Shin pain...or glad wrap?

Shin pain...or glad wrap?

Intro

The medical world hates the term ‘shin splints’. Apparently it’s not a physiologically-accurate-enough term. The term is actually derived from horses, who have a bone in their lower leg called the splint. Lumpy or swollen splint bones are apparently a common ailment in horses.

Personally, I don’t mind using the term on humans. We may not have a bone called splint, but painful shins can feel like the bone is splintering, or that it feels like it needs to be splinted and supported to help with the pain.

Regardless, ‘shin splints’ is an easy to use, common knowledge term to refer to pain in the shin area. It does not label the actual diagnosis, but it doesn’t have to.

Anyway, enough about semantics. My time working with Defence populations has provided ample opportunity to see the anguish, longevity and exquisite pain associated with shin splints. I also believe that the condition is completely avoidable if we give our shins what they need in the right amounts.

Anatomy

The main bone in our human lower leg is not the splint as in horses, but the tibia. You would know this bone if you have ever accidentally walked into the tow ball of a car. It is through the tibia that all of the impact occurring under our feet is transmitted. (The fibula is the other lower leg bone – it is thinner and not directly weight bearing – we can literally live without it if need be, but that is another story!).

The tibia is coated all over by the periosteum, which is like a well fitting glad wrap. The muscles of the lower leg attach to the tibia via this glad wrap.

Bones are always progressively changing according to the loads we put though them. They lay down more bony fibres in areas of load provided by new pulling or impact. These changes in bony structure take weeks to months to occur.

What goes wrong?

If you made a New Years Resolution to get fit, you might decide to take up running. You head out for a run on the 2^nd, 3^rd, 4^th, 5^th and 6^th of January. (On the 1^st you had a hangover). You are picturing how hot you will look in your swimmers next beach visit, and after a day or two off, you pound the pavement again, impressing yourself by going further each day. After a couple of weeks, that ache in your shins that you put down to muscle soreness is getting worse. A lot worse. You are so frustrated - you finally feel fitter, yet you are unable to continue the running due to the stupid shin pain. It doesn’t seem fair! The running ends, the New Years Resolution dies, and you are back to the tired, unfit person you were last year.

You have made the ultimate mistake of not allowing enough time for your tibias to lay down new bone to accommodate the change in impact. Because you have asked your legs to do more impact than they had the capacity to withstand, something had to give. That ‘something’ commonly turns out to be an irritation of where muscles attach onto the glad wrap. This tends to happen in two main places on the tibia – along the inside (‘medial’) tibia, and along the front/outside (‘anterior’) tibia. 

What can be done to prevent this?

The solution to avoiding shin pain is easy – don’t do too much too soon!

There is no specific exercise to add to the magic list of preventative actions, rather, a short list of points to follow when introducing or changing your impact activity.

• If you are starting from scratch, start gradually – this is different for everyone, but as a rule of thumb make your first few sessions about 70-80% of your max capacity.
• Increase the impact activity by no more than 10% volume each session
• Perform the new or increasing impact activity on alternate days, at least for the first 4 to 6 weeks