Shin-splints May Not Be What You Think They Are!

June 17, 2010
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Shin-splints, especially to a high school track athlete, can be very debilitating and recovery periods can exclude competitive participation for several weeks as the healing process takes place. The definition of a shin-splint is variable, depending on who you ask, so it is first important to begin by differentiating between what the average citizen calls a shin-splint and what a “true” shin-splint really is.

Most people diagnose themselves with shin-splints when they have pain anywhere in the front of their leg. However, true shin-splints delineate pain within the bone in the front, or anterior portion of the leg (tibia), as inflammation of the periosteum of the bone itself is what induces shin-splint pain. Every bone in the body is covered by periosteum, which is the outer covering of bone providing the bone with its blood supply and allowing it to thrive. When the periosteum is disrupted as is the case in shin-splints, the periosteum reacts generating inflammation, pain and swelling. In shin-splints, he periosteum becomes disrupted when the muscles attaching to it, and to the bone that it surrounds, apply “pull” on the bone, creating a periosteal reaction. The resultant symptoms include pain that is increased with activity, especially early in a workout session, as well as pain with pointing the toes downward (plantar flexion) of the foot.

The question becomes: why are muscles in the leg applying extra pull to the periosteum and bone, so much so that they generate a periosteal reaction? The answer: it can be a number of things!

Running on uneven surfaces is a huge contributor to the development of shin-splints. This often occurs during pre-season training sessions and in cross-country runners, who are constantly running from pavement to grass, and gravel to synthetic track surfaces. The extra stress and strain on the muscles of the leg as they adjust from one surface to the next creates disruption of the periosteum and eventually, symptomatic shin-splints. In addition to uneven surfaces, improper training techniques can also be an inducer of leg pain and increased pull of the muscles on the tibial bone, leading to shin-splints. As a young athlete it is important to have a regimented training routine that has been reviewed by a coach or trainer who can advise you on what workouts are best for your specialty, but also best for your body and your health!

There are also outside factors, unrelated to athletic activity, that can contribute to the development of shin-splints, which include flat feet (pes plano valgus) and calf tightness. We’ve touched on calf tightness before and its contribution to heel pain syndrome (plantar fasciitis), and unfortunately, the same etiology applies here! When the calf muscles are tight, they don’t allow the ankle joint to work maximally, flexing the foot upwards and downwards as intended. Therefore, in order to get the motion at the ankle joint that is needed for daily activity, the body looks elsewhere and tends to apply stress on the muscles of the anterior and posterior leg. Prevention and treatment of shin-splints in patients who have calf tightness as the sole etiology of their problem can be quickly rectified with some simple stretching exercises!

Take a look back at our blog entitled “Plantar Fasciitis,” posted on May 5, 2010 ( The following stretches mentioned in that blog can also apply here and should be used daily whether you suffer from symptoms of shin splints or not, as they can be great preventative exercises:
A. Wall Gastrocnemius Stretch
B. Stair Gasctrocnemius Stretch
C. Soleus Stretch

Shin-splints can be extremely painful and can result in a withdrawl from activity for several weeks as the body heals itself and the periosteal reaction subsides. Rest is certainly the best thing, but application of ice is also helpful to decrease inflammation. Anti-inflammatory medications can also be beneficial in decreasing symptomatic pain in addition to helping control inflammation of the periosteum, leading to a faster recovery! In prevention, stretching as mentioned above is extremely important in addition to wearing appropriate shoes and running on even and shock absorbing surfaces such as synthetic tracks, as opposed to sidewalks and grass. Shin-splints can be very debilitating to the competitive athlete, thus it is important to treat them at their onset, otherwise your recovery period increases as the pain and inflammation takes longer to leave the bone.

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