Are Shin Splints The Cause Of My Shin Pain?
Overuse injuries are a frequent occurrence in athletes in a wide variety of sports and activities. They are also prevalent among military recruits and other work environments that require significant walking and running. Shin splints are one type of chronic overuse injury. This collection of symptoms is particularly common among runners, ballet dancers, and military recruits. In this article, let’s take a look at what this term means, and explore its symptoms and potential causes.
There is some debate over what the common term shin splints actually means. Currently, researchers tend to use that term to refer to a description of symptoms, rather than a specific diagnosis. Even the more technical phrases “medial tibial syndrome” or “medial tibial stress syndrome” may be used to refer to more than one diagnosis. What all these terms have in common is that they refer to the experience of chronic pain at the medial border of the tibia.
Causes of medial shin pain
There are many causes of pain and soreness at the medial border of the tibia. Most generally, medial tibial pain could be a symptom of:
- Compartment syndromes
- Stress fracture
- Shin splints
What are shin splints?
The current consensus is that shin splints differ in etiology from other sources of medial tibial pain like stress fractures, compartment syndrome, and tendinitis. However, researchers studying this injury have not yet honed in on exactly what type of tibial pain constitutes shin splints as opposed to other dysfunctions or what its specific causes are. Two common hypotheses include excess contraction of the soleus and/or the tibialis posterior muscle.
The “shin” refers to the anterior portion of the lower leg. It’s usually used more specifically to refer to the anterior portion of the tibia bone. (That’s the larger of our two lower leg bones.) The tibia goes from your knee to your ankle and forms part of each of those joints. The pain from shin splints typically shows up along the medial border (the side closer to the inside of your leg) of the anterior side (the front) of this bone.
The most superficial muscle on the back of the leg is gastrocnemius and deep to that is soleus. Underneath soleus, you can find the small tibialis posterior. These are the muscles that researchers have been most interested in as a potential cause of shin splints. Excess contraction of muscles on the posterior side (back) of the leg could potentially cause reciprocal tension through the front of the leg. And that, could lead to shin splint-type pain through constant irritation of these tissues, trigger point formation, and other mechanisms.
In order to differentiate between shin splints and other injuries, one study used a particular type of bone imagery. The bone imaging (radionuclide angiogram and blood pool images) showed markers associated with abnormality of the lower extremity that might be associated with shin splints. Specifically, they found abnormalities of the medial origin of soleus and its fascia, but not the tibialis posterior (Michael and Holder, 1985). They extrapolated the biomechanical significance from their direct findings and hypothesized that excess contraction of soleus and pronation of the foot at the ankle could cause the effects they saw (Michael and Holder, 1985).
Other more recent research supported the contributions of excess contraction of soleus to shin splints. However, they also suggested contraction of tibialis posterior as a potential contributor (Wilder et al., 2004; Thacker et al., 2002). It’s also possible that there is more than one cause of this particular collection of symptoms. Shin splints are generally diagnosed during an in-person exam by a doctor and with supporting information from an X-ray and/or an MRI.
Symptoms of shin splints include medial tibial pain and tenderness. The pain is usually found along the middle to distal (lower) third of the tibia. And, the tenderness is especially common after exercise. There is sometimes some slight edema in the area. Additionally, the muscles in the region where people experience pain may also feel tense.
Causes of overuse injuries, including shin splints
There are a number of factors that contribute to overuse injuries generally and shin splints in particular. They include intrinsic issues within the body as well as extrinsic issues, such as approaches to training for a sport. Those causes include combinations of the following:
- Muscle imbalance, inflexibility, and/or weakness in the leg, particularly overly tight and/or weak soleus and gastrocnemius
- Hyper-pronated feet
- Body mass index over 30
- Muscular imbalances in the thoracolumbar area
- Poor technique and/or improper equipment in a relevant sport or activity
- Poor footwear
- Overtraining or an increase in training too quickly
Treatments for shin splints depend, of course, on each individual case. If you are experiencing medial shin pain, please see an appropriate medical professional for a diagnosis. Depending on the situation and the extent of the injury, treatments might consist of:
- Physical therapy
- Flexibility exercises/stretching
- Surgery is usually a last resort and is variable in its effectiveness.