Shin Splints
Shin splints most often can be captured in just four words: too much, too soon

by: Marlene Cimons


The nature of shin splints most often can be captured in just four words: too much, too soon. "I always seem to get them when I start up running again after a break," says Doug McDougal, 33, a 2:50 marathoner from Fort Worth, Tex. "I've noticed shin splints to be a problem mainly for those like me: either new runners or runners starting over."

Paula Palka, 37, of
Thomaston, Maine, agrees. She hasn't had shin splints since 1980, when she was new to running. "I had mild shin-splint pain when I began running a long time ago and was only doing 2 to 3 miles at a time," she says. "After I got up into the 4-mile-plus category, it wasn't a problem anymore. It seemed like I had worked the kinks out or something."

What are they?
Shin splints, the catch-all term for lower leg pain that occurs below the knee either on the front outside part of the leg (anterior shin splints) or the inside of the leg (medial shin splints), are the bane of many athletesrunners, tennis players, even dancers. They often plague beginning runners who do not build their mileage gradually enough or seasoned runners who abruptly change their workout regimen, suddenly adding too much mileage, for example, or switching from running on flat surfaces to hills.

Seems like shin splints.
Shin pain doesn't always mean you have shin splints. It might be a sign of some other problem. Following are two conditions that are sometimes mistakenly diagnosed as shin splints.

Compartment syndrome:
Pain on the anterior (outside) part of the lower leg may be compartment syndrome?a swelling of muscles within a closed compartment?which creates pressure. To diagnose this condition, special techniques are used to measure the amount of pressure. "With compartment syndrome, the blood supply can be compromised, and muscle injury and pain may occur," says podiatrist Stephen Pribut, D.P.M., of
Washington, D.C. Sometimes surgical "decompression" is required.

So how do you distinguish compartment syndrome from shin splints? "Symptoms of compartment syndrome include leg pain, unusual nerve sensations and, later, muscle weakness," says Pribut.

Stress fracture:
Pain in the lower leg could also be a stress fracture (an incomplete crack in the bone), which is a far more serious injury than shin splints. A bone scan is the definitive tool for diagnosing a stress fracture. However, there are clues you can look for that will signal whether or not you should get a bone scan.

Press your fingertips along your shin, and if you can find a definite spot of sharp pain, it's a sign of a stress fracture; the pain of shin splints is more generalized. "Usually stress fractures feel better in the morning because you've rested the bone all night," says Letha Griffin, M.D., an
Atlanta orthopedic surgeon who specializes in sports medicine. "Shin splints are worse in the morning because the soft tissue tightens overnight?you get out of bed, and you can hardly walk."

"Shin splints will be most painful if you forcibly try to lift your foot up at the ankle," says Sheldon Laps, D.P.M., a podiatrist in the
Washington, D.C., area. "If you flex your foot and it hurts, it's probably shin splints." Also, a horizontal rather than verticalline of tenderness across the bone is typical of a stress fracture, says Pribut.

So what causes them?
There can be a number of factors at work, such as overpronation (a frequent cause of medial shin splints), inadequate stretching, worn shoes, or excessive stress placed on one leg or one hip from running on cambered roads or always running in the same direction on a track.

Typically, one leg is involved and it is almost always the runner's dominant one. If you're right-handed, you're usually right-footed as well, and that's the leg that's going to hurt.

The most common site for shin splints is the medial area (the inside of the shin), according to Sheldon Laps, D.P.M., a podiatrist in the
Washington, D.C., area. Anterior shin splints (toward the outside of the leg) usually result from an imbalance between the calf muscles and the muscles in the front of your leg, and often afflict beginners who either have not yet adjusted to the stresses of running or are not stretching enough. "In general, the muscles in the front are working hard to overcome the power in the muscles in the back of the leg," says Stephen Pribut, D.P.M., a Washington, D.C., podiatrist.

But what exactly is a shin splint? "Over the years, there have been several theories," says Julie Colliton, M.D., a sports-medicine specialist and board member for The Physician and Sports Medicine journal, "small tears in the muscle that has pulled off the bone, an inflammation of the periosteum [a thin sheath of tissue that wraps around the tibia, or shin bone], an inflammation of the muscle, or some combination of these, but there's no hard-core consensus among sports scientists." Fortunately, there is some hard-core advice on how to treat shin splints.

Treatment and prevention.
Experts agree that when shin splints strike you should stop running completely or decrease your training depending on the extent and duration of pain. Then, as a first step, ice your shin to reduce inflammation. Here are some other treatments you can try:

Gently stretch your Achilles if you have medial shin splints, and your calves if you have anterior shin splints. Also, try this stretch for your shins: Kneel on a carpeted floor, legs and feet together and toes pointed directly back. Then slowly sit back onto your calves and heels, pushing your ankles into the floor until you feel tension in the muscles of your shin. Hold for 10 to 12 seconds, relax and repeat.

In a sitting position, trace the alphabet on the floor with your toes. Do this with each leg. Or alternate walking on your heels for 30 seconds with 30 seconds of regular walking. Repeat four times. These exercises are good for both recovery and prevention. Try to do them three times a day.

If you continue running, wrap your leg before you go out. Use either tape or an Ace bandage, starting just above the ankle and continuing to just below the knee. Keep wrapping your leg until the pain goes away, which usually takes three to six weeks. "What you're doing is binding the tendons up against the shaft of the shin to prevent stress," Laps says.

Consider cross-training for a while to let your shin heal. Swim, run in the pool or ride a bike.

When you return to running, increase your mileage slowly, no more than 10 percent weekly.

Make sure you wear the correct running shoes for your foot type specifically, overpronators should wear motion-control shoes. Severe overpronators may need orthotics.
Have two pairs of shoes and alternate wearing them to vary the stresses on your legs.

Avoid hills and excessively hard surfaces until shin pain goes away completely, then re-introduce them gradually to prevent a recurrence.

If you frequently run on roads with an obvious camber, run out and back on the same side of the road. "If you don't do this, you'll always be putting stress on only one leg or one hip," says Laps. Likewise, when running on a track, switch directions.

If you are prone to developing shin splints, stretch your calves and Achilles regularly as a preventive measure.