Your lower legs throb and ache after workouts, so you think you have shin splints. There’s a good chance you’re wrong.
People often incorrectly self-diagnose shin splints. With the information readily available to the public, it’s not hard to see why. WebMD lists shin splints as a pathology, and other websites classify it similarly. Their descriptions usually read something like this: “Shin splints refer to pain in the lower leg.” But as an athletic trainer, I can tell you: This doesn’t provide you with nearly enough information.
When people say they have shin splints, usually what they are really saying is that their shins hurt and they don’t know why. But many injuries can manifest themselves as shin pain, including some that don’t even originate in the shin. If we’re going to understand how to treat the problem, we first need to understand what the problem actually is. Should we treat a stress fracture the same way we would treat tendonitis? Certainly not. If that problem isn’t addressed, the pain won’t be either.
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What it isn’t
A similar common junk term we hear is Medial Tibial Stress Syndrome (MTSS.) Shin splints and MTSS are used interchangeably in a lot of literature. This is not akin to calling a “fracture” a “broken bone.” Rather, it implies that we’ve thrown up our hands and given up on making an effort to properly classify each injury. This is most notable in studies where investigators try to find the best treatment for MTSS and fall short with a poor conclusion, because they were never sure what the injury was in the first place. MTSS is not definable because it is too broad a term. Commonly, however, it’s used to describe periostitis (inflammation of the outer layer of bone on the tibia), which can be the beginning of a stress fracture.
Athletes typically label general pain somewhere on their lower leg as “shin splints.” They don’t really think beyond that generality, and they try things like foam rolling, ice buckets, massage and stretching to ease the pain. This can be a huge mistake. They are not treating the source of the pain, only the symptoms. The treatment they give themselves may not be optimal and can sometimes be detrimental.
So why do their shins hurt? Over a dozen common injuries are associated with shin pain. The best way to know is to get a professional evaluation. Terms like MTSS and shin splints are broad general terms for an unknown pathology, and any term that covers everything doesn’t tell you anything.
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No concrete data exists on the most common injuries classified as “shin splints,” because they aren’t often properly diagnosed. In my experience, the most common maladies are periostitis and posterior tibialis tendonitis. The posterior tibialis tendon runs along the mid shaft of the tibia and is adhered to by connective tissue, making it sometimes difficult to differentiate in terms of pain.
Athletes who have pain that increases during activity and are tender directly on the tibia may have periostitis. If pain and stiffness initially subside during activity and return once the muscle has less blood flow, it is more likely to be posterior tibialis tendonitis. Again, this doesn’t rule out the possibility of a stress fracture or other less-common injuries such as tendonosis (a longer term degeneration of the tendon sheath). The only thing this injury is not: shin splints.
What to do
If you’re experiencing lower-leg pain, step one is always to see a sports medicine orthopedist or certified athletic trainer. There are simple ways to differentiate among the major injuries and large red flags that require referral for further testing. A physical therapist may be more accessible but not trained to diagnose injuries—unless he or she also has an athletic training certification.
When physical therapists evaluate athletes, a prescription from an orthopedist identifies the injury. If you must do a self-assessment to narrow down the source of the injury, use your thumb to press down and pinpoint the actual pain. If it’s clearly on the bone, you probably need an x-ray to rule out a stress fracture. If it’s more in the soft tissue, it may be tendonitis caused by overtraining, improper training, an increased workload or bad mechanics. Don’t assume it’s either one. Get a qualified professional’s opinion.
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Beyond the injury
We also need to think a level deeper than simply looking at the shins. Stress fractures and tendonitis are common in runners, but for many different reasons. Especially in the context of running, pain below the knee is often caused by a problem at or above the knee. Weak glutes, anteverted hips, poor posture, patellafemoral syndrome and other issues can cause excess pounding on the tibia, eventually causing further injury. Flat feet can cause concern as well. Again, you need a full evaluation. Alleviating the pain in your shins may immediately help, but treating the cause of the pain is more important.
Since shin pain is often accompanied by another structural issue, you need to work hard to correct it. For example, if you have flat feet, often you’ll also have squinting patella, an inward rotation of the kneecap, which can also be seen with excessive internal rotation of the hip. So, the question is: which came first? The flat feet, the shin pain or the rotated hips? This question needs to be answered by a professional.
On the flip side, athletes should do things proactively to prevent these types of injuries in the first place. Proper mobility in the shoulders and hip joints, strengthening the muscles and connective tissue around joints, and proper posture all contribute to establishing a stable base before you engage in athletic activities.
Since some of the most common athletic issues stem from general lack of mobility, core instability and weakness in the glute muscles, some general mobility exercises such as long Lunges and Shoulder Pull-Aparts with a band are great ways to determine your own baseline. To test your own lower-body strength, perform a Depth Jump from a 24-inch box, landing on both feet at the same time. If your knees cave in, more than likely you need to strengthen your hips before considering running or strength sports. You need to get a comprehensive evaluation to look at all the possibilities. Otherwise you’ll just be slapping tape on your shins.
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