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Shin Pain

If you have ever embarked on a new fitness regime you would most likely have tried to run or walk. Running and walking combined are the two most common forms of recreational fitness and given the repetitive nature of each of these it is not surprising they both commonly cause lower limb (e.g. shin) injuries.

Shin splints are an extremely common injury that present at our clinic. As a podiatrist I love it when someone beings to tell me their story of two weeks of running followed by some general pain through the inside or outside of their shin bone and then an inability to continue at the desired intensity due to pain. It excites me because I know I can help.

To have grasp on how we are going to treat shin splints we need to be clear on the structures that are actually getting sore. Shin splints is a term that can be used by the average punter, but your podiatrist will inform you there are multiple and more specific types of shin pain.

Medial tibial stress syndrome (MTSS)

This is where the membrane, which envelops the bone, becomes inflamed. Often the muscles attaching to the tibia bone are also involved; these are the soleus and tibialis posterior.

What does it feel like?

  • Often very painful and sharp.
  • Warms up when getting going with exercise.
  • Sore once cooled down after your work out.
  • Pinpoint pain along the inside or outside of the bone.

How can I fix my MTSS?

  • Ice and soft tissue massage for the surrounding tissues, try not to massage directly on the bone.
  • Improve your loading patterns; assess how your running or walking program may be impacting on your body’s ability to cope with the stress.
  • Improve your calf strength, especially with bent knee calf raises.
  • Check your footwear.

Stress reaction/fracture

When we run we inflict damage to all our tissues. With adequate rest our body can repair and our bone tissue becomes stronger. A stress reaction occurs when the damage caused from exercise out-weighs the ability of our bone to repair, causing the bone structure to breaking down and becoming weaker. At this point a fracture is not present, however if the damage is not treated then the stress reaction can become a stress fracture.

What does it feel like?

  • More of a dull pain; the dull ache is often present when we are resting.
  • A stress fracture will be painful all the time, it will not warm up and running is becoming really difficult to even think about.

How can I fix my stress reaction/fracture?

  • It may be necessary for you to rest until the symptoms have gone.
  • Improve your loading patterns; assess how your running or walking program may be impacting on your body’s ability to cope with the stress.
  • Improve your calf strength.
  • Have your biomechanics assessed.
  • Check your footwear.

Compartment syndrome

Compartment syndrome occurs when there’s a large amount of pressure inside a muscle compartment. Compartments are groups of muscle tissue, blood vessels, and nerves surrounded by a very strong membrane called the fascia. During exercise these compartments increase in pressure and this can cause significant pain or loss of function.

What does it feel like?

  • Compartment syndrome can feel like a heavy tightness or pressure build up in your leg, this then becomes too painful to continue.
  • It can progress to a loss of function or numbness.
  • It usually occurs after ten minutes of higher than usual intensity of exercise however once this is over the symptoms should reduce.

How can I fix my compartment syndrome?

  • This is probably the most difficult of them all; it can require biomechanical intervention, or running technique changes.
  • Correct footwear is extremely important to ensure loading is taking place away from the painful site.
  • Improve your strength all over your body.
  • Have your biomechanics assessed – as mentioned gait retraining is critical.
  • Loading is still important; trialling a slowing build up into your running program may also help.

A Podiatrist’s role in all of this is critical. If you are on the more severe end of the scale you may also be referred to a physiotherapist for assessment and strength training. Orthoses, footwear, strengthening and gait retraining all need to be considered and at the appropriate time introduced into the ongoing care. Not all of these will be required however having a clear understanding of your critical risk factors will give the best chance of developing a treatment protocol and ultimately a reduction in injury.

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