I made the decision to start my blog with a condition that has been fundamental in my progression from perma-injured semi-professional footballer, to running DC Injury Clinic. Anyone who has had the misfortune of being a team mate of mine over the years – generally involving chasing my ‘hollywood’ 40 yard passes out of play – will know of my on-going battle against, and whinging about, shin pain, so I can now look at what is generally called “Shin Splints” from both sides of the treatment table. I say generally called as Shin Splints is very much an umbrella term for lower leg pain, and so the location of the pain, the cause of the pain and therefore the treatment of the condition can all vary massively.In this blog, I am going to take a brief look at 4 types;
Periostitis: Bones are encased in a blood and nutrient rich membrane called a Periosteum, and ‘..itis’ is inflammation, so basically the clingfilm like wrap around the bone is becoming inflamed and thus putting pressure on the bone. This is mainly considered an over use injury, and generally the pain occurs at the inside lower half of the shin. In many cases it is very painful at the start of exercise, but pain eases as exercise continues, only to return afterwards. Lumps or bumps may be felt when feeling along the inside of the shin bone. This is the type I was ‘diagnosed’ with, becoming so problematic that I had an operation on both legs to drain the excess blood within the membrane, which proved unsuccessful. I then went through numerous steroid injections (cortisone) afterwards – again, unsuccessfully. Anti inflammatories can help short-term, but in my experience, the best form of treatment for this is a full biomechanical assessment coupled with some deep manipulation of the surrounding soft tissues.
Stress Fractures: In my opinion, this is the closest thing to true Shin Splints (although I think most authorities would choose Periostitis) as this is where hair-line cracks appear in the bigger of the two lower leg bones – the tibia – most commonly in the lower third. Again, the main causes of this is over use. It can also be caused by a sudden change of surface, for example, changing from grass running to road running. Symptoms to be aware of include, naturally, pain (can center around the lower third of the shin bone) when exercising, and particularly, pain on touch. Rest is the most common – and dreaded – recommendation for Stress Fractures.
Compartment Syndrome: This is essentially where the separate compartments of the lower leg (below the knee) grow to such an extent that layers of soft tissue that encase it (fascia, skin) cannot grow at the same rate and so the nerve endings, blood vessels and even bone that is underneath starts being crushed. This can result in depleted blood flow and oxygen to fuel the muscle, and this could eventually lead to the muscle dying. Compartment syndrome can start fairly suddenly, and key signs include pain even when at rest, a tightness of the area, numbness, paleness and the area may feel cold and hard to touch.
Muscle Problems: Arguably the most common and most mis-diagnosed. I think we all have a tendency to ‘fear the worst’, certainly if we are deep in a training regime for a marathon; the up coming season; an imminent event. But often these pains are merely the soft tissues (Muscle, Tendon, Ligament) being damaged, sometimes at a microscopic level. Everyone who spends any amount of time on their feet will at some stage feel aches and pains between the knee and the ankle. Consider a typical runner will be putting those joints under 2-4 times their own body weight (depending on your source) PER STEP, and you can imagine the stress that our soft tissue are put under. It’s incredible that we can walk at all after a run, and its easy to see why elite sportsmen and women are turning to therapists to aid in their recovery and keep the body working at its maximum.
Self Treatment: Shin pain is a common complaint amongst runners and footballers, and you will often hear people complain of having shin splints. But as you can see, there is no one answer to the treatment as everyone’s “shin splints” could be very different. One common factor in the cause, however, is the high impact training; for example running on roads or hard grass (the glorious pre season training regime!). A simple solution would be to say ‘stop the high impact training’, but as I was never happy with that advice myself, I loathe to give it to you. The P.O.L.I.C.E procedure will undoubtedly help, whilst undertaking some low impact cross training (swimming, for example), until the pain has subsided enough to restart your primary training. There is usually a Tibialis Posterior involvement, and this should be checked/ruled out. Shin compression sleeves are becoming more visible on runners/triathletes in particular, although evidence is mixed at best.
Below are some strengthening and stretching exercises that are lower leg specific, and aim to improve range of movement and muscle elasticity.
Exercise 2 – Rotating the ankle against resistance. This is great with a theraband (as shown), but can also be carried out using a towel hooked around the foot.
N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldnt be seen as such. They are merely guides to a better understanding of how our bodies work.
For more information please contact Dan@DC-InjuryClinic.co.uk