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When you're a runner and you start to get shin pain, if you're like the runners I know, you ignore it. And then you ignore it. And when it gets to the point where you can't ignore it, you start worrying whether it's a stress fracture or if you have some kind of soft tissue injury that's going to plague you forever.
At the bottom of all these fears is the same concern:
The first thing to do is locate your shin pain
This article will mainly deal with what people call 'shin splints,' known to your doctor as Medial Tibial Stress Syndrome, or MTSS. The trouble with MTSS is that it's very ambiguous: it's an umberella term for a wide range of injuries like compartment syndrome, muscle damage and stress fractures. The symptoms of a stress fracture are pretty similar and you can't always detect one of those with X-rays, so telling the difference in terms of diagnosis is difficult for medical professionals. With that in mind, go see one!
If you know you have MTSS or you're pretty sure you do, here's what you've got
On the leg that hurts - and it's often both legs, though usually worse in one than the other - you'll have a strong ache-like pain in the mid to bottom third of your shin, on the inside, just behind the shin bone, or the outside, just in front of it. That bone is your tibia, incidentally. If this is you, you've probably run through it even when it hurt after you ran, every time. Only when it actually hurts to run do runners usually seek help!
Here's the bad news:
Sorry, but that's the truth.
You don't need to stop training, though. Not being able to exercise is frustrating for everyone. For runners, who thrive on the challenge and endorphins of going a little further or a little faster, who find both pleasure and peace in the rhythm of the pavement or the park, it's torture.
But if you take a break you can avoid, well, taking a break, further down the road.
MTSS can be a number off things, so first let's look at what they are:
Stress fractures are tiny cracks in bone caused by repeated pounding or twisting. They're very painful, exacerbated by impact exercise and frustratingly sow to heal, especially if you keep doing a quick five miles to see if you're better yet. Because they're small and don't go all the way through the bone stress fractures can be hard to detect. If your leg pain is very, very localized, you're more likely to have a stress fracture.
Compartment syndrome refers to a painful, and sometimes very serious, problem caused when you get bleeding or swelling within an enclosed bundle of muscle fibers. Muscles are surrounded by fibrous sheaths that keep them separate from each other and allow them to move around each other. These sheaths are referred to as fascia. When you repeatedly do something that shortens or traumatizes a fascia, it tends to tighten - and they're already quite tight and inflexible. As a result you can experience swelling or internal bleeding in a single compartment, and there's nowhere for the pressure to go. At its worst this can be genuinely dangerous - you can be looking at permanent tissue damage, because the fascia aren't elastic, but blood vessel walls are. That means if the pressure gets high enough the surrounding tissue will clamp down on the blood vessels and squeeze them shut, stopping blood flow. What's much more common is to experience very painful muscle cramping and loss of function.
Strictly speaking, the pain you'll get with MTSS is more than just muscle tears. It's caused by the muscular attachment tearing slightly away from the bone, which means it's felt partly in the fibrous muscular attachment and partly in the pereosteum, the sheath around the bone that supplies the bone with blood and nutrients. The mass of bone is more or less free of nerves - the pain of a bone injury mostly comes from the pereosteum, so that's another reason why it's difficult to tell if your injury is in the muscle or the bone.