My Shins are hurting, but I just want to Run!

With Marathon, half marathon and 10K preparations well underway, shin pain can be a common complaint during training. The question I mainly get asked is can I just run through it? Will I cause further damage?

 

Running isn’t just for those training for a specific event, distance or even fitness, it is an enormous part of stress control and mental health for many. So stopping for any period of time can be really detrimental and have a massive impact on your wellbeing.

 

Shin pain has an incidence of 4% to 19% in the athletic populations and 4% to 35% of the military population (Winters et al. 2018).

 

 

 

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What causes shin pain?
In most cases, shin pain is a result of overuse, an increase in training load whether that be pace, distance, intensity or duration. Other contributing factors can be, worn out shoes not providing enough support of cushioning, running on hard surfaces or simply a heavy boot.

 

These contributing factors result in tired, tight muscles which then put too much stress on the tendons which become strained and sometimes torn.

What can my shin pain be?

Shin splints is often the terminology use for shin pain which is an umbrella term for a few conditions.

1. Medial Tibial Stress Syndrome- this is caused by stress on the bone and the surrounding tissue called the periosteum . The current definition is ‘Pain felt along the middle or distal third of the posteromedial border of the tibia that occurs during exercise, excluding pain from ischaemic origin or signs of stress fracture' (Yates & White, 2004). The complaint is of a nagging ache/pain along the inside of the tibia, with pain being experienced during and after exercise.

 

2. Muscle Strain- this is when the muscle is too weak and tight to complete the action required. Within the shin area the tibialis anterior and tibialis posterior are the main muscle groups that will be affected. These muscles control the arch of your foot and the lowering of your foot on each step. If other muscles are not working to their optimum this often results in further loading through the muscles around the shin.

 

3. Stress Fracture – A stress fracture is a small crack within the bone which has been caused by overloading the muscles to the point they can no longer absorb the shock of running, this then translates into the bone. The treatment for this is strictly rest from running allowing the bone to heal, if you suspect a stress fracture, an x-ray will be required.

 

Can I continue to run?

Firstly it is important to determine exactly the cause of the pain. A period of rest will be required if persistent shin pain, by continuing to run you risk worsening your injury and a potential further injury due to compensation methods, which is likely to result in taking a longer period of time off running.

Typical recovery time for shin splints is 2-4 weeks but this will be longer if it is a stress fracture.

 

When can I return to running?

 

Often persistent shin pain will not resolve with rest alone, a biomechanical analysis is advisable, so you can get to the real reason of the persistent pain. This will involve looking at muscle length and strength throughout both your lower limbs. Ensuring optimal functioning and strength of your lower limbs will prevent future injuries and assist you back to running with a smooth transition.

During your rest period it will often be advised to cross train, cycling or swimming, which allows you to maintain your CV fitness during your time out of running. Cross training alongside a tailored strength and conditioning program is your quickest way to returning to your running training program. Patience and perseverance with down time is essential.

In terms of when to return to impact, it is advised you initially start on a treadmill and start a graded program back to running once you are pain free and have regained lower limb strength.

 

How else can I treat and prevent shin splints?

It is so important to complete lower limb and core strengthening along side any running training program. When you run you its thought that you load 2.5x your body weight through your lower limbs, are yours strong enough to with stand this, repetitively for potentially 2-4 hours?

 

To speed up returning to running, alongside rest treatment can include proprioception, balance, acupuncture, taping and running analysis.

 

Another essential is ensuring you are wearing the correct footwear, getting a specialist to analysis your running pattern and your foot structure, to advice you the correct trainer for you. Sometimes orthotics are required for additional support.

If you have any further questions or want a diagnosis of your shin pain or assistance to rehabilitate and return to running, please email southcoastphysiopilates@gmail.com

Yates, B., & White, S. (2004). The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. Am J Sports Med, 32(3), 772-780

 

Winters, M., Bakker, E. W. P., Moen, M. H., Barten, C. C., Teeuwen, R., & Weir, A. Medial tibial stress syndrome can be diagnosed reliably using history and physical examination. Br J Sports Med.2018; 52(19): 1267-1272.