April 8, 2015

shin splints

If you have been reading my blog, my goal was to initially complete a series on needling in the profession of physiotherapy. Don’t worry folks, I still plan on completing that series! It’s just on pause for now. I have chosen to stray from my previous plan and look at a common problem that plagues many runners, because as we all know, April showers bring May flowers, and a boat-load of running injuries! Also, my boss wanted me to do a blog on running. Since she is of course, my BOSS, I figured I should make like a good employee and write about shin splints!

Shin splints is a funny diagnosis. It’s a funny diagnosis because shin splints is typically used as a catch-all term to describe shin pain. In fact, shin splints is defined by the American Academy of Orthopaedic Surgeons as “pain along the inner edge of the shinbone (tibia)”. So in a nut shell, shin splints = shin pain. This makes its diagnosis confusing. Imagine this typical made-up conversation:

              Hello doctor, I have pain in the inner, lower portion of my legs after running.

              That is easy! You have shin splints!

              Oh, that answers EVERYTHING. I have shin splints!

But I just told you that shin splints = shin pain. See the problem here? Shin splints doesn’t actually tell me what’s causing your pain! Here are three reasons you may develop shin pain, also known as the notorious shin splints.

1) Medial tibial stress syndrome. This is also known as “too much, too soon” syndrome. MTSS is typically the result of overloading the tibia with biomechanical inefficiencies. This can lead to periostitis, an inflammation of the membrane (a.k.a. periosteum) covering the bone. Ever wonder why it feels like your bone is bruised? Muscular imbalances commonly seen in the tibialis anterior, tibialis posterior and soleus muscle in combination with excessive pronation often puts too much stress on that poor tibia bone. As a result, the tibia bends and bows more than it should. This pulls on the connective tissue attaching to the bone itself. More pulling = more inflammation = more periostitis = more pain. Addressing the biomechanical inefficiencies while decreasing excessive load is key in making sure this bad guy goes away! It usually presents as a dull, diffuse ache along the bone of the tibia.

2) Compartment syndrome. Compartment syndrome is the compression of nerves, blood vessels, and muscles inside a closed space, or compartment, surrounded by a sheet of fascia. There are four different compartments in the lower leg. In order to understand compartment syndrome, you need to understand the role of fascia. Fascia is connective tissue, which attaches, stabilizes, encloses, and separates muscles and other internal organs. It is literally EVERYWHERE in the body. It also does not like to expand very much. As a result, if a compartment in the lower leg swells beyond the stretching capability of the fascia, pressure inside the compartment can increase and increase, and INCREASE. This is serious and can cause tissue death due to the compression of blood vessels (lack of oxygen). If you are experiencing extreme tightness, burning, pins and needles and/or temporary paralysis with running, PLEASE STOP and seek a medical opinion!

3) Tibial stress fracture. A stress fracture is exactly what it sounds like, a fracture or crack in the bone. It is the consequence of the tibia failing mechanically due to repetitive submaximal stress. It is also known as “too much, too soon, too late” syndrome. But Bailey, I’m only running. This is a submaximal stress! How can I get a fracture?! Well, repetitive submaximal stress can cause an imbalance in your body’s ability to resorb bone and form bone. In this case, there is more bone resorption then formation. So even the smallest, most microscopic crack in a bone can progress and worsen under repetitive, submaximal stress. With tibial stress fractures, a runner will experience very localized tenderness directly on the bone. You may even feel a bony anomaly under your finger. Unlike MTSS, you will probably experience pain immediately when you start running in a very point-specific spot. If you suspect a fracture, PLEASE STOP and seek a medical opinion!

Bailey Gresham is a registered physiotherapist for Whole Therapy. She specializes in manual therapy and movement-based therapy. She likes bridging the gap between rehabilitation and performance training.  More about Bailey here.