Very professional and full of help and knowledge in trying to solve my on going ankle issue. All very friendly bunch of people I will certainly recommend.
Sue, Arborfield

Running with Shin Pain


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Running has become a popular pastime in the UK with the evolution of large city marathons and charity fun runs making endurance exercise a realistic and achievable target for both novice and experienced runners. With an increase in running participation, however, there has been a subsequent increase in running injuries.

Factors that commonly predispose a runner to injury include:

  • Sudden changes in training; a non-progressive change in the volume of training including running distances, frequency, intensity and type of training i.e. hill, interval, sprint or endurance will often overload the body exerting inefficient forces putting excessive pressure on the body that often manifest into injury.
  • New equipment such as training shoes or running kit may also result in an altered running pattern leading to injury. Certain injury patterns may develop when an individual switches from running on a soft surface, i.e. sand or grass, to concrete or a treadmill.
  • Previous injury and body conditioning have both been shown to have significant effects on running injuries whilst correct nutrition will also have a positive influence on injury prevention.
  • Biomechanical abnormalities frequently predispose running injuries. For example, an excessively high arch generally results in reduced force dissipation on foot strike with greater force transferred to the shin. Excessive foot pronation on the other extreme increases the distance across which the shin muscles must act to drive the body forwards during the propulsive phase of gait.

At Drummond our experienced staff believe in addressing all factors that may influence injury prevention and management.

The scope of this article is to highlight a predominant running injury: Shin Pain.

  • Do you feel ‘tightness’ that worsens with continued activity and eases rapidly on cessation, leaving an aching sensation?

You may be suffering from Chronic Exertional Compartment Syndrome (CECS). This occurs when the pressure within the calf compartment becomes elevated during exercise resulting in reduced blood flow and subsequently pain, a typical pattern of onset is after a certain set time or distance e.g my pain always comes on after 20mins running and eases rapidly when I stop, leaving an aching sensation .

  • Do you feel  pain of gradual onset that is exacerbated by exercise and may be present at rest or at night. Have you recently increased your training intensity or duration?

You may be suffering from a Tibial stress. This occurs when large amounts of compressive forces are placed through the tibia beyond what it can withstand. When these forces are excessive, or too repetitive, and beyond what the bone can withstand, bony damage can gradually occur. This initially results in a bony stress reaction.

  • Do you feel pain along the inner border of the shin that ‘warms up’ with initial exercise and worsens after exercise, with aching after prolonged rest or sleep?

You may be suffering from Medial Tibial Tenoperiostitis or ‘Shin Splints’  these occur when excessive traction forces are exerted upon the shin bone, commonly as a result of the repeated ankle movements during running, resulting in damage and inflammation of the connective tissue joining muscles to the inner shin bone. Runners more commonly develop this condition early in the running season following a period of reduced activity (deconditioning) and when running surfaces are generally harder.

What to do?

You: Initial management of running related shin pain requires an ice massage to reduce inflammation. An alteration of activity is advised, undertake low impact activity initially i.e. swimming, cycling, cross trainer. Eliminating hard surface running will reduce forces exerted up through the lower leg. Frequent calf stretches are also advised.

Intrinsic factors such as bone mineral density must also be considered with shin pain, especially in women, so women should be aware of any menstrual disturbances.

Us: Recognition and correction of abnormal biomechanics that are preventing you from running efficiently is essential to injury prevention and management. This may include addressing instability and compensating running patterns and/or orthotic support.

Together: Training environment and program should be discussed and adjusted accordingly to eliminate those factors that are predisposing injury, such as training surface, inappropriate footwear, inadequate warm up etc. Areas of weakness e.g. core and/ lower limb de-conditioning should also be addressed via a specific individualised rehab program. Recognising our body weight in relation to the type and amount of activity we are doing is another important factor to be considered in relation to shin pain and running injuries.

Summary

Diagnosis Pain Associated features Can Drummond Clinic help?
Chronic exertional compartment syndrome (CECS) None at rest, aching and tightness builds on exertion after specific duration May develop pins and needles or numbness to foot secondary to nerve compression with raised compartment pressures Yes
Tibial stress Localized sharp pain with subcutaneous tenderness Pain exacerbation with jumping and landing on injured leg Yes
Medial tibial periostitis (MTP) Diffuse ache—medial tibial border Worse in morning or after exercise Yes

Source: Adapted from Brukner and Khan. Clinical sports medicine (3rd edition) (2007) McGraw-Hill ISBN 007471520-8.

All of the above conditions can often co-exist and require a detailed management approach. At Drummond clinic we are experienced in and passionate about effective and efficient running, injury prevention and injury management to ensure you go all the distance!

 

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