I Went Running, And Now My Shin Hurts

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 

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

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.

See Also: Long Distance Running: The Good and the Bad

Muscle tears

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.

So What Should You Do About Shin Pain?

First of all, don't run.

Whichever 'flavor' of MTSS you have, they're all caused by repetitive impact and torsion. Plan to be out of running for six to eight weeks.

That doesn't mean you can't train: exactly the opposite. you should be getting on top of this injury right from the get-go. Here are some treatment tips. Underneath each, you'll see the types of injury they're good for. Don't see yours on the list? Skip that exercise.

1: Calf raises

Muscle tears, compartment syndrome

You're going to do single-leg negative calf raises with a full range of motion under control. Use one leg to get you to the top of the movement then lower yourself slowly under control to the most dorsiflexed position you can hold with voluntary contraction going on in the muscle: don't just hang there on your soft tissue structures, you'll make it worse.

Do a set with the knee almost, but not quite, locked out, as this strengthens different muscles in your calf. I know your pain's not in your calf - but stronger calf muscles means more stable foot striking when you get back to running.

2: Toe circles

Muscle tears, compartment syndrome, stress fractures

You partly got this injury by having poor motor control over your feet. Take your socks off and sit. Extend one foot and draw the biggest circle you can moving only your foot from your ankle. If you've never done this before, you'll be shocked how little control you have and how hard the movement is! Expect some slight cramping. To begin with this is a strength as well as a mobility move. Draw circles in both directions. Rather than go for a certain number of reps, go for a perfect circle and try to do this one several times a day.

3: Dancer's walks

Muscle Tears, compartment syndrome, stress fractures (be careful!)

Stand on the balls of your feet, and flex your feet as much as you can, so you're standing tall. Straighten your legs as much as you can and slowly walk. A few steps is enough for most people to start off with, but improve gradually. You're building awareness, movement and strength in the soles of your feet and your calves, but you're also improving your conscious ankle stability - a key factor in avoiding injury.

4: Deep slow massage

Compartment syndrome, muscle tears - NOT stress fractures!

You can use your hands, or a small ball like a golf, tennis, lacrosse or even a baseball. Find the part where it hurts and start slightly above it. Slowly massage down, increasing and then decreasing the pressure. This should be somewhere between uncomfortable and painful - if it's agony, stop! The idea is to stretch out the compartment's sheath, the fibrous wall that's holding everything in place a little too tightly, and to relieve some of the pressure. So you can expect the pain to get worse while yo're doing it - but it should get better after you've done it a few times. Stick at it.

5: Kneeling calf stretch

Muscle tears, compartment syndrome

Kneel on one leg, facing a wall, with your front toes touching the wall. Move forward without letting your front heel off the ground until your knee touches the wall. This should stretch out the back of your calf, but it should also involve the front of your calf.

6: Walking

Muscle tears, compartment syndrome, stress fracture

Walk for between 30 and 90 minutes a couple of times a week. No, I know it's not running, but it will help to keep your basic aerobic fitness in some kind of shape - you'd be surprised the difference it makes to your stress levels too. And it will keep your metabolism turned up. 

See Also: Tired Of Extreme Fatigue, Sleeplessness And Muscle Pain? Beat Your Catabolic State

7: Foam rolling

Easing muscle tightness and preventing compartment syndrome.

Using a foam roller, roll over your calf and anterior shin muscles to release tightness. Apply gentle pressure and move slowly, spending extra time on particularly sore or tight areas. This promotes blood flow and muscle relaxation.

8: Ankle alphabet

Increasing ankle mobility and reducing strain on the shins.

Sit down and extend one leg. Draw the alphabet in the air using only your ankle movements. This exercise promotes flexibility and strength in the ankle joint, reducing the risk of injuries that could lead to shin pain.

9: Eccentric calf drops

Strengthening calf muscles and reducing stress on the shin bone.

Stand on a step with your heels hanging off the edge. Raise both heels by pushing up onto your toes, then lift one foot off the step. Slowly lower the heel of the standing foot down below the step level. This controlled descent (eccentric movement) is crucial in strengthening the calf muscles, reducing the risk of associated shin pain.

Hopefully, if you follow these tips yo'll be running again soon - a few weeks in the case of milder soft tissue injuries, a few months in the case of stress fractures which can take up to a year for the bone to return to full health.

If you've found these tips useful, or you have a comment to make or a story to tell (or a bone to pick!) get in touch below.