physical activity, if we’re going to get technical, shin splints is actually a non-specific term that can refer to three separate conditions:

1. Medial tibial stress syndrome
2. Exertional compartment syndrome
3. Stress fracture of the shin bone
   

Medial Tibial Stress Syndrome (MTSS)

The most common shin pain of the three above is MTSS, and occurs when there is too much stress to the front and inside of the shin bones. This stress is typically caused by overusing the muscles that attach to the shin bone, or the lining of the bone itself. 

The result is shin pain and swelling, that may stay mild or become severe. Generally, shin splints pain tends to be worse at the beginning and end of exercise. As the injury progresses without adequate treatment, however, you may find you also experience pain during activity and at rest, which may limit your ability to partake in the sports and physical activities you enjoy.

Exertional Compartment Syndrome

There are four compartments in your lower leg, distinctly separated by your tissues. Each compartment only has so much space to contain specific muscles, arteries, nerves and other tissues. Damage or overuse to muscles within the front (anterior) compartment means that these muscles swell, increasing pressure within that compartment and resulting in pain or discomfort, a feeling of tightness, and a swollen appearance. 

As the muscles within the anterior compartment are heavily used during running, these symptoms often start during or after a run. As the muscles have a chance to rest as you recover from your run, the swelling subsides, and with it your painful symptoms. Unfortunately, they may quickly recur during your next run.

Note: this type of compartment syndrome is also known as chronic (or exertional) compartment syndrome and requires treatment with your podiatrist, but is not limb-threatening. Acute compartment syndrome, on the other hand, is considered a medical emergency and you must contact your doctor immediately. Signs for acute compartment syndrome include severe pain, pale skin tone at the leg, numbness, a faint pulse and weakness when trying to move the affected leg. 

Shinbone Stress Fracture

Stress fractures are caused by repetitive stress and pressure on the bone, which can be contributed to by running sports, as well as problems with foot posture, foot function, your training schedule and intensity, footwear and more. Starting as small cracks with few symptoms and little pain, stress fractures can quickly progress to severe, painful fractures that prevent you from being active. 

Symptoms of a stress fracture include pain and tenderness along the shin bone that is localised to a particular area. You may or may not see some swelling, and the pain can worsen with physical activity and ease with rest. It’s important to stop and treat stress fractures before they have a chance to worsen. The earlier the detection and treatment, the easier and faster they are to repair.

The most common cause of shin splints is overuse from exercise and daily activities. When repetitive high loads are placed on the shin bone and surrounding soft tissue structures, they sit in a constant state of stress and fatigue. This results in a diminished ability to absorb the excessive shock forces they are being placed under. As the shin bone and its surrounding tissues are not designed to manage this level of stress, damage occurs.

Anyone who is physically active will be at risk of developing shin splints. The condition is commonly associated with weight bearing activity or running-based sports. It especially tends to affect those participating in sports that require you to stop, start and change direction quickly such as soccer, basketball, dancing, tennis, netball and any sprinting sports. Other factors that may also contribute to shin splints include:

• Beginning intense training without gradually increasing your load
• Not warming up correctly before exercise
• Running or jumping on hard or uneven surfaces
• Wearing inadequate or worn out footwear for activity or exercise
• Poor levels of strength, mobility and flexibility in the lower limbs
• Rigid feet with poor mobility and flexibility that are inadequate to absorb shock
• Muscle imbalances and dysfunction
• Flat feet or high arches
• Overpronation of the ankle and feet (when your foot rolls inward excessively)
• Leg length difference
• Bowed or knocked knees
• Irregular walking and running patterns

When you’re experiencing shin splints, stopping the activity that has brought on your symptoms and allowing your legs to rest can help your symptoms subside, so you can get some temporary relief. You can also try:

• Icing your shins (through a towel or cloth to protect the skin) for no more than 15 minutes at a time, four times per day
• Using non-steroidal anti-inflammatories to help you manage any pain and swelling
• Switching to supportive footwear, like running shoes with built-in arch support, or your orthotics if you already have a pair from your podiatrist
• If you need to stay active, you could try switching to low-impact activities like swimming or cycling. This won’t treat your shin splints, but it may help you exercise without pain until you are able to sort the problem

Here at Matt Raden Podiatry, our trusted and experienced podiatrists listen to the concerns, goals and needs of our patients with shin splints, and utilise a range of evidence-based treatment methods to help you get the best outcome. Our goal is not only to make you comfortable now, but get down to the root of the problem so you can exercise and stay active without worrying if your shin splints pain will reappear.

Every appointment starts with a comprehensive assessment to uncover the causes of shin pain, which includes looking at your foot posture, analysing your gait, testing for muscle imbalances, assessing joint stiffness or tightness, and more. We’ll then create a tailored treatment plan based on the results. This may include:

• Orthotics (insoles): using the results of your assessment, our podiatrists can prescribe custom foot orthotics that will work to add the right support to help reduce the stress and load on your shin bones. For some, this may look like adequate support through the arch to better stabilise the position of the foot and ankle. For others, this may mean additional layers of cushioning beneath specific areas of your feet to reduce the way shock and forces are transmitted when you’re physically active.
• Footwear recommendations: your footwear plays a vital role in preventing shin pain and injury, supporting your everyday foot health, housing your orthotics, and keeping your legs and feet comfortable. This is why we make custom footwear recommendations and take the time to assess your footwear and answer all of your footwear-related questions. We can also provide advice on sports-specific shoe options to support your sports performance, too.
• Strengthening and stretching exercises: to help with any muscle imbalances, restrictions or weakness that may be contributing to your shin splints pain

Gait retraining: we may work with you to help retrain your gait to address biomechanical issues that may be contributing to your pain and injury. This includes looking at temporary activity modification techniques.