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Shin splints: an explanation

The term ‘Shin Splints’ (also known as “runner’s leg”) is in fact a general umbrella term used to describe quite a few different lower leg injuries. Each of the injuries can be grouped in to one of four different categories depending on where the area of pain is felt. I will mention each individual injury but not cover each one in depth. I will, however, give an example of one of the injuries from each of the 4 shin splint group types so as you have an idea of how each of the 4 types presents. I will however not be covering how to treat these areas as that is a whole different kettle of fish and I would recommend seeing a specialist if you feel you have any of the following to receive a personal treatment plan.

A summary of the four types: 1. muscular (various lower limb muscle strains) – tibialis posterior and anterior syndromes, soleus syndrome 2. periosteal (most outer layer of a bone) – periostitis of tibia 3. fascial (Fascia) – exertional compartment syndrome 4. osseous (bone) – tibial and fibular stress fractures

1. Muscular Tibialis posterior Syndrome

Essentially is as a result of a strain or incomplete tear of Tibialis Posterior:

  1. caused by biomechanical dysfunction (esp. overpronation) of the foot and ankle.

  2. pain usually appears at the beginning of a workout and later disappears, only to reappear afterwards.

  3. palpable tenderness along the medial side of the lower leg.

  4. tenderness is also elicited by resisting plantar flexion and inversion of the foot radiography helps to rule out stress fracture of tibia/ tibial periostitis.

  5. additional treatment – lower leg strap (like elbow strap) for redistribution of muscle tension.

2. periosteal

Tibial periostitis/ Medial tibial stress syndrome (MTSS)

Painful inflammation of the outermost layer of bone called the periosteum specifically along the central border of the shin, usually the distal 1/3 .

  1. Originally thought to be related to stress along the posterior tibialis muscles and tendons causing myositis, fasciitis and periostitis, it is now believed to be related to periostitis of the soleus insertion along the posterior medial tibial border. As a result of excessive pulling of the muscle.  Excessive pronation or prolonged pronation of the foot causes an eccentric contraction of the soleus, resulting in periostitis.

  2. May be as a result of a change in running distances, speed, form, stretching, footwear, or running surfaces.

  3. Tenderness along the anterior side of the tibia and sometimes slight swelling and thickening above the bone can be noticed.

  4. Additional treatment – ice and NSAID, soft running surface, cushioning of the heel.

3. Fascial

Exertional Compartment Syndrome (ECS)

Thick sheaths of Fascia divide the muscles of the leg into four compartments each with their own muscles, blood and nerve supply. The four compartments are the ‘Anterior compartment’, ‘Lateral Compartment’, ‘Posterior Deep compartment’ and the ‘Posterior Superficial Compartment’. The mechanism involved is as a result of fascia that is too tight along with an increase in muscle volume within the compartment as a result of increased activity which can lead to a decrease in compartment space around the muscles. This therefore increases the pressure within the compartment and diminishes the compartment’s veins ability to return blood therefore increasing the pressure further. If really severe the arterial blood supply in this compartment can also be cut off.

  1. ECS is usually exercise induced aching leg pain and a sense of fullness, both over the involved compartment. These symptoms are almost always relieved by rest, usually within 20 minutes, only to recur if exercise is resumed.

  2. Both legs is common

  3. Activity related pain begins at a predictable time after starting exercise or after reaching a certain level of intensity

  4. Many individuals with anterior ECS describe mild foot drop or paraesthesia (or both) which are amplified by physical exertion.

  5. The most common compartment involved is the Anterior 50-60% then the Deep Posterior 20-30% and the remaining 10-20% is between the Lateral and Superficial Posterior compartments.

  6. Home advice involves Ice and reducing the level of strain, though for an active individual fasciotomy provides a quicker and long-term solution (surgery to release the tight fascia and therefore decrease the pressure in the involved compartment.

  7. This particular condition is notoriously difficult to manage conservatively, if there are any practitioners out there with suggestions then I would love to hear their experiences.

  8. Do not confuse with an acute compartment syndrome which is in fact a medical emergency.

4. Bone

Stress fracture of tibia

  1. as a result of repeated sub-maximal loading.

  2. dull pain, swelling and palpable tenderness is confined within 2-3 cm in diameter.

  3. Insidious onset.

  4. Increased pain with activity/ decrease with rest.

  5. Pain usually limited to fracture site.

  6. Pain on percussion and vibration.

If you are still unsure as to which of these problems you are experiencing or you wish to get more advice then feel free to message me for more advice. Otherwise I would recommend an experienced manual therapist such as a sports Chiropractor, Physiotherapist or a sports Osteopath.


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