Rehab. Prehab. Performance.
Many people especially runners experience pain down the front of the shin and have either self diagnosed or been to their GP who have given them the diagnosis of "shin splints".
So what exactly is shin splints? many medical professionals use the term shin splints as an umbrella term for pain down the front of the shin either due to lack of real understanding or perhaps just simple misdiagnosis.
This mis understanding is not the fault of the medical professional, but rather because of the vague definition given to shin splints and so shin splints has been used as more of an umbrella term rather than defining it as the specific condition it is. The American Medical Association of Nomenclature of Athletic Injuries state that the term shin splints should be confided to conditions of musculoskeletal origin, However this definition would mean that conditions such as tibial stress fractures, chronic exertional compartment syndrome, Tibialis Anterior strain etc are all put under this umbrella term. Krenner, 2002 on the other hand describes shin splints as micro tears in either the origin or insertion of the tibialis musculature which may also include interosseous membrane pain and tendonitis alongside periostitis, which I believe is a far better and more specific definition.
So how do you know if you have shin splints or Chronic Exertional Compartment Syndrome (CECS). People with CECS can go months if not years before they are properly diagnosed, as some of the symptoms are similar to shin splints i.e. pain usually starts in the front of the shin. However, there are a few other symptoms that will differentiate CECS. First of all pain usually starts at a predictable distance into a run and will gradually get worse the further you try and run. Second, numbness and pins and needles will start to develop if you continue to push through the pain to the point where your entire shin and foot will go completely numb. Stopping will usually relieve the symptoms. Please note: If you experience these symptoms and stopping the activity does not relieve your symptoms within a few minutes then you should seek immediate medical attention.
CECS can be successfully treated using conservative measures especially people who run more for general fitness and enjoyment and who are not pushing themselves to achieve long distances. In those who are perhaps looking to achieve long distances then surgery may be the best option depending on the severity of your symptoms. The surgery is called a Fasciotomy, which is where the fascial sheath or compartment around the shin is cut to allow a decrease in pressure.
Conservative measures include changing running style. The typical heel-to-toe running style that most people tend to adopt puts a large amount of force on the Tibialis anterior and other muscles of the anterior compartment requiring more blood to allow for effective cellular respiration and removal of metabolic waste products. This increase in blood demand will mean the muscles will swell and essentially take up more room than at rest leading to CECS.
Changing your running style is one of the most effective ways in reducing the pressure build up in the front of your shin. Most runners land with a heel-to-toe motion, which requires the Tibialis anterior muscle to absorb a large proportion of the shock or ground reaction force. By changing to a forefoot or even mid foot strike will put the demand onto the calf muscles which is far larger and will actually allow you to recycle this ground reaction force for better energy efficiency, due to the calf essentially acting like a spring. Below you can see the differences between a normal heel-to-toe vs forefoot running style.
The benefits don't end there however, studies show that running with a forefoot strike actually reduces the amount of ground reaction forces that are enacted on the body; theoretically reducing the chances and incidence of injury, below you can also see the difference in the impact transient between the two running styles.
Note: Changing your running style to a barefoot style should be done gradually. Try walking around the house barefoot more often and build up to walking with a minimalist shoe such as a vivobarefoot shoe or vibram five fingers to begin with and slowly increase your walking distance before trying to run. I will be writing more on this in a later blog post.
If you would like to know more or would like to have an assessment to determine the cause of your shin splints feel free to contact me via email at firstname.lastname@example.org or call 07500059064.
Andy has been involved in the health & fitness industry for over 10 years, specialising in corrective exercise, injury prevention and rehabilitation of low back, neck and shoulder pain. He also has an interest in the use of Osteopathy for the management of headaches.