I turn again to my running physical therapist friend Jessica Garcia here in Paramus, NJ for answers to those nagging shin splints!   Here you go:

“Anytime we get lower leg pain we are quick to say that we have shin splints but is that actually true or have we just grown accustomed to saying that because it’s what we have heard.  Shin splints has become the go to term for any lower leg pain that we get below the knee, either on the outside front part of the leg or the inside of the leg. Shin splints are the bane of many athletes, runners, tennis players, dancers and military recruits. They are much more common among beginning runners who build their mileage too quickly but can also affect seasoned runners who abruptly change their workout regimen. Shin splints can be summed up in 4 words….. Too Much, Too Soon.

Shin splints, (most commonly known as medial tibial stress syndrome), were always considered a soft tissue injury but with new information it is now thought that the cause of shin splints may actually be repeated stress to the bone. With running the tibia (bigger shin bone) bends backward slightly on impact with the ground, putting compressive forces on the inner side of the bone. The body responds to this but this process can take several weeks to months during which time the bone is even more vulnerable. Shin problems are more common in less experienced runners because the bone has not yet adapted. Did a light just go on?

Be careful, shin pain doesn’t always mean you have shin splints. It can be a sign of another problem, 2 conditions in particular, with potentially greater ramifications. The first of these is Compartment Syndrome– a swelling of muscles within a closed compartment which creates pressure. This pressure can decrease blood flow, which prevents nourishment and oxygen from reaching nerve and muscle cells.  Symptoms include leg pain, unusual nerve sensations and eventually muscle weakness. Compartment syndrome can be either acute or chronic. Acute compartment syndrome is a medical emergency.

The second, one that evokes fear just at the mere mention, is a Stress Fracture-an incomplete crack in the bone. The pain of shin splints is a generalized ache that may be worse in the morning because the soft tissue has tightened up overnight. They are at their most painful when forcibly lifting the foot at the ankle or flexing the foot. By contrast the pain from a stress fracture becomes focused on a smaller area of the bone and is sharp or burning in nature. The pain may be noticed more during the run eventually hurting while walking or even when you’re not putting any weight on it at all. They may feel better in the morning because the bone has rested overnight. If you suspect you have a stress fracture you should get it checked.

There can be a number of factors that cause shin splints, those related to the body and those related to training errors.  When shin splints strike it is best to stop running completely or decrease your training, depending on the extent and duration of pain. The initial focus is on decreasing the inflammation and once that is achieved it turns to reducing the relative amount of stress on the tibia. This can be accomplished by increasing flexibility and strength, reducing impact, wearing the correct footwear, cross training and,  once returning to running, avoiding hills and hard surfaces, avoiding running the same direction on a track, gradually increasing mileage, gradually increasing intensity and increasing stride frequency.

Most runners don’t want to interrupt their training unless absolutely necessary but the decision is not a clear cut one. In an attempt to help patients make this complicated decision I use this simple spectrum:  Red zone(stop): localized tenderness, sharp burning pain, pain with hopping, pain with walking, Yellow zone (caution): Tight aching pain when running; goes away when you stop, hopping isn’t painful, Green zone (go): Completely pain free while running. In most cases shin splints are often not serious however, call your health care provider if: you have pain even with rest, icing, and pain relievers after several weeks, you are not sure whether your pain is caused by shin splints, the swelling in your lower leg is getting worse or your shin is red and feels hot to the touch. So while in many instances you could run, the question becomes…. should you run?  If there is any hesitation when answering this question err on the side of caution. If you think having to rest because of a mild injury is difficult, you don’t even want to think about what it would be like with a full blown one.”

Thanks, Jessica!   Happy Running……

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