Several factors can cause shin pain in runners. The most prevalent are poor shoes, hard or crowned running surfaces, not stretching enough before running or simply flat or too highly-arched feet.
There are few running injury physiology voices on the Internet more valuable than Dr. Stephen Pribut’s, who speaks authoritatively and lucidly on a wide range of topics of essential interest to any serious runner. On his excellent page he pronounces the term “shin splints” as passe, out, dead, replaced by “medial tibial stress syndrome”, “compartment syndrome” and “stress fracture”. On this, as many other topics, you’re well advised to take his word for it.
“Most athletes have used the term shin splint,” the good doctor writes, “to refer to pain occuring either in the anterior or the medial portion of the leg. This correlates well with the type of problems that are most often clinically seen and will be discussed here.” He notes that problems occuring “in the lateral aspect of the leg” are usually either fibular stress fractures, or “peroneal tendon injuries following an inversion injury of the ankle.”
Usually the first warning you get is an achy sensation at the front or inside of the tibia bone, which increases the more you work it. Even though you rest and it appears gone, when you start running again it reappears. If you have pain even when at rest the odds are you have a stress fracture.
Although the term “medial shin splints” has been superseded by “medial tibial stress syndrome”, the pain remains the same – next to the medial tibia. Sufferers feel sore anywhere up to 12 centimeters above the tip of the medial malleolus, and when touched the soreness is actually behind the most medial part of the tibia, where you find periostitis.
This is where stress fractures can also happen, and which can be tested for by bone scans. A clinical physical examination can tell the difference between the two, and should be performed before treatment is administered.
Overtraining is a common culprit in shin splint-associated injury. The mechanical name for it is “pronation” as in when the foot pronates the medial structures of the leg it causes undue stress and greatly increases the odds that your leg will suffer injury. If you train on the side of a crowned road the upper leg is in danger, since you’re forcing your upper leg to perform in a pronated position.
If you feel – or suspect – shin splint pain, SLOW DOWN. Why purposely injure yourself? “Do not run if pain occurs during or following your run,” Pribut says, advising such non-weight bearing exercises as swimming, biking, and pool running to keep in shape. Packed dirt is a great surface for avoiding such stress, and some shoes actually help control pronation. Don’t forget posterior stretching exercises, but if pain symptoms continue, see a doctor.