Solving the Mystery of Shin Splints

When it comes to shin pain, the theories abound. Muscular imbalances, training errors and pes planus (flat feet) are frequently pointed to as being contributing factors. Let's take a look at the factors that I believe are most often implicated.

Anterior (front) leg or shin pain is perhaps the most common complaint reported by novice track athletes.

The classic scenario includes a de-conditioned and often over-weight runner who, in an effort to make up for lost time, attempts to do too much too soon.

The initial complaints are of vague soreness following activity. If the condition isnt addressed, the pain will begin to be present both during and after running. The athlete who attempts to "run through" this pain will likely discover that his or her symptoms have increased in both intensity and duration.

Those of us in the sports medicine community discourage the use of the term "shin splint." Athletes and their coaches have used "shin splints" to describe any pain experienced below the knee and above the ankle. To group all such pain under this heading, I believe, is a dangerous practice, because it dismisses the possibility of other more serious conditions including, but not limited to, stress fractures.

Although there is some disagreement as to what condition creates this pain, I favor the idea of what is referred to as an enthesitis. At its most elementary level, the term enthesitis describes minute tearing of the muscles which attach to the inside edge of the tibia or shin bone.

This tearing, which produces no evident swelling or discoloration, is believed to be ground zero for pain related to "shin splints".

By accepting enthesitis as the source of pain, one can easily see how flat feet may also work to bring about this condition.

The arch, it must be remembered, plays a pivotal role in absorbing the shock associated with running. If the arch is absent, that shock which would otherwise be dissipated is instead delivered up the length of the leg.

This repeated microtrauma is, in my mind, the most obvious explanation of the root cause of this condition.

With all of that said, what can one do to prevent this condition from developing?

  1. Give preseason conditioning and early season training their due consideration. For mountain bikers and soccer players alike, conditioning should build incrementally so as to allow the body opportunity to adjust to the increasing work loads.
  2. If you are among those whose feet are flat, consider an insole or orthotic which will improve your ability to absorb shock.

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