There’s a certain exuberance that comes at the beginning of a decision to undertake a new challenge. You are sitting around the table with your mates, and someone comes up with the idea of all taking on a Spartan Race, or a Tough Mudder or the Sydney to Gong ride – and with each passing story of past achievements on the bike, or as a teenage ninja, the illusion rises that you could once again relive those wonderful and exciting days when you were fearless – where heights didn’t matter and a leap off a 60ft bridge into the Macquarie River seemed like a great idea!!!?? Ok maybe that was a different enthusiasm in a different time and place – but you get my drift!
The combined fervour of excitement when you begin an undertaking can be absolutely intoxicating. Then comes the realisation when you have finally gotten around the group and decided on team colours, tee shirts and sponsors logos where you actually have to put the grit in and organise your first training session. So when you wake cold on an early Spring morning, realising that you have only got 4-6 weeks to actually start training before you undertake this ‘adventure’ and you drag yourself into your athletic gear, and stare down the road into the misty suburban front lawns, you find yourself determined, motivated and ready to plunge into a long training session. It goes great and you finish feeling awesome.
The next day you get up and go again and whilst there’s a little bit of stiffness in your legs from your previous days run, you still got some energy. Fast forward to the end of the 1st week of these training runs and your early morning rising routine turns out to be a dishevelled shuffle to the front door and an aching lope down the stairs. You shimmy off down the road and you can feel your body aching, but then comes a pain in the lower part of your anterior leg that burns – aches and permeates your whole leg. And it lasts – not just for the run but ALL DAY LONG. The merest step to the kitchen for a cup of tea fills you with dread as you try achingly to not move your legs at all for fear of the pain you are ensuing. Even lying in bed feels tragically unforgiving.
Enter – the Shin Splints. Many of us have suffered through these pains in our legs when we have first decided in a moment of insanity and enthusiasm to train for our first marathon. Its not that we’re not healthy – we just aren’t used to using our legs in a certain way. Pounding the pavement in bad shoes, going out too hard and too quickly and having ineffective ankle alignment are all precursors to this condition. It happens to jumpers too. Basketballers, gymnasts, pole vaulters – all of us involved in explosive movements where ‘landing’ is the important key have often felt the sting of the Shin Splint.
I remember first starting full time ballet training and suffering from this condition as my legs just weren’t used to the pure load of jumping that I was having to do in repetitive classes that lasted all day long. The pain was excruciating and my lecturer (perhaps unwisely) said that ‘everyone has to go through it’. He may have been right - in that my lower leg muscles needed to get used to the load of this continuous jumping but it certainly was lucky that I bounced back out of it after a relatively brief period - oh the joy of being 18! I still bounced!
Anatomically the shin splint is a collection of conditions that can be coined into this ‘umbrella term’. From muscular tears, inflammation of the periosteum (connective tissue enveloping bones at joints) and even hairline fractures. They are usually the result of overuse of the Tibialis Anterior, Extensor Digitorum Longus and Extensor Hallucis Longus muscles that run down the lateral part of the anterior lower leg. It can also relate to tearing of the Tibialis Posterior Muscle and soleus that lie in the posterior compartment. These muscles are connected to the tibia via a periosteum - a connective sheath that runs the length of the tibia bone and encases the muscles within it. Which is perhaps unique in the body as most muscles attach only at the ends of their tendinous insertions.
It is worth noting that the fascia that wraps around the certain muscular compartments of the lower leg is terribly inelastic and tough. If fluid builds up here from overuse or regular prolonged use, this creates pressure and interferes with Venous return and lymph activity – thus limiting the bodies ability to remove the fluid. Likewise when we are involved in running and our foot rebound is inadequate to effectively let us bounce along like a kangaroo, the tibialis anterior (along with Tibialis posterior and soleus) absorb much of the shock that running puts into the joints and the body. This is not it’s job and it can result in tears and irritation of the periosteum and even the bone underneath. Foot strike is vitally important and the supportive longtitudinal arch of the foot is paramount here (thank god I did tendues for years).
It is the fluid that becomes trapped in the periosteum and compartment of the lower leg that creates issues as there is virtually no space here to deal with the excess fluid (caused from action) and the excess fluid creates issues with nerve endings and blood flow. This creates pain and – voila – you have shin splints.
Whilst the Tibialis Anterior is the main muscle to be concerned with in this condition and usually accounts for the pain in the antero-lateral (front and outside edge) of the lower leg. The Tibialis Posterior (deepest posterior leg muscle underneath the calf) is very indicated in this condition. Tears here will illicit pain deep underneath the calf but are still termed as part of this ‘umbrella term’. The Soleus is also indicated in this condition as it serves part of the muscles that act on the shock absorption aspect of the lower leg.
Conditions of Shin Splints
· Micro-tearing of the Tibialis Anterior, Tinbialis Posterior and Soleus
· Periostitis – inflammation of the periosteum fibres that connect the lower muscles the length of the tibia.
· Stress Fractures – hairline fractures of the tibia resulting from ‘running through the pain’ – bone scan necessary (radiograph may not pick up fractures)
· Exertional Compartment Syndrome – excessive fluid in any of the lower leg compartments. Increased fluid puts pressure on the nerves causing pain and inflammation
· Actue Exertional Compartment Syndrome – Circle of edema that limits blood flow and thus limits the removal of excess fluid. Emergency treatment required.
So when it comes to treatment what to do? I have been known to have a reputation for having ‘maimed a swan’ treating shin splints. In my opinion though I think he was bluffing and just wanted a show off! Specific draining of the anterior compartment and getting space in this area is effective in getting length back into tightened structures. Working not only on the muscles but the fascia that separates the compartment.
Massage is very indicated for this condition as long as you catch it early. It is important to get the fluid moving if there is any build-up of fluid in the lower leg compartments. It is very difficult to actively stretch the lower leg muscles in the anterior compartment and massage can help with creating length and space in this area.
For more acute cases where the condition has been present for a period of time or the area is hot and inflamed, it may have progressed to the Exertional Compartment Syndrome phase and needs to be treated medically. If the fluid build-up is excessive then no amount of massage will assist. It needs to be rested and assisted with Steroidal injection if needed. Pain should not last more than 2-3 days and if it does, medical advice is advised.
Ensuring the foot and ankle are in good alignment and that the longtitudinal arch of the foot is supported and in good condition (bare foot runners can insert a little chuckle here) is vital for ensuring that shin splints doesn’t become a problem. We have many articles on this and advice to help you with training up your feet.
So by all means, get into that training and be tough when you are involved in your new adventures, but also be mindful that there is a point where running through the pain isn’t necessarily going to win you any medals. It’s just going to hurt more!
