Nov
Shin Pain
A Pain in the Shin
Aches and pains may seem like a regular part of life now that we are getting ready for fall marathons. However sharp, worsening shin pain should not be ignored. Increase in training distance or intensity, foot overpronation (rolling in), and change in running surface or shoe may be partially to blame for the pain. “Shin splints” is actually a catch all term for several different conditions. The three most common causes of shin pain in a runner are:
- Periostitis (per-ee-os-tie-tis)
- Stress Fracture
- Compartment Syndrome
Anatomy
The lower leg has two long bones: the tibia and the fibula. Additionally the muscles of the lower leg are divided into 3 long “sausage like” compartments. These compartments are named by their positions on the leg. The anterior compartment is on the front, while the lateral and posterior compartments sit on the outer side and backside respectfully.
I. Periostitis
Most bones are lined by a thin layer of tissue called periostium (literally, around the bone). On the front of the leg, the periostium is continuous with the muscles that lift the foot off the ground (an important part of running). Overuse of these muscles pulls on the periostium causing irritation and inflammation. An inflamed periostium is called “periostitis.”
Early treatment of periostitis is focused on controlling pain and inflammation. RR (relative rest), ice, stretching, physical therapy, and anti-inflammatory medication may be helpful. Once pain and swelling are under control, a program to strengthen the muscles of the front of the leg is necessary. Your Sports Medicine practitioner can prescribe an effective program.
II. Stress Fracture
Of coarse not all boney leg pain has the same cause. Tibial or fibular stress fracture is a fairly disabling injury. Distinguishing stress fracture from periostitis means a visit to your Sports Med physician for x-rays or other radiology tests.
Training errors, worn out foot wear, and poor biomechanics put a runner at risk for this injury. Women are at risk for stress fractures if they are amenorrheic or oligomenorrheic (have no periods or irregular periods). These menstrual abnormalities are potentially dangerous and should be treated.
Stress fractures take several weeks to heal. Although a big bulky cast in not necessary, certain types of splints have been shown to speed recovery, and a good period of RR is mandatory. During this time, non-impact activities (like riding, and deep water running) are OK. Your health care provider can decide when you are ready to start hitting the trails.
III. Compartment Syndrome
Shin pain is sometimes located over the muscles, rather than over the bones of the leg. If this is the case, and things do not get better with a bit of RR, stretching, and ice, then compartment syndrome is a possibility.
We already said the muscles of the lower leg are divided into 3 sausage shape compartments. Because these compartments are rigid, when an overused muscle wants to get angry and swollen, there is nowhere for the swelling to go. This swelling causes the pressure in the sealed off compartment to rise. If the pressure gets too high in a compartment, circulation and nerve function may get “squeezed off.”
Proper diagnosis of compartment syndrome requires measuring the pressure in the compartment with a needle and pressure gauge (like inner tube pressure). If a runner does have high pressure after a workout, she might be offered a surgical procedure to open up the tissue that keeps the compartment rigid. Most athletes do very well with this procedure; however, it is surgery and should not be taken lightly.
Happy trails! Tune in next month…
