Top 3 Reasons For Shin Pain While Running

Shin Pain While Running

• Pain below the knee/above the foot?
• Tight shins while running?
• Gets worse while running?

Shin pain while running is common in our sport, but it does not have to be the end of your training this season.

Hi, I’m Dr. Sebastian Gonzales. I own a rehab clinic in Huntington Beach, CA where we specialize in reduction of running injuries.

I’ve run many races from 5k’s to 1/2 Irons. I’ve experienced aches and pains as a runner, just as you have, yet I’ve been fortunate to have a profession where I have an education to trouble-shoot “what works and what doesn’t work” to heal conditions like shin pain.

I’m here to guide you through you’re search about recovering from shin pain as a runner.

If you’re in the Southern CA area, book a time with me. The proof is in the pudding and it’s faster to make pudding when you can use your hands.

Believe me, this too will pass, just as it has with many other runners before you.

People recover from shin pain everyday. All you need to do is duplicate what works. Just book an appointment with me HERE.

I know an injury can be frustrating, but when treated and rehabbed well, it can be a blessing in disguise.

Here are the “Big Three” when it comes to shin pain while running:

• Shin Splints
• Anterior Compartment Syndrome
• Stress Reaction/Fracture

Through this article you learn symptoms, causes, common treatments (good and bad), and rehab.

I’ve included some video on treatments and corrective exercise yet to be honest some of the info is about a year outdated. 2.0 videos can be found in the Volume 1 of the Shin Guide.

There will be more in-depth information and “how to” videos on how to overcome shin issues as fast as possible… so you can run again.

Find it here if you’re interested… if you don’t like simply return for a full refund.

SHIN SPLINTS

• Throbbing shin after a run?
• Tender to touch?
• Swollen inside the shinbone?

Shin Splints is the most common reason for shin pain while running, but it doesn’t just afflict runners.

Many beginner exercisers will develop it, and sadly, it can be a reason why they stop on their journey to health.

Let me get real for a second…if you are a seasoned runner, this normally occurs if you jump around in your mileage.

Some of my patients with decades of running under their belts have developed this after they took a month off from another injury and jumped back in with a high mileage volume.

Shin splints is an injury of negligence.

What Causes Shin Splints?

Shin Splints is also known as Medial Tibial Stress Syndrome (MTSS), so don’t get confused by the verbiage.

Let’s break down the name Medial Tibial Stress Syndrome:

• Medial: to the inner side
• Tibial: this is the proper term for the shin bone
• Stress: when a load is being placed on something
• Syndrome: a presentation of a collection of common symptoms that they thought it would be cool to name.

Pretty easy to understand, right?

Some of you who have come to this article from another site may be saying, “Hey, I saw on another site that it is a bone injury…?”

Yes, you are correct.

The top three conditions causing shin pain while running are almost all the same injury as one another, but they differ in their severity. Don’t ask me why they named each of them something different…I didn’t name them!

The term Shin Splints actually refers to injury of the muscle and the “skin of the bone”. It can also be called Medial Shin Splints.

There is Posterior Shin Splints, which I cover in my “Calf Pain” page.

Injury to the muscles of the shin occurs when they become damaged, torn, swollen and irritated; they can start to really hurt. The “splint” is known more as the muscle/tendon injury with a small effect on the bone.

The shinbone, just like every other bone, has a “skin” layer on it called the periosteum. In shin splints, the periosteum is being elevated from the bone or pulled away. Tension from the muscle presents a strain on the bone surface creating irritation.

Cause Of Shin Splints

This pulling of the muscle and/or tendon on the bone creates so much local irritation, it can stop you dead in your tracks. The more the muscle/tendon pulls, the more painful.

Some may argue the muscle develops scar tissue and this is what causes the shin tightness. Some may say it is more of a bone injury.

I would say it depends on the runner. If you come in with clear swelling in the belly of the muscles of the shin, I would say it is more the muscle.

If you come with more tenderness around the surface of the bone I would investigate the bone more and advise getting imaging to better visualize the bone.

Shin Splints Rehab

A quick disclaimer on this: if you do have a bone injury, there is a rest period that is needed.

If you have read my other articles, then you’ll know I don’t emphasis this often, so I really do mean it this time.

To rehab the area around the ankle and foot, we normally use exercises to accomplish the following goals:

• Foot arch strengthening
• Ankle muscle strength
• Foot/ankle proprioceptive control

Here is a great starting exercise from my good friend, Dr. Dimak.

It’s called Vele’s Forward Lean to assist in improving the forward fold envelope, which assists in load management of the shin in running gait.

Here’s a series of exercises I recommend to begin mobilize and strengthening of the muscles that cross the ankle. In clinical practice, I’ve found many runner’s feel really good after a simple mobility circuit like this, but the feeling doesn’t lasting too long unless they add some loaded movement in after. I’ll cover some in the next section.

One exercise we can use to hit the “save button” on the mobility/ “feel good” work we just did is the single leg deadlift. No weight is required, because we will be using our own body weight to get the same results.

You may be thinking “what does a weightlifting exercise have to do with shin pain?”… well, consider what’s supporting body. Your foot, ankle, arch, hips and core. As we start to move our bodyweight over both feet (from a shift of the hips), we begin to slowly expose the tendons and muscles of the shin, foot and arch to resistance. Tendons and muscles repair well when they are exposed to progressive loading (first slow, then fast). Rather than throwing you into a long run, we can decrease the risk of pain returning if we load the arch this way.

Does this work with bone stress reactions and fractures? Not in the beginning no. Healing a bone injury is different in the beginning, but when you start to return to running this is a great plan of attack.

Can you use weights when doing these types of exercises? Yes, but as you start to add weights risk of back injury will increase without proper coaching. As a general rule, no movement is bad but too much exposure too fast will create an injury. Improper form with weightlifting loads the spine very quickly so injuries happen.

This exercise is just one example. In the Mini-Guide, An Introduction Into The 9 Best Effective Corrective Exercises For Shin Issues, I cover a few more that you’ll want to know. Again if you hate it just email for a full refund.

Shin Splints Treatment Options

Here are some treatments that can greatly assist in decreasing shin pain while running:

• Active Release Technique
• Deep tissue massage
• Anti-inflammatory injections
• Prolotherapy
• Chiropractic adjustments or mobilizations
• Strength training/rehab (see last section, most effective option)
• PRICE therapy
• Running gait training

If you’re in Southern CA come on in and see me. Let’s get this all handled ASAP. Book a time at the top of the page.

ANTERIOR COMPARTMENT SYNDROME

Anterior Compartment Syndrome is an advancement of your typical Shin Splints.

How will you know you have one versus the other then?

Anterior Compartment Syndrome will feel more like swelling and extreme pressure; it may also include lack of sensation on the top of the foot and toes.

If you have been reading other websites on this condition, you may have seen there are two types: acute and chronic/overuse.

The acute type occurs with a trauma such as with a bone fracture. This type is a medical emergency, and you should be in the ER like an hour ago.

The chronic type develops over a long period of time and can respond to treatment and rehab.

What is Anterior Compartment Syndrome?

The anterior compartment is the section of the shin that contains the muscles, tendons, nerves and blood vessels. If we break down this name, it means:

• Anterior: in the front of the body
• Compartment: a fascial partition for the soft tissues of the body.

How does Anterior Compartment Syndrome cause shin pain while running?

Anterior Compartment Syndrome is when the compartment of the shin is not flexible or large enough to accommodate its contents. The compartment contains the muscles, tendons, nerves, and blood vessels.

When chronic Shin Splints occur, the muscles in this compartment slowly grow. As they grow, the relative space in the compartment decreases, leaving less room for the expansion of its contents during exercise.

When numbness occurs in the foot, the nerve passing through the compartment has become crushed.

Anterior Compartment Syndrome Rehab

Rehab for Anterior Compartment Syndrome is much like Shin Splints, but you should expect significantly slower progress.

It can become down right frustrating and because of this, many people seek surgical intervention too early.

Part of my rehab for Anterior Compartment Syndrome includes a psychological approach because many runners I meet run as a means to control weight and “be healthy”.

Running is not the only way to accomplish these goals. So if we can steer the person into doing something different as a recreational activity, many times we can buy time for someone to give rehab a chance.

If you are a professional or collegiate runner, this is a different story.

Anterior Compartment Syndrome Treatment Options

Here are some treatments that can greatly assist in decreasing shin pain while running:

• Active Release Technique
• Deep tissue massage
• Anti-inflammatory injections
• Prolotherapy
• Chiropractic adjustments or mobilizations
• Strength training/rehab
• PRICE therapy
• Running gait training

STRESS REACTION/FRACTURE

And now we are on to the worst severity of shin pain…actually, I take that back. Although bone injuries like Stress Reactions and fracture will mean rest, which many runners find frustrating, compartment syndrome, more often than not, yields longer-term frustration for runners.

• Does your shin pain feel like it’s directly on the bone?
• Does it not get worse over the run?
• Next to no pain when you start?
• Even painful at night sometimes?

Stress Fractures often need advanced imaging to see. By advanced, I do not just mean x-rays.

X-rays are a great starting point for ruling out other injuries, but they often miss a Stress Reaction. The have more potential to see a fracture.

Why?

X-rays are great at visualizing actual fracture lines in the surface of the bone, but they can’t pick up on the beginning of the injury.

An MRI can see a breakdown of the bone matrix (inside) and confirm the diagnosis of a Stress Reaction.

What Is A Stress Reaction/Fracture?

I saw a great reference about having a more descriptive term for this condition than Stress Reaction.

The corrected term was “Chronic Repetitive Stress Injury of Bone.” Love it!

The term ‘Stress Reaction’ confuses many patients, so let’s get it clear right now: while it is not a fracture, it is an injury to the bone. The bone is breaking down, and a fracture will be next with the same activity level.

Stress Reaction/Fracture Causes

Too much too soon is a great yet simple answer.

Bones are very adaptable and WILL become more strong and dense in response to running and jumping forces, but if you do too much too fast, you don’t allow the bone to remodel.

It doesn’t remodel overnight.

Some other contributing factors that will limit the bone’s ability to remodel at the correct pace are:

• Osteopenia
• Osteoporosis
• Metabolic bone disorders
• Collagen disorders
• Hormonal imbalances
• Inadequate nutritional intake

I hope all of the women read the last two.

That’s right. If you are not eating enough or have lost your period periodically, you could have an eating disorder or be overtraining, which is contributing to your bone injury.

You should not be having bone injuries through the bulk of a training program… I can understand the beginning, but not in the middle or the end.

If you are, then you really need to take a look your eating and body weight.

How does a Stress Reaction/Fracture cause shin pain while running?

Again, a Stress Reaction or fracture to the shinbone will become aggravated with impact or landing. Walking, running, and jumping are high on the list of aggravating factors.

Activities that would hurt less are lighter strength training, swimming and cycling because they all have significantly lower impact on the tibia and the muscles of the shin.

Stress Reaction/Fracture Rehab

We like to consider the downtime from running as a blessing. This will give you some time to work on other aspects of your training that you may have not had time for when you were running.

Some things we typically add are:

• Multidirectional core stabilization
• Hip strengthening
• Lower limb proprioception

The Pallof Press is a great way to stabilize the core against rotation.

For hip flexibility, we like to do the following:

For leg proprioception, I like this as a starter:

Stress Reaction/ Fracture Treatment Options

Sadly, a bone injury requires some waiting around, but that doesn’t mean you can’t strengthen and mobilize your core, hips, ankles and feet during that time.

Other treatments that you may find useful for reducing the discomfort are:

• Active Release Technique
• Deep tissue massage
• Chiropractic adjustments or mobilizations
• Strength training/rehab
• Flexibility work
• Rest
• Immobilization