Enter your search terms Submit search form

SaveYourself.ca helps you solve pain problems

• TUTORIALS
• ARTICLES
• ABOUT
• CONTACT
• MORE

Save Yourself from Shin Splints!

Causes and treatment options for shin splints explained and discussed in great detail, especially shin pain caused by myofascial trigger points, compartment syndrome, medial tibial stress syndrome, and stress fracture

by Paul Ingraham, Vancouver, Canada MORE

close

Credentials and qualifications

I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.

For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.

Welcome to the most detailed exploration of shin pain available. This is not just a web page: it is an online book, about 18,000 words dedicated to the most scientifically current exploration of shin splints. The average orthopedics text devotes only a paragraph or a page to shin pain, and tutorials published in medical journals are usually no more than a few pages.

This tutorial is many times that long and thoroughly explores every common type of shin pain: the kinds of tissue failure involved, surprising scientific controversies and mysteries, plus the most neglected and underestimated factors in shin pain, crucial to understanding many difficult cases.

What works for shin pain? What doesn’t? Why? I can’t promise that the information in this tutorial will lead to a cure for your shin pain. However, I can guarantee that you will get a much deeper understanding of the subject.

What are shin splints?

Shin splints is an extremely common problem in runners and running athletes12 and can be impressively complicated and stubborn. It is almost always called “shin splints,” but that’s a curiously old-fashioned term — like “lumbago” or “consumption.” Why does only shin pain get called “splints”?3 Because shin splints means shin pain — sort of4 — it’s a bit silly to offer it up as a diagnosis to someone complaining of shin pain:

“Doctor, I have shin pain.”

“Ah, you have shin splints!”

“I just said that.”

The term “shin splints” has multiple personality disorder: it might refer to nearly any of several problems that cause shin pain, depending on what you read or who you talk to. This extremely detailed tutorial aims to help readers, both professionals and patients, with all the different shin pain problems that get stuck with the label “shin splints.” It might have been easier to create a tutorial for each of those different conditions, but it is shin splints that people get diagnosed with and shin splints that people think they have — so this is a shin splints tutorial!

Which shin splints is the “real” shin splints: compartment syndrome, medial tibial stress syndrome, or stress fracture?

They are all “real” shin splints. People often mistakenly believe that the real shin splints is limited to just one of these. For instance, medial tibial stress syndrome — irritation and degeneration of the shin bone, and/or the soft tissue around it — is probably what most professionals think shin splints is these days. And it probably is the most common type of shin pain.

“Shin splints” is a curiously old-fashioned term — like “lumbago” or “consumption.”

However, it is definitely not the only kind! Until I studied this subject intensively, I believed that real shin splints was “compartment syndrome,” and other kinds of shin pain were just … well, just other kinds of shin pain. But I soon learned that there are actually at least three major, known and common kinds of shin pain, as well as some little known and rarer types, any of which may get labelled as the “real” shin splints, depending on who you are listening to. Effectively, shin splints really does mean any kind of shin pain.

The confusion about the naming of shin pain probably can be traced to the truly deep and cosmic mysteries that surround shin pain. Many cases defy easy classification. Either they seem to possess the symptoms of several different problems, or they actually are more than one problem.5 Many scientific studies of shin pain have created more questions than they answered. Diagnosis and treatment can be difficult, and some cases of shin splints are almost freakishly severe. There is almost no limit to how intense and stubborn shin splints can get.

Shin pain is routinely misunderstood and mistreated

SaveYourself.ca is devoted to education about pain problems that are often misunderstood and ineffectively treated, and for which there are particularly good-bang-for-buck opportunities for more effective treatment. Shin splints involve several issues that doctors and therapists are particularly uninformed about, and often fail to consider or treat:

1. Few professionals understand how dangerous acute compartment syndromes are, and often fail to recognize them and give appropriate warnings to patients. This is a symptom of widespread ignorance about the causes of shin pain, and generally poor training among certain kinds of health professionals. If your physical therapist isn’t aware that some shin pain can actually be lethal, how well are they likely to understand a complex chronic case?
2. Painful muscular dysfunction is a significant factor in many cases of shin pain, but this is almost always missed or underestimated — health care has a huge blind spot for muscle, and often ignores the role of muscle in injuries.6
3. Tissue fatigue is another critical shin splints concept, and yet the majority of professionals have rarely or never thought of it in this way, thinking instead only of the mechanics of tissue failure instead of the chemistry (homeostasis).7 Many clinicians probably aren’t even aware that there is a major scientific controversy about this — as major as a controversy about shin pain can be, anyway.

There are no “shinologists” — for most professionals, shin pain is just one of a list of hundreds of common pain problems they deal with, and they are more or less completely unaware of the finer points of the subject, particularly recent scientific research. In many cases they only thing professionals know is quarter-century old conventional wisdom. Such significant gaps in professional knowledge make it nearly impossible for patients to find competent help for more severe and stubborn cases of shin pain.

How can you trust this information about shin pain?

I’m inspired by the MythBusters approach: I question everything and I have fun doing it. (No explosions, alas.) I assume that anything that sounds too good to be true probably is. I make no big promises, I do not claim to know the one true cause of anything, and I am not selling a treatment system or my own services. When I don’t know something, I admit it. I actually read scientific journals, I clearly explain the science behind every key point (there are more than 50 footnotes), and I link to the original sources so you can check them yourself.

Danger! Please do not try to run through shin splints! Acute compartment syndrome can be extremely dangerous!

Until you feel confident that you know which type of shin pain you have, you should assume the worst and avoid aggravating the condition. Why?

One kind of tissue failure in the lower leg — compartment syndrome — is extremely dangerous when acute. Compartment syndrome involves a vicious cycle which is not necessarily self-limiting (as many other injuries are). Once it starts, it may spiral out of control and literally kill the affected muscles, causing permanent deformity and disability at the very least, and even risk lethal infection. Triple yikes! This is absolutely serious, and quite unlike most other athletic injuries.

Although the pain is usually severe enough to stop people from running, some athletes may be foolhardy enough to try to keep going — if this is you, please stop! Rapidly worsening shin or calf pain absolutely must be treated like a medical emergency, and not just a cramp on your style. You are in danger of destroying your athletic career!

Ken Hildebrand of Alberta, Canada, knows just how serious compartment syndrome can be. On January 8, 2008, Mr. Hildebrand was pinned under an all-terrain vehicle in the Rocky Mountains. He survived for 96 hours by eating rotting animal carcasses, drinking melted snow, fending off coyotes with a whistle, and thinking of his grandchildren.

But compartment syndrome was his worst problem!

My legged swelled up about four times the size of normal. And in order for blood to get through they have to slice the muscle and that so that it can drain and then they slowly let it repair itself. The leg is good now, I'm going to be able to keep the leg, but the foot is still iffy.

Ken Hildebrand on “As It Happens,” CBC Radio One, January 23, 2008

In Mr. Hildreband’s case, compartment syndrome was the consequence of trauma, and he suffered a particularly severe case of compartment syndrome, with extreme swelling. However, equally dangerous consequences are possible in runners who try to “run through the pain.” So don’t!

Reassuring concluding note: chronic compartment syndromes, by contrast, are relatively safe — frustrating and uncomfortable, but much less dangerous. Shin or calf pain that has been around for a while and isn’t rapidly worsening is pretty unlikely to be a serious problem.

What “causes” shin splints?

There are two ways of thinking about the “cause” of shin pain:

Acknowledgements

This document and all of SaveYourself.ca was, for many years, created in my so-called “spare time” and with a lot of assistance from family and friends. Undying thanks to my wife, Kimberly, for countless indulgences large and small, and for being my “editor girlfriend”; to my parents for (possibly blind) faith in me, and much copyediting; and to Mike Gobbi, buddy and digital mentor, for many of the nifty features of this document (hidden and obvious). And thanks to all of the above, and many others, for many (many) answers to “what do you think of this?” emails.

Thanks finally to every reader, client, customer, and big tipper for your curiosity, your faith, and your feedback and suggestions and stores. Without you, all of this would be pointless.

And a few thanks to some health professionals who have been particularly inspiring to me: Dr. Steven Novella, Sam Homola, DC, Dr. Harriet Hall, Simon Singh, and Dr. Stephen Barrett.

Notes

1. Estimates run as high as 35% in some studies (see Yates), which found shin pain in more than a third of naval recruits doing at the end of basic training. This is the highest figure ever reported, but other studies have also reported quite high numbers. Shin pain clearly ranges anywhere from “pretty darned common” to “really amazingly frequent.” Return to text.
2. As are all knee injuries from the knee down. Ferber et al estimated in 2009 that about 80% of all running injuries occur in the knee and lower leg. 50% of those are in the knee, while “injuries to the foot, ankle, and lower leg—such as plantar fasciitis, Achilles tendinitis, and medial tibial stress syndrome (also known as shin splints)—account for almost 40% of the remaining injuries.” Return to text.
3. Back splints, anyone? Shoulder splints? Head splints? I’ve been wondering about this little bit of language oddity for years now, but I still can’t dig up anything about the origins of “splints” and why it’s apparently exclusive to shin pain. Return to text.
4. Batt. Clinical Journal of Sports Medicine. 1995. “Currently the term [shin splints] is used widely and variably, with little consensus of definition. Broadly, it denotes the occurrence of exertional lower leg pain …” Return to text.
5. Edwards et al. American Journal of Sports Medicine. 2005. The authors of this paper describe several common lower leg pain problems (several of which are covered by this tutorial, and including at least three types of shin splints) and then comment that “symptoms associated with these conditions often overlap, making a definitive diagnosis difficult.” Return to text.
6. The importance of muscle dysfunction is a recurring theme throughout this website. It’s not relevant to every injury, but it is involved to some degree in most kinds of injuries, either as a root cause or a significant complicating factor. I’ll explore this in much greater detail below. Return to text.
7. Generally speaking, medical philosophy about overuse injuries is significantly bogged down by a simplistic over-emphasis on “mechanical” risk factors such as various kinds of crookedness. Shin pain is certainly blamed on a variety of common anatomical scapegoats (like excessive foot pronation), none of which have ever really been established scientifically. Much more about all this below! Return to text.

There are 42 more footnotes in the full version of the shin pain tutorial. See above for details, or click the “buy” button to buy it now.

• TUTORIALS
• ARTICLES
• ABOUT
• CONTACT
• MORE


• & THE INEVITABLE MEDICAL DISCLAIMER

SaveYourself.ca is © 1999–2010 by Paul Ingraham, Vancouver, Canada