SHIN SPLINTS
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related talks: shin bone fracture, tibial stress fracture, runners knee, barefoot running
What are Shin Splints?
“Shin splints” is a term common term used to describe exercise-induced leg pain however, it doesn’t refer to one specific medical condition (unlike “Runners knee” for example which is a layman’s term to describe iliotibial band friction syndrome, see talk). So when we talk about “shin splints” we will review some of the major causes of shin pain associated with exercise. Exercises places stress on your bones, on your muscles, and on your tendons (tendons attach your muscle to your bone).
Bone, muscle, and tendons, can all be a source of exercise-induced pain. Lets take a look at each.
Your bones (especially the tibia, your leg bone) can become a source of pain if you have recently started a new training program, and you are really working that body. Within the first 4 weeks of a new exercise routine, you are at greatest risk for developing a stress fracture (see talk).
Another type of exertional bone pain that is believe to be closely related to a stress fracture, and which is commonly called “shin splints” is a condition called “Medial Tibial Stress Syndrome”. This is a condition described as pain along the inner and back portion of the leg. People report that its tender both during and after activity. Unlike an exercise-induced compartment syndrome (which is discussed in the next paragraph), MTSS is tender even after exercise has stopped. And unlike a stress fracture (which is a specific crack in the bone on MRI), MTSS will show up on MRI as generalized bone and muscle swelling.
Your muscles can produce pain with activity for many reasons. A common cause is a muscle tear (duh!). Another cause is Exercise-Induced Compartment Syndrome. All of our muscles are kept in their proper place (compartment) by thick capsules of tissue (called fascia). This can be a problem for some people because their muscles enlarge too much while working out. Our muscles need more energy during exercise, and our blood delivers this energy. To increase delivery, our blood vessels within the muscle enlarge during exercise. However sometimes this causes our muscles too swell soo much that it dramatically increases the pressure within the muscle compartment, and this has the undesirable effect of cutting off blood supply to the muscle, and causing significant pain (the muscle is crying out “im starving”). Exercise-Induced Compartment Syndrome will cause severe pain after a few minutes into a work out, and it will quickly resolve with rest. It most commonly occurs within the leg muscles (like the calf). This condition can really limit an athletes performance, and many times it requires surgery (which removes the muscle’s fascia covering).
Tendons can produce pain with activity typically when they are overworked and become inflamed.
What is the long term outcome?
People typically do well when treated in a stepwise fashion.