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4 types of shin splints and their causes

The great thing about French Rugby teams is that they usually play in stadiums that are municipality owned venues that more often than not have a tartan running track around them.

The club I am currently with in the south of France had their stadium built for the USA Track and Field team in preparation for the Barcelona Olympics. To be running on the same track that Dennis Mitchell, Carl Lewis, Michael Johnson, Gail Devers and Evelyn Ashford ran on is a bit of a buzz. But surprisingly the tartan is also killing my shins.

It is not the tartan that is the problem, it is more my behaviour. Being on a tartan track is very motivational for pumping out repeat speed efforts. And this is what is killing my calves and shins. It is the volume of running and the speed at which I am doing it. So I am suffering from garden variety shin splints at the moment.

Shin splints can be broken down into a number of types. These are listed and explained as follows;

• Medial tibial stress syndrome (periostitis). This is an irritation of the muscle attachments that originate on the medial shin and pass downwards into the arch of the foot. Muscles such as soleus, tibialis posterior and flexor hallucis longus have been implicated in this type of shin splint. The pain is usually widespread along the distal third of the medial tibia.
• Stress fractures. Usually found in the tibia, these stress fractures can be very painful to touch (excruciating point tenderness) and may get night pain or resting pain. These may often be the end result of medial tibial stress syndromes if the runner ignores the pain and continues to push through. A bone overload develops and a stress fracture may result.
• Tibialis Anterior muscle trigger points. This is characterised by pain at the very front of the shin through the tibialis anterior. Usually caused by high volumes of downhill running where the eccentric control of dorsiflexion is required.
• Compartment syndromes. The calf and shin muscles are enveloped into four separate muscle compartments. A compartment syndrome develops due to growth of the muscles within the compartment without a subsequent stretching of the enveloping fascia. A deep tight ache is felt the further the person runs due to blood flow constriction and nerve compression. They may feel some numbness and tingling into the feet.

The cause of any of these problems can usually broken down into the following;

1. Biomechanical faults. Things such as overpronation, tightness in the calf muscles, weak anti-pronation muscles are examples of such causes.
2. Environment. The surface the runner runs on and sudden changes in the surface. Running on unforgiving concrete surfaces usually required a greater absorption of shock in the muscles and bones of the shin. This may then set off a shin splint type problem.
3. Equipment. Running in the wrong shoes or without orthotic support if required. These will both change the muscle recruitment and absorption forces across these muscles.
4. Training. Sudden increases in volume and/or intensity may also set off a shin splint type problem.

Therefore management of the various “shin splint” varieties is based on eliminating the causes and not on any recipe treatment. In my case, I need to modify the load and not go so hard for so long, but have a more gradual build up.

For someone else their cause may lie elsewhere and they may need correction of their over-pronation, or massage of their tight myofascial calf structures, or strengthening of their hip rotators and pelvic stabilisers. For others they may just need good advice on wearing the right running shoes.

Dr. Lavine has been an innovator in the use of movement and touch to promote health since 1981. He practices in New York City and Princeton, NJ.

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