Do I have shin splint?

Shin splints is a common colloquial term used to describe pain along the shinbone, which is the large front bone in the lower leg. However, it’s important to recognise that shin splints can be a broad and imprecise term, as various conditions can lead to similar symptoms. Runners, often experience shin pain, and it’s crucial to distinguish between different causes, such as stress fractures, medial tibial stress syndrome (MTSS) and posterior tibialis tendinopathy for example.

Stress Fractures in runners

One significant cause of shin splints is stress fractures. Stress fractures occur when repetitive stress on the shinbone exceeds the bone’s ability to repair itself. In runners, this can be a result of overtraining, sudden increases in running intensity, or running on hard surfaces. The symptoms of stress fractures include:

• Pain: Stress fractures often present as a localised, sharp pain along the shinbone during or after running. The pain gradually worsens with exercise to the point you can no longer continue to run and may persist at rest and even give pain at night in your sleep.
• Swelling: Swelling may accompany the pain, and the affected area may feel tender to the touch.

It’s important to note that stress fractures are not well seen on US and are often missed on x-ray so an MRI scan will be required for diagnosis. It’s crucial for runners experiencing these symptoms to consult a physio for a proper diagnosis and treatment plan, which may include rest, ice, and modified training. An interesting study from the Israeli Military showed that enforcing and minimum of 6 hours sleep and reducing load of marching and running decreased stress fracture rate by 10%. So, if you’re suffering a stress fracture – get plenty of sleep as well as looking at your diet for adequate amounts of protein, calcium and vitamin D.

On a side note, certain stress fractures are thought to be low risk and can be managed conservatively. An MRI might be useful however, a short period of rest can settle symptoms. These include:

• Posterior medial tibia (shin splints)
• Fibula / lateral malleolus
• Femoral shaft
• Pelvis
• Calcaneus
• Diaphysis of 2^nd to 4^th metatarsal

Others are thought to be high risk and if suspected need an urgent x-ray or MRI and may require 6-8 weeks of non-weight bearing to allow them to heal, so it’s best not to chance it.

• Femoral neck
• Anterior cortex of tibia (shin splints)
• Medial malleolus
• Talus
• Navicular
• Proximal diaphysis of 5^th metatarsal
• Base of second metatarsal
• Big toe sesamoids

What is Medial Tibial Stress Syndrome (MTSS)?

MTSS, commonly known as shin splints, is another prevalent cause of shin pain in runners. It occurs due to repetitive stress on the tissues surrounding the tibia, leading to bone oedema or swelling. MTSS is often associated with inadequate footwear, running gait faults such as over-pronation or excessive hip drop, or sudden changes in training load. The symptoms of MTSS include:

• Diffuse Pain: Unlike the localised pain of stress fractures, MTSS typically causes a diffuse pain along the inner edge of the shinbone. The pain may be present during and after exercise.
• Tenderness: Runners may experience tenderness along the inner aspect of the shinbone, and this tenderness may extend over a larger area compared to the focused tenderness of stress fractures.

Treatment for MTSS involves a period of rest and addressing the underlying causes, such as correcting running mechanics, using appropriate footwear, and incorporating strength training for the lower limbs.

Posterior Tibialis Tendinopathy

Posterior tibialis tendinopathy is a less common but annoying cause of shin pain in runners. It involves the dysfunction of the posterior tibialis tendon, which supports the arch of the foot. The Posterior tibialis tendon is very well seen on ultrasound, and we can distinguish if there is a tendon problem without further imaging. The symptoms of posterior tibialis tendinopathy include:

• Pain on the Inner side of the shin: similar to MTSS, pain is often felt along the inner side of the shin, but it may extend into the inner arch of the foot.
• Weakness and instability: Runners may experience weakness and instability in the arch of the foot, leading to changes in gait.
• Swelling: Swelling may be present, particularly along the course of the posterior tibialis tendon.

Treatment for posterior tibialis tendinopathy involves rest, physical therapy to strengthen the affected tendon, and orthotics to support foot mechanics. Sometime a course of shockwave may also be useful.

While shin splints is a term commonly used to describe shin pain in runners, it’s essential to recognise that this can be an umbrella term for various conditions. Stress fractures, medial tibial stress syndrome, and posterior tibialis tendinopathy are just a few examples of the potential causes of shin pain. Runners experiencing persistent shin pain should seek the advice of a physiotherapist for an accurate diagnosis and a tailored treatment plan.