In his latest blog for Precision Fuel & Hydration, Sports Physiologist Ben Cox sheds some light on the myths surrounding shin splints by explaining what they are, what causes them and how we can treat them...
As a running coach, I'm regularly asked two questions - "how do I get rid of a stitch?" and "why do I keep getting shin splints?".
Considering they're both very common conditions, they're equally shrouded in mystery when it comes to cause and cure.
The first thing I need to point out is that shin splints don’t actually exist as a single definable condition. If you asked a range of athletes what shin splints are exactly, they would give you a variety of answers.
What are shin splints?
If you asked medical practitioners and therapists for a definition of shin splints you would get a wide range of explanations.
The reason for this is that shin splints is a convenient term for lower leg pain and so it's important to diagnose what type of lower leg pain the athlete is suffering with.
A common misdiagnosis of shin splints is 'medial tibial stress fracture'. This is clearly a fracture and not a splint. When researching academic papers on 'shin splints', some will refer to it as a condition in the bone and some will state that it's a muscular condition – it’s both and more.
I must point out that I don’t want to play down the importance of 'shin splints', in fact I think we need to pay more attention to this lower leg pain. As a coach, if someone comes to me complaining of shin splints, it needs to ring alarm bells rather than shrugging it off and telling them to use a foam roller on their shins.
The reason I suggest a more focused approach to lower leg pain is because it could mean that the person is suffering from something more sinister. For example, if they have Medial Tibial Stress Syndrome (MTSS), then this can progress into a full-blown stress fracture.
Assuming that someone has had shin splints redefined as lower leg injury, and has been to see a medical professional to make sure that there's no stress fracture or that it's not the result of bony growths at the proximal or distal ends of the tibia, then we may come down to the most common diagnosis: Medial Tibial Stress Syndrome (MTSS).
Causes of MTSS
We finally got there, the shin splints are MTSS, but what can we do?
To cure something, we first need to know the cause. It appears that MTSS can have a whole host of causes, both muscular and skeletal.
For example, the following is a typical (but far from complete) list of causes:
- Foot and ankle biomechanics during activity
- Hip rotation degree
- Over use of the Achilles
- Calf girth and lower leg metrics
- Inflammation of the periosteum
- Repetition of impact forces
- Narrow tibial bone ratio
- Soft tissue traction
- Navicular drop height
- Iliospinale height
- Trochanteric tibial lateral length
The reason I have honed-in on MTSS is because I believe it to be the most common, and the most likely, cause of self-reported 'shin splints' amongst runners.
To show how common MTSS is I’ve pulled out a few raw statistics from studies. Amongst studies of military recruits, one study reported that 35% of 124 recruits developed MTSS during basic training and another reported 16.6% of 181 recruits developed MTSS.
A study of high school cross-country runners reported 12% of 125 runners developed MTSS.
In a study of 146 running and jumping collegiate athletes, 20% developed MTSS during their competitive season.
How to treat MTSS
It's clear that telling someone to roller if they ask you what to do about shin splints doesn’t cut the mustard.
We need to make sure medical diagnosis is obtained, isolate the root cause and then treat the root cause.
In treatment of MTSS, pretty much all advice for immediate relief is R.I.C.E (Rest. Ice. Compression. Elevation), although this amounts to relief rather than cure.
I believe that in general, MTSS in runners is manifested by an inflammation of the periosteum, so anti-inflammatory methods could help, either natural or medicinal.
It's reported that having ‘flat feet’ is a precursor to MTSS, so a visit to the podiatrist and some orthotics is likely to be a good starting point for those athletes.
Through reading various studies on treatment of MTSS, it seems that reducing running volume and increasing strength training in the lower leg is the most sensible approach.
Ultimately, MTSS is a repetition injury so we need to reduce the repetition.
There's plenty to say it's an imbalance and muscular reaction, so strength training ticks this box. In addition, there's plenty of evidence to suggest strength training promotes and increases bone growth, so we get the bone strengthening too.
Finally, it's worth noting that several studies have shown lower leg Kinesio taping has been successful at preventing the onset of MTSS during exercise.