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Shin splints is a term used to describe pain in the lower leg that occurs during exercise. This condition has many causes and can affect athletes at all fitness levels. One common cause of shin splints is posterior tibial syndrome (PTS). The pain associated with PTS occurs on the medial (inside) border of the tibia (shin bone). The pain present when you start exercising becomes less severe as you warm up but becomes worse than ever after you stop exercising. Posterior tibial syndrome often occurs in beginning runners, who are unaccustomed to the activity and running surface, but can occur in seasoned athletes when they change running surfaces, exercise in different shoes, or increase their intensity or duration of exercise.

TIBIAL STRESS SYNDROME

This is another catch-all term that covers several more specific diagnoses including posterior shin splints, anterior shin splints, and perhaps could even include compartment syndromes. For the purposes of our discussion we’ll look at the two most common: posterior and anterior shin splints. Anterior shin splints are really an inflammation of the tendons that attach to the front of the shin bone to the outside. One large muscle, the Tibialis Anterior, is primarily responsible for keeping your toes from dragging when you swing your leg through to take a step, and acts to gently lower the forefoot to the ground when the heel strikes. It also is responsible to help decelerate the pronation of the foot that occurs shortly after heelstrike. This muscle acts in opposition to the larger calf muscle group in the back, and hence a primary cause of irritation is a lack of adequate flexibility in the calf muscles. Early symptoms usually consist of aching in the muscle on the front outer part of the shin during running, and gradually persist until there is a defined and sharp pain along the front outer tibia (shin bone) even with walking. Posterior shin splints are an inflammation of the tendons that attach to the inner side of the shin bone. A common muscle involved is the Posterior Tibialis. This muscle is quite active in decelerating the pronation (inward rolling) motion of the foot. Symptoms usually consist of an aching that occurs along the inner front surface of the shin bone and may progress down to the arch of the foot. Generally the pain occurs when you first run, and may subside later in the run only to return later. As the inflammation worsens, the symptoms are present with walking and may also present as a tenderness and stiffness when first arising. With either of these syndromes, there may be localized tenderness to the touch and there may also be some swelling. If there is acute tenderness, warmth, redness and swelling, a stress fracture should be ruled out by a physician using X-Ray or bone scans. The most common causes for both of these syndromes are lack of adequate calf muscle flexibility, and faulty biomechanics. If rest, ice and stretching don’t give substantial relief fairly quickly you should definitely pursue the advice of a biomechanical specialist.

PROBABLE CAUSES

  • tight calf muscles
  • biomechanical faults (excessive or prolonged pronation)
  • increasing mileage too fast
  • excessive shoe wear
  • training errors (too much hill work or speed work too soon)

TRAINING STRATEGIES:

  • stretch tight calf muscles (several times a day is good)
  • decrease mileage and hill work / speedwork
  • assess shoe wear and replace frequently
  • see biomechanical specialist for full gait analysis, orthotics and treatment as needed.