Shin Splints

Shin Splints

Medial tibial stress syndrome (shin splints) is a condition commonly experienced by runners, triggered by muscular irritation. 

Typical sensations are (cramp-like) pains along the inside of the tibia when just starting to run, usually towards the center of the shin. 

The pain should not be ignored, as continuing to train without treatment can lead to stress fractures. 

Underlying causes can be excessive training, incorrect running technique, and wearing the wrong running shoes. 

Depending on the causes and extent of the symptoms, therapy can include taking a break from or adjusting the training plan, changing running shoes, cryotherapy, physiotherapy, and ongoing stretching of the calf muscles. 

Shin splint syndrome is often called shin splints and is a common result of overexertion by runners (but also by aerobic trainers and dancers). These symptoms have also been termed "Medial Tibial Stress Syndrome" (MTSS) in specialist literature. Up to 20% of all breaks in training by runners can be attributed to shin splints.

Cramp-like pain on the medial side of the tibia when starting to train is typical, often halfway up the tibia. The pain may also run from the ankle to the Knee . During the initial stages of symptoms, most runners report pain occurring at the beginning but then disappearing during the course of the run. The pain then reoccurs on the next run. The longer the shin splints persist, the longer the phases of pain endure.
Runners who overpronate are particularly at risk.

CAUSES

Shin splints are caused by irritation of the musculature attachment (predominantly the posterior tibial muscle and the soleus muscle) due to overstraining. The posterior tibial muscle is very important for tensioning the arch of the foot. It is therefore important to rest the foot upon experiencing pain, otherwise the muscle can fail, with a flat foot can begin to develop. An additional risk of ignoring pain is the possibility of a fatigue fracture - the symptoms must therefore be examined by an experienced sports physician and a break in training must made.

The pain itself occurs because the attachment of the musculature to the skin on the leg is overstimulated (tendinitis of the tendon attachment). As a result of the inflammatory stimulus, muscle cells often also harden and myofascial trigger points form, which are painful at the location and can also cause radiating pain (e.g. into the Achilles tendon, the heel, and the knee joint).

Shin splints more rarely occur due to excessive supination in the forefoot (when a runner pushes off with the little toes). In these cases, the long toe flexor muscles are overstrained and the tibial periosteum becomes irritated.

Inexperienced long-distance runners who have just started endurance training often have deficits in their running technique as well as unsuitable shoes, and an inadequate recovery schedule, and are thus particularly frequently affected.

TIP: By choosing the right running shoes for your foot using treadmill analysis, such overexertion problems can often be avoided.

TIP: A break in training can be used to reconsider your training plan, book a running technique seminar, or have your running style and running shoes checked.

TREATMENT

Treatment depends on the severity of the symptoms:

• When pain is moderate, running should be reduced and mountain running should be avoided entirely.
• When pain is severe, running must be stopped and training done on an elliptical, cycling, or swimming.
• Cryotherapy (Ice Packs) and cold compresses can help a great deal in the initial stages of shin splints.
• Physical therapy treatment often has better success than medication, however, treatment must be carried out by an experienced physiotherapist skilled in treating trigger points. Manual therapy of the irritated skin on the leg must be avoided.

TIP: If the symptoms occur shortly before a competition, your doctor can apply a tape dressing that prevents excessive pronation. In the event of long-term pain, a tape dressing is generally applied to relieve the musculature.

For severe pain in the area of attachment, anti-inflammatory medication can be prescribed by your doctor (Diclofenac, Ibuprofen).

Exercises to stretch the calf muscles must be done consistently before and after running to help prevent problems. If symptoms have already begun, you should stretch several times daily.

Once symptoms have subsided, calf strengthening exercises can help prevent another injury. Coordination exercises on the MFT balance board are also beneficial – or make your own tilt board! Dr. Gäbler advises approaching barefoot running with caution; while it can work well for some, the lack of arch support does pose a risk. Similarly, running on the beach in sand can be dangerous at first, resulting in overstrained muscles.

After the acute symptoms have subsided, heat treatment prior to running can be useful.

If the pain persists, a stress fracture (fatigue fracture) of the tibia and chronic compartment syndrome must both be ruled out.

TIP: Prevention is better than cure, as with any sport. Consistent exercises to stretch the calf muscles even for long-distance runners are strongly advised.