What are shin splints?

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Idiopathic pain in or around the shin is often just covered with a blanket term of “shin splints”. I would often separate whether it is true shin splints or “psuedo” shin splints meaning that something else which is not a true case of shin splints is mimicking the pain or simply causing pain in the area. 

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True shin splints are characterised by pain in the front of the shin running vertically down the tibia and associated trigger points in the surrounding musculature of the Tibialis anterior, Extensor digitorum longus and extensor hallucius longus. The pain generally gets worse with loading and impact activities such as running and walking which will generally get worse as the activity continues. To successfully treat true shin splints there are a few key points to consider about what is actually happening at the shin and why this may have happened.

So the first question to answer is what is actually happening at the shin and causing the pain?

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Shin splints in short are tearing of connective tissue and fascia away from the periosteum of the tibia which causes inflammation of the periosteum and the tibia. If left untreated this inflammation can become chronic and in ignored cases has been seen to lead to stress fractures and bone damage. Fascia covers and runs within and around every muscle in the body connecting and becoming a part of every body part in one continuous system. A connective tissue matrix also runs adjacent to the tibial periosteum and connects the muscles of the tibialis anterior and posterior as well as other musculature within the leg. Repeated microtrauma to this site can tear the fascia and connective tissue away from the periosteum and induce an inflammatory response at the site. 

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Causes of shin splints can be a variety of pinpoints but broadly; Poor mechanical loading of the tissues during impact activities through foot or hip pathologies must be examined through the walking and running gait. Another key factor is a poor training approach or “too much too hard too soon”. Shin splints is a common injury in runners when they begin a new training cycle in which they may be trying to up their times and distances. GAA , Soccer and rugby in a similar fashion when training intensities are upped too quickly or with the combination of hard training and a hardening of the ground on which training is taking place. Most often it is a combination of the two. In order to successfully treat true shin splints the Periosteum, connective tissue, fascia will need to heal the Myofascial trigger points splinting the surrounding musculature to be treated and the tissue loading issues to be corrected to ensure this will not become a repetitive injury. This is a simplified view and I am not going into detail about tissue hardening and scarring which may occur also but with treatment and rehab adherence shin splints pain can dissipate in a couple of weeks. 

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What are the mechanical considerations to explore for shin splints?

Without going into too much detail; foot function and hip function are two great places to start. With over pronation Internal knee rotation and pelvic tilting just a few things to be considered. Flattened arches must also be considered with a view to the restoration of the lower leg fascial springs. Through an accurate history and examination of the deep longitudinal chain we can see if the tension running through the area is coming from higher up the myokinetic chain from the Hamstrings, Musculature of the hip or force transfer through TCL or  into the Opposite shoulder.

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There being a number of things to consider shin splints is not a long term sentence with careful treatment and rehab. 

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So now that we've covered what happens during true shin splints;

What are other causes of pain in or around the shin which may be labelled as shin splints? 

First and foremost and in a lot of causes chronic tearing of the connective tissue and inflammation of the periosteum will not occur without a great deal of force being driven through the area. Where there is excess tension there are always problems with metabolic pathways leading to energy crisis and myofascial trigger points. Sometimes the Pain in the shins can be from Trigger points in muscles such as Tibialis anterior which runs down the shin sometimes into the big toe, Flexor hallucius longus which can present with more medial calf and soleus related symptoms. Extensor digitorum and hallucius longus which can refer pain into the distal anterior portion of the shin and I have also seen soleus trigger points refer in similar patterns. Tendinous issues from any muscles in the lower leg compartment can cause issues with ankle flexion which can present in pain in the shin. With previous injuries nerves can become adhered to fascia, tendons and muscles and any instance of movement can exacerbate symptoms.  Tarsal tunnel related issues from nerve compression through the tarsal tunnel can refer to pain from below the foot above the level of the ankle. And the list goes on. All in all every possibility will be explored.

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The take home really is that The causes of many of these injuries are the same meaning that correctional movements and motion restoration will be key to ensure proper function of the limb. To pinpoint the pathology and treat that will just get rid of the pain. I have had multiple different accounts of shin splints diagnosis and it is roughly 50/50 whether it has been true shin splints or a case of referred pain.

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If I have shin splints what can I do ?

Firstly I would always advocate to go to a Physiotherapist/physical therapist/ Neuromuscular therapist to discern the cause and treatment protocol to follow. If there are mechanical issues causing the pain they will need to be fixed. If you suspect that your shin splints may be coming from poor training practices; Try slower progressions of training and have a look at your footwear. Our bodies are not machines no matter how much we love to think they are.

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