That Nagging Shin Pain…The Good, The Bad and The Ugly

Whether it’s your New Year’s Resolution or you’ve always been a runner – shin pain is one ailment that can really get in the way of your runners high! One of the most common injuries in runners, shin splints can often stop people from running and can get worse with continuation of running.

As with all activities, runners are susceptible to injuries, one of the most common being shin related aches and pains. We lump these injuries into a category of “overuse injuries” and in the shins specifically, injury can evolve into Stress Reactions and Stress Fractures if not treated properly. Shin Splints is a term used by many to describe any type of pain experienced in the front or inside of the lower leg. You may also see Shin Splints referred to as Medial Tibial Stress Syndrome, or MTSS.  Shin Splints occur as a result of inflammation to the muscles, tendons and periosteum of the tibia, the larger of the two lower leg bones. Symptoms include pain and tenderness along the inside or front of the tibia. Shin Splints can be diagnosed through a physical exam with a Sports Medicine Provider and are initially managed conservatively, without impacting an athlete’s training goals.

Risk Factors for Shin Splints:

  • Repetitive pounding on hard surfaces (too much concrete/asphalt)
  • Improper footwear (bad shoes)
  • High or low arches (blame the factory)
  • Too much mileage, too soon  (don’t push it)
  • Continued running when fatigued (listen to your body)
  • Poor flexibility (utilize Orthopedic ONE Therapy Services’ Dynamic Warm-Up and Static Cool Down Warm-Up and Static Cool Down video)
  • Decreased stability and strength in the core, hips and legs (try Orthopedic ONE Therapy Services’ Core Strength Exercises and Gluteal Muscle Exercises videos )
  • Unhealthy bone such as osteopenia and osteoporosis (talk to your Sports Medicine Provider)

This chart illustrates of how a typical Shin Splint can progress into something more if you don’t listen to your body!

 Stress Reaction: Stress Reactions are overuse injuries, caused by repeated or excessive stress on the bone. Runners experiencing this ailment report aching in the bone or soreness at rest and when running when a stress reaction is present. These injuries are more challenging to diagnose with a physical exam and may require imaging tests, such as an X-ray, MRI or bone scan. An imaging test that is positive for a Stress Reaction will show increased bone metabolism in the area of the injury and may even show “microscopic fractures” along with changes in the bone. These changes are reversible and your Sports Medicine Team can create a rehab program that will allow you to resume running after a short break. If left untreated, a Stress Reaction can be a precursor to a Stress Fracture.

Stress Fracture: A Stress Fracture is the outcome of unmanaged Shin Splints. With each stride you take while running, you are loading your body weight into the ground and the ground is pushing back up through your body with an equal amount of force. With proper mechanics your joints and muscles help absorb this shock, ensuring that too much stress is not put on the shaft of the bone. However, when your muscles are fatigued or if you have poor mechanics, this causes an extreme amount of stress, leading to a weakening of the bone and the potential for a Stress Fracture.

Radiographic Changes:  If you begin experiencing shin pain and seek treatment, oftentimes your Sports Medicine Provider will recommend getting an X-ray so they can fully understand the scope of your condition. When the results of your X-ray show changes to the bone, there is good news and bad news. The good news is that the damage cause by the Stress Fracture is reversible. The bad news is that this will put a halt to your current training plan. There are several different Radiographic Changes that are indicative of a Stress Fracture.

  • Periosteal Bone Formation is the creation of new bone on the fibrous tissue that covers the bone shaft.
  • A horizontal or angular line of Sclerosis, (a hardening of tissue) on the bone is another sign of fracture.
  • Endosteal Callus Formation occurs when a callus forms on the endosteum, the connective tissue that lines the bone marrow cavity inside the bone.
  • Finally, and probably the most obvious of radiographic changes, is a visible fracture line.

 If you are experiencing pain in your shins that is limiting your training, Orthopedic ONE can help! Our team of physicians, therapists and trainers provide orthopedic, injury prevention and rehabilitation services to some of the most elite professional organizations in central Ohio, as well as collegiate, high school and club programs. Our goal is to keep athletes out of our office and back to doing the activities they love.