Track Coach

Shin Splints

It’s a condition which can cripple an athlete. Here’s some advice on reducing the problem.
This article first appeared in Athletics Weekly, November 2, 2017.

There’s barely an athlete out there who hasn’t suffered from shin pain at some point in their career. Paul Hobrough, a physiotherapist and author of Running Free of Injuries (Bloomsbury, £18.99), says he sees “a tsunami of shin pain sufferers each year” and Matt Todman, director of the Six Physio chain of physiotherapy clinics in London, says it is among the most common problems he treats among patients.

In most cases, pain at the front of the leg will be diagnosed as ‘shin splints’, an umbrella term for multiple different possible diagnoses ranging from muscle DOMS (delayed onset muscle soreness) to tendinitis and periostitis.

What are shin splints?

Known medically as medial tibial stress syndrome (or MTSS), the condition causes pain on the lower, inside part of the shin bone and while it initially might feel painful during exercise, it can progress to feeling sore even during periods of rest.

‘‘My belief is that we have become overly diagnostic in labeling some injuries and problems,” says Todman. “Shin splints are a case in point and you may have been given very complex-sounding names for pain in the front of your leg. Basically, it’s all shin splints.”

What causes it?

There are multiple causes and no case of shin splints is the same. “Risk factors have been shown to be increased BMI (body mass index), poor alignment of the bones in the foot, a loss of plantarflexion (ability to point the toes) and a loss of hip rotation externally,” says Hobrough.

One or more of these biomechanical factors­—or overtraining—contrive to overload the muscles of the lower leg. “Muscles need a chance to develop in size, strength and flexibility and most people who lift weights know not to do bicep curls every day,” Hobrough says. “Running is basically the same as working the equivalent muscle in the lower leg this way.”

How do you know if you have shin splints?

A painful spot on the inner edge of your shin is often a giveaway sign you have developed shin splints.

“The periosteum, the surface of the bone, becomes inflamed and tender as it’s constantly trying to repair the stress that repetitive activity places on it,” says Dr Juliet McGrattan, a GP and author of Sorted: The Active Women’s Guide to Health (Bloomsbury, £16.99).

If you feel pain over a few inches of your lower leg then it is likely shin splints.

McGrattan adds: “If the pain is in a very precise location, then you may need an X-ray to rule out a bone problem like a stress fracture.”

How to treat it

McGrattan says the PRICE technique—Protect, Rest, Ice, Compress and Elevate—should be used in the acute stages.

“Mild MTSS will improve quickly with rest, she says. As with any injury or pain, if you begin to develop shin pain, listen to your body and reduce or stop the aggravating activity,” suggests Hannah Zreik, the physiotherapy team lead at Bupa Health Clinics. “If the pain doesn’t go away after rest, see a physiotherapist.”

How to prevent it

Check your shoes—they can often be an underlying cause. “Other possible reasons are poor flexibility or poor core and lower body strength,” Zreik says.
Todman suggests practicing walking on your heels twice a day for three minutes at a time. “Do it barefoot around the house,” he says. “It really helps to strengthen the muscles in the shin area.”