Top 3 Reasons for Shin Pain while Running

Big 3 Reasons for Shin pain while running

• Pain below the knee/above the foot?
• Tight shins while running?
• Gets worse while running?

Shin pain while running is common in our sport, but it does not have to be the end of your training this season.

I know an injury can be frustrating, but when treated and rehabbed well, it can be a blessing in disguise.

Here are the “Big Three” when it comes to shin pain while running:

• Shin Splints
• Anterior Compartment Syndrome
• Stress Reaction/Fracture

In this article, you will learn more than you ever wanted to know about shin pain while running and how to correctly treat and rehab its causes.

SHIN SPLINTS

• Throbbing shin after a run?
• Tender to touch?
• Swollen inside the shinbone?

Shin Splints is the most common reason for shin pain while running, but it doesn’t just afflict runners.

Many beginner exercisers will develop it, and sadly, it can be a reason why they stop on their journey to health.

Shin Pain while Running

Let me get real for a second…if you are a seasoned runner, this normally occurs if you jump around in your mileage.

Some of my patients with decades of running under their belts have developed this after they took a month off from another injury and jumped back in with a high mileage volume.

Shin splints is an injury of negligence.

What causes Shin Splints?

Shin Splints is also known as Medial Tibial Stress Syndrome (MTSS), so don’t get confused by the verbiage.

Let’s break down the name Medial Tibial Stress Syndrome:

• Medial: to the inner side
• Tibial: this is the proper term for the shin bone
• Stress: when a load is being placed on something
• Syndrome: a presentation of a collection of common symptoms that they thought it would be cool to name.

Pretty easy to understand, right?

Some of you who have come to this article from another site may be saying, “Hey, I saw on another site that it is a bone injury…?”

Yes, you are correct.

The top three conditions causing shin pain while running are almost all the same injury as one another, but they differ in their severity. Don’t ask me why they named each of them something different…I didn’t name them!

The term Shin Splints actually refers to injury of the muscle and the “skin of the bone”. It can also be called Medial Shin Splints.

There is Posterior Shin Splints, which I cover in my “Calf Pain” page.

Injury to the muscles of the shin occurs when they become damaged, torn, swollen and irritated; they can start to really hurt. The “splint” is known more as the muscle/tendon injury with a small effect on the bone.

The shinbone, just like every other bone, has a “skin” layer on it called the periosteum. In shin splints, the periosteum is being elevated from the bone or pulled away. Tension from the muscle presents a strain on the bone surface creating irritation.

How do Shin Splints cause shin pain while running?

This pulling of the muscle and/or tendon on the bone creates so much local irritation, it can stop you dead in your tracks. The more the muscle/tendon pulls, the more painful.

Some may argue the muscle develops scar tissue and this is what causes the shin tightness. Some may say it is more of a bone injury.

I would say it depends on the runner. If you come in with clear swelling in the belly of the muscles of the shin, I would say it is more the muscle.

If you come with more tenderness around the surface of the bone I would investigate the bone more and advise getting imaging to better visualize the bone.

How can you rehab Shin Splints?

A quick disclaimer on this: if you do have a bone injury, there is a rest period that is needed.

If you have read my other articles, then you’ll know I don’t emphasis this often, so I really do mean it this time.

To rehab the area around the ankle and foot, we normally use exercises to accomplish the following goals:

• Foot arch strengthening
• Ankle muscle strength
• Foot/ankle proprioceptive control

Here is a great starting exercise from my good friend, Dr. Dimak.

It’s called Vele’s Forward Lean.

Here’s a series of exercises I recommend to begin strengthening of the muscles that cross the ankle.

Here is one of the exercises for Shin Splints that targets proprioception.

To correct the underlying cause of the issue, we often need to correct the function of the hip and core region. I usually narrow the exercises down based upon an indivdual’s needs, but I have used these exercises and stretches many times.

This is our Shin Splints stretching series. Although they are not all on the shin, they are extremely important to limiting the shin pain from returning when you start running again.

Here are some of our Shin Splints strength training exercises. Note, we are working on the core and hips…these are the key to preventing running injuries.

What kinds of treatments can be done for Shin Splints?

Here are some treatments that can greatly assist in decreasing shin pain while running:

• Active Release Technique
• Deep tissue massage
• Anti-inflammatory injections
• Prolotherapy
• Chiropractic adjustments or mobilizations
• Strength training/rehab
• PRICE therapy
• Running gait training

Shin Pain while Running

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ANTERIOR COMPARTMENT SYNDROME

Anterior Compartment Syndrome is an advancement of your typical Shin Splints.

How will you know you have one versus the other then?

Anterior Compartment Syndrome will feel more like swelling and extreme pressure; it may also include lack of sensation on the top of the foot and toes.

If you have been reading other websites on this condition, you may have seen there are two types: acute and chronic/overuse.

The acute type occurs with a trauma such as with a bone fracture. This type is a medical emergency, and you should be in the ER like an hour ago.

The chronic type develops over a long period of time and can respond to treatment and rehab.

What is Anterior Compartment Syndrome?

The anterior compartment is the section of the shin that contains the muscles, tendons, nerves and blood vessels. If we break down this name, it means:

• Anterior: in the front of the body
• Compartment: a fascial partition for the soft tissues of the body.

How does Anterior Compartment Syndrome cause shin pain while running?

Anterior Compartment Syndrome is when the compartment of the shin is not flexible or large enough to accommodate its contents. The compartment contains the muscles, tendons, nerves, and blood vessels.

When chronic Shin Splints occur, the muscles in this compartment slowly grow. As they grow, the relative space in the compartment decreases, leaving less room for the expansion of its contents during exercise.

When numbness occurs in the foot, the nerve passing through the compartment has become crushed.

Shin Pain while Running

How can you rehab Anterior Compartment Syndrome?

Rehab for Anterior Compartment Syndrome is much like Shin Splints, but you should expect significantly slower progress.

It can become down right frustrating and because of this, many people seek surgical intervention too early.

Part of my rehab for Anterior Compartment Syndrome includes a psychological approach because many runners I meet run as a means to control weight and “be healthy”.

Running is not the only way to accomplish these goals. So if we can steer the person into doing something different as a recreational activity, many times we can buy time for someone to give rehab a chance.

If you are a professional or collegiate runner, this is a different story.

What kinds of treatments can be done for Anterior Compartment Syndrome?

Here are some treatments that can greatly assist in decreasing shin pain while running:

• Active Release Technique
• Deep tissue massage
• Anti-inflammatory injections
• Prolotherapy
• Chiropractic adjustments or mobilizations
• Strength training/rehab
• PRICE therapy
• Running gait training

STRESS REACTION/FRACTURE

And now we are on to the worst severity of shin pain…actually, I take that back. Although bone injuries like Stress Reactions and fracture will mean rest, which many runners find frustrating, compartment syndrome, more often than not, yields longer-term frustration for runners.

• Does your shin pain feel like it’s directly on the bone?
• Does it not get worse over the run?
• Next to no pain when you start?
• Even painful at night sometimes?

Stress Fractures often need advanced imaging to see. By advanced, I do not just mean x-rays.

X-rays are a great starting point for ruling out other injuries, but they often miss a Stress Reaction. The have more potential to see a fracture.

Why?

X-rays are great at visualizing actual fracture lines in the surface of the bone, but they can’t pick up on the beginning of the injury.

An MRI can see a breakdown of the bone matrix (inside) and confirm the diagnosis of a Stress Reaction.

Shin Pain while Running
Shin Pain while Running

What is a Stress Reaction/Fracture?

I saw a great reference about having a more descriptive term for this condition than Stress Reaction.

The corrected term was “Chronic Repetitive Stress Injury of Bone.” Love it!

The term ‘Stress Reaction’ confuses many patients, so let’s get it clear right now: while it is not a fracture, it is an injury to the bone. The bone is breaking down, and a fracture will be next with the same activity level.

What causes a Stress Reaction/Fracture?

Too much too soon is a great yet simple answer.

Bones are very adaptable and WILL become more strong and dense in response to running and jumping forces, but if you do too much too fast, you don’t allow the bone to remodel.

It doesn’t remodel overnight.

Some other contributing factors that will limit the bone’s ability to remodel at the correct pace are:

• Osteopenia
• Osteoporosis
• Metabolic bone disorders
• Collagen disorders
• Hormonal imbalances
• Inadequate nutritional intake

I hope all of the women read the last two.

That’s right. If you are not eating enough or have lost your period periodically, you could have an eating disorder or be overtraining, which is contributing to your bone injury.

You should not be having bone injuries through the bulk of a training program… I can understand the beginning, but not in the middle or the end.

If you are, then you really need to take a look your eating and body weight.

How does a Stress Reaction/Fracture cause shin pain while running?

Again, a Stress Reaction or fracture to the shinbone will become aggravated with impact or landing. Walking, running, and jumping are high on the list of aggravating factors.

Activities that would hurt less are lighter strength training, swimming and cycling because they all have significantly lower impact on the tibia and the muscles of the shin.

How can you rehab a Stress Reaction/Fracture?

We like to consider the downtime from running as a blessing. This will give you some time to work on other aspects of your training that you may have not had time for when you were running.

Some things we typically add are:

• Multidirectional core stabilization
• Hip strengthening
• Lower limb proprioception

The Pallof Press is a great way to stabilize the core against rotation.

For hip flexibility, we like to do the following:

For leg proprioception, I like this as a starter:

What kinds of treatments can be done for a Stress Reaction/Fracture?

Sadly, a bone injury requires some waiting around, but that doesn’t mean you can’t strengthen and mobilize your core, hips, ankles and feet during that time.

Other treatments that you may find useful for reducing the discomfort are:

Active Release Technique
• Deep tissue massage
Chiropractic adjustments or mobilizations
• Strength training/rehab
• Flexibility work
• Rest
• Immobilization

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