Shin Splints

What are they?
Shin splints refer to pain anywhere in the vicinity of the shin area (front of calves). The main two types of shin splints are medial shin splints and anterior shin splints.
Medial shin splints refer to pain in the medial aspect of the leg, adjacent to the medial tibia. Tenderness is usually found between 3 and 12 centimeters above the tip of the medial mealleolus at the posteriomedial aspect of the tibia. In laymen’s terms, you have a lot of pain in the lower 2/3rds of the inside of your shin.
Anterior shin splints refers to pain in the anterior tibial region, or laymen’s terms, pain on the outside of your shin area. The involved section of the upper tibia is usually 5 to 8 centimeters long and about 1 to 2 centimeters wide.
 
What causes them?
The most common causes for medial shin splints are overtraining, pronation, and running on a slanted surface (i.e. crowned roads).
The most common causes for anterior shin splints are tight posterior muscles; imbalance between the posterior and anterior muscles; running on concrete or other hard surfaces; improper shoes with inadequate shock protection; and overtraining.
 
How to prevent or treat it?
To prevent or treat medial shin splints:

• Decrease your training immediately. Substitute non-impact cross-training activities such as swimming, biking or pool running.
• Running on soft surfaces will also help as long as you do not pronate excessively.
• Stretching the posterior muscle groups will also help.
• Applying ice will help provide some relief but will not be curative.
• Anti-inflammatory medication may be used.
• Electrical stimulation and ultrasound may be helpful to treat the problem.
• Taping the foot the limit pronation and decrease stress on the medial structures of the leg.
• Try different shoes or orthotics. 

To prevent or treat anterior shin splints:
 

• Decrease training immediately.
• Stretch your posterior muscles.
• Don’t log too many miles on your running shoes.
• Avoid downhill running.
• Don’t run on concrete.
• Apply ice to alleviate the symptoms.
• Take anti-inflammatory medication.
• Use electrical stimulation.
• Use a heel lift to reduce the tightening of the posterior muscles.
• Consider using orthotics. 

….and more on shin splints from another expert
Just one run or walk can cause shin splints. One run or walk can be over training for your body…if you start too vigorously, or go too far, or use poor shoes, or exercise on too harsh a surface such as concrete. A stress fracture pain is likely to be a continuous pain and restricted to one spot. Do not run. If you have a more diffuse pain or tenderness in the lower third of the leg on the inside, or along the entire shin, a fracture is less likely. Pain is felt on extending the toes and weight bearing. It hurts if you press the area with your finger. Physiologically, it is an inflammation of the tendons or muscle in this area. Pain eases when you are well warmed up, but resumes at the end of exercise.
Causes
 

• Running with the weight too far forward;
• striking the ground with the first third of the foot;
• over-striding;
• shoes too tight around the toes;
• inflexible shoes;
• weak arches may be present;
• tight calf muscles stress the shin structures;
• running or walking on hard surfaces;
• overpronation;
• overtraining is its trademark;
• beginners are very susceptible. 

Prevention

• Flexible foreshoe – use a combination or slip lasted design.
• Use a heel lift to reduce jarring, along with arch supports or padding if necessary.
• Run or walk fewer miles; do them on softer surfaces.
• Pool run.
• Bring back road mileage a mile or two at a time as you ease back to full training.
• Use orthotics or anti-pronation shoes.
• The shin muscle works against the large calf muscles; the shin muscle is the last muscle to warm up and the first to cool down. With this in mind, do an exercise to build it up–the paint pot exercise, or hooking an elastic belt or similar item under the toes and pushing against it ten times each day should suffice.
• Wearing long thick socks will help to avoid the chill when not running, making it easier to warm up the muscle before you do run or walk. 

Treatment

• Flexibility work.
• Ice alternating with moist heat…then put the muscle through its full range of motion. 

Compartment Syndrome
Compartment Syndrome is a muscle pain due to the muscles growing faster than the sheath surrounding them. It includes one form of shin splints; it also affects the other smallish muscles of the lower leg. Ice and anti-inflammatories can help, but surgery may be required to allow the muscle more room to expand. Some muscles grow so much that they constrict the blood flow into the sheath…resulting in necrosis (a medical emergency) of the muscle.
 
Stress Fracture of the shin bone (the tibia)
If you feel pain when you put pressure on the shin…rest. Stress fractures don’t show up on x-ray until healing is well under way; they can be confirmed quite early by a bone scan. The dilemma–a fracture requires six to eight weeks non impact exercise to heal. Use non running exercise to maintain muscle tone until you’ve confirmed if you have a fracture.
Muscle and connective tissue injuries to the front of the leg are due to overtraining–too many miles before your body has adapted to the load–or by too much fast training on surfaces which are too hard. Concrete is six times harsher to your shin tissues than asphalt. Asphalt is three or more times harsher on your shin muscles than packed dirt trails. Grass and muddy trails are still softer, and significantly decrease your risk of shin splints.