Anterior and Lateral Shin Splints in Runners: Pump or Emergency?

You're listening to the Restoring Human Movement podcast, and now your host. Hey everyone, this is Dr. Mandy Riehl for the Restoring Human Movement podcast. Thank you for joining the movement movement. I'm in the car today, so fair warning, there might be a little bit of noise here. Apologies in advance, but again, I'm your handy running injury expert at performance place sports care and at finish line personal training. Today we're talking about anterior and lateral shin splints. So anterior is the front, so if you run your hands down, your shin bone, we're talking about the front and lateral meaning to the outside.

So run your hand on your shin bone, that's the front, that's the anterior aspect, and if you go slightly to the outside, away from the midline of your body, that's the lateral aspect. In between the anterior and the lateral aspect, there's this big muscle called the tibialis anterior, and that is usually the muscle that's indicated in anterior shin splints, so we'll start there. Now, for those of you who are experienced with this, one, I'm sorry, it sucks, and two, you probably notice it most when you're doing a lot of speed work, especially if you heel strike, which again is not the bane of all existence.

I'm a heel striker. I've run thousands of miles. It's fine. But you might experience it more if you heel strike, doesn't mean change it, and you might experience it more in downhill running, particularly if you're going fast and you're not used to downhill running. So for me, I experience a little bit of this every summer when I get back into trail season and I'm doing a lot of vert because I'm in a cool place and I want to run up stuff, but the way back down the evening after, sometimes my anterior tibialis can get sore. Now, this usually feels like a muscle pump. So for those of you who say you've done rock climbing and you climb until you're super tired and all of a sudden your forearms are pumped, like you can't really move your hand or your wrist anymore because it's so full feeling and achy and sore, this is the same feeling, but in the front outside of your shin.

So for most people, that means when you're pointing your toes up towards your nose, it's feeling pretty sore and stiff and really full. And when you're pointing your toes down, like you're pointing your foot, it can feel like you're stretching a really sore muscle. Usually the pointing toes up towards your face is more indicative of anterior shin splints because that fullness feeling is key here. But pointing your foot away can help rule that in as well. Now, if you look up anterior shin splints or anterior tibialis shin splints online, you're going to see something about compartment syndrome.

And it sounds really scary on Google, and it really depends on what type of compartment syndrome you have. So how I categorize it is true or traumatic compartment syndrome, inherited compartment syndrome, or athletic compartment syndrome. And I don't think all of these are real official terms, but these are the categories I use. So true or traumatic compartment syndrome is, say you got in a car accident or you got hit with a baseball in a muscle. The muscle swells. You have a contusion, a bruise inside the muscle, and it creates enough swelling that you actually push on the kind of sausage casing that surrounds the muscle.

Now, that sausage casing doesn't stretch that much. It's like a fascia material. It's not like a stretchy, pliable material there. So it doesn't stretch much. So imagine, you know, a sausage that you just pumped more meat into. All of a sudden, it's really full feeling. Now, the scary part about true or traumatic compartment syndrome that you'll see online is it is a medical emergency, but it's fairly obvious when you have it because you can't move that muscle and you're in fairly excruciating pain. If it's somewhere in the lower limbs, you might actually feel that your foot is going cold. And the emergency part of it is because it might be so full that you're cutting off blood flow and the muscle could die because it doesn't have the blood flow.

So, again, this is fairly rare. This is usually indicated in a car accident or a freak traumatic accident. Again, like a baseball pitch to a muscle or blunt trauma. But if you look up compartment syndrome in your searchings of anterior tibialis pain or anterior shin splints, that's what's going to come up. So I've had several patients talk to me and they're like, oh, my God, is this an emergency? And then we come into acquired or athletic compartment syndrome, which isn't necessarily compartment syndrome. It just feels like compartment syndrome. So this is where that fullness comes in. This is that pointing toes up towards the nose and it feels like you have a pump in the muscle.

But the key difference here is it is due to activity, like running downhill really fast when you're not used to, and it goes away. So if you're feeling that you have that compartment syndrome, it's achy, it's full, and it goes away after a few days or it gets better throughout the day, you're not talking about true compartment syndrome. Usually you're not talking about traumatic compartment syndrome because there was no trauma to the area. So this is the most common for anterior tibialis type shin splints or anterior lateral shin splints, anterior shin splints, whatever you want to call it. It's that fullness feeling in the front little bit outside part of the shin.

Now, inherited compartment syndrome is fairly rare as well. I actually had one patient quite recently who had this, and he's a medical professional, so this was confirmed and imaged and all that good stuff. But inherited compartment syndrome is essentially something you're predisposed to through your genetics. And I don't think, to my knowledge, that there's any way to really tell that, at least the case that I saw recently, who I wasn't treating them for that, but he had told me about it in his history. He didn't know that he was predisposed to it until it happened. But it essentially is a predisposition to compartment syndrome without trauma.

So for him, it wasn't an emergency, but it was persistent. And he had testing done where they essentially put a dye into the blood vessels that go through whatever muscle you think has compartment syndrome, and they watch it on a dynamic image. So you can actually see, you'll see the blood flow, and you'll see it more clearly because it has that dye in it. And if suddenly that dye does not go through the muscle, the assumption is that the muscle is squeezing down on the blood vessels enough to cut off blood flow. And that's when you're talking about true traumatic or inherited compartment syndrome.

So again, true traumatic compartment syndrome, scary, go to the ER. Inherited compartment syndrome, fairly rare. Doesn't sound like it's an emergency, but I'm sure it can vary on the intensity of why it's showing up when it shows up. And most commonly for anterior shin splints, you're talking about athletic compartment syndrome or feeling of fullness and soreness and that pump feeling that is transient. So it goes away at some point, usually over the course of hours or days, and doesn't truly cut off blood flow. You don't have any cold feet symptoms. You don't have any crazy tingling or numbness.

It's just that full, really uncomfortable feeling, particularly in the shins when you point your toes towards your nose. So if you need help differentiating this, just a reminder, I'm not just a podcaster. I am a doctor of chiropractic and a personal trainer. So if you need help with this, our information is below. Shoot us an email or give us a call and we'd be happy to help you out. Until next time.