Shin Splints, Compartment Syndrome & Stress Fracture

Shin splints are the typical first injury to walkers and runners...due to too much walking or running too soon.

Shin Splints

The most likely injury for beginner runners is: SHIN SPLINTS - painful shins, also called Medial tibial stress syndrome...which is simply an inflammation along the inner side of the shinbone.

A stress fracture pain is likely to be a continuous pain and restricted to one spot. Do not run.

If you have a more diffuse pain or tenderness in the lower third of the leg on the inside, or along the entire shin, and if
stretching eases the pain, a fracture is less likely. Run on soft surfaces if the pain is not severe and read on.

With shin splints, pain is felt on extending the toes and weight bearing. It hurts if you press the area with your finger. Physiologically, it’s an inflammation of the tendons OR muscle in this area. Pain gradually gets worse as you run, though for some types it eases when you’re well warmed up, but resumes at the end of exercise. Other types ease shortly after stopping.

* Running with the weight too far forward;
* Striking the ground with the first third of the foot;
* Over-striding;
* Overpronation;
* Shoes too tight around the toes;
* Inflexible shoes;
* Weak arches may be present;
* Tight calf muscles stress the shin structures;
* Calf muscles too much stronger than the shin muscle...
* Which, tighten and pull on the shin muscles;
* Beginner runners are very susceptible;
* Overtraining is its trademark; especially:
* Increasing mileage too quickly;
* Running on hard surfaces;
* Too much speedwork, too early, on hard surfaces.


Prevention - Flexible foreshoe—Wear a combination or slip lasted design in preference to heavy or stiff shoes. Replace shoes every 300 to 400 miles. Use a heel lift to reduce jarring, along with arch supports or padding if necessary. Don’t make a sudden increase in training or run too fast too soon. Balance your training. Run fewer miles and do them on softer surfaces. Include pool running and other cross training.

Concrete is six times harsher to your shin tissues than asphalt. Asphalt is three or more times harsher than packed dirt trails. Grass and muddy trails are still softer, and significantly decrease your risk of shin splints. Bring back road mileage a mile or two at a time as you ease back to full training. Use orthotics or anti-pronation shoes.

Stretch before running, and again after warming up. Made a training mistake and hurt your shins? Ice them, take some NSAIDs and don’t do it again!

Shins always hurt after a track session? Do your speedwork on dirt, grass, sand, up hills, on a treadmill, or pool running. Also, correct any training errors. Do an appropriate amount of speedwork and run at a reasonable pace. Gradually work up to 10 percent of your weekly mileage in one session, and run no faster than 5K pace until you can do that 10 percent without severe aches and pains.

Do not forget your warmdown...perhaps the most under rated part of a training session. Running for two to three miles may sound gruesome if you’ve just done 20 times 400 meters at 5K pace. It is gruesome if you were not in good enough shape to run those intervals with a bit to spare! Easy running brings in blood with its nutrients and speeds the extraction of waste products from fast running. Add a quarter mile of walking at the end and you’ll also decrease your post exercise blood pooling which adds to muscle inflammation. Hose your legs with cold water, put your feet up for 20 minutes while you rehydrate and cool down, then take your shower and stretch.

The shin muscle works against the large calf muscles, is the last muscle to warm up and the first to cool down. With this in mind, do an exercise to build them up. While sitting in a chair, draw large circles with your big toe, and then write the alphabet with your big toe. After a few weeks, add the paint pot exercise (sit on a table, hang a weight from your toes and pull your toes up i.e., flex your ankles for sets of 12). Or hook an elastic belt or similar item around your toes and push against it ten times, then pull it toward you 10 times. Reduce your mileage to get over the shin splints. The shin muscles are the last to warm up. Wearing long thick socks will help to avoid the chill when not running, making it easier to warm up the muscle before you do run.

Pain on the outside of the shin? Walk with your toes pointed in for one minute a day.

Pain on the inside? Walk with toes pointed out for one minute. Build up toward five minutes.
Then practice walking on your toes and on your heels with toes pointed in and out.

Treatment - use ice and NSAIDs for the initial swelling. Then flexibility work: Stretch pre and post exercise. Lie on your back with one foot in the air. Place a towel around the sole of your foot, and pull with your left hand to bring the toes down and to the left, which will stretch the muscles on the right. Hold for 30 seconds and repeat to the right and with the other leg.
Also, massage gently down the muscle to your pain tolerance, and then back off by 10 percent to avoid damage. Use ice alternating with moist heat...then put the muscle through its full range of motion. Use NSAIDs.

Compartment Syndrome

This malady usually relates to the anterior compartment of the lower leg, which is on the outer part of the leg, the area in front of the fibula. The inner part of the lower leg is dominated by the tibia bone. The compartment set up by these bones is surrounded by a tough sheath containing muscles, nerves and blood vessels.

Compartment syndrome is a muscle pain due to the muscles growing faster than the sheath surrounding them. It includes one form of shin splints, though it also affects the other smallish muscles of the lower leg. Your shin muscle will feel tight, numb (if nerves are involved) and you may have a sensation of pressure due to excess fluid or muscle development. The pain is on the outside of the leg, and unlike true shin splints, the pain comes on during exercise and lasts well beyond the finish of your session. Diagnosis is with a pressure check, though your specialist will usually rule out shin splints and stress fracture first.

Some muscles grow so much that they constrict the blood flow into the sheath...resulting in necrosis (a medical emergency) of the muscle. The nerves in the sheath can also be pressured.
Massage, ice and anti-inflammatories can help, but several months off of running may be required. Surgery (fasciotomy) may be required if the pains return, releasing pressure and allowing the muscle more room to expand. First though, reduce mileage to allow your muscles and the sheath surrounding them to adapt.

Like shin splints, compartment syndrome is attracted to people who make sudden mileage increases or suddenly introduce speed running. Stretch regularly and do weight training using light weights for many repeats to decrease your risk.

Other muscle problems

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These and other MUSCLE PROBLEMS are usually treated with RICE.

Prevent or protect your muscles from more damage with Rest, Ice, Compression and Elevation.

A slightly strained muscle often responds well to running fewer miles at a slower pace than which you normally train.

When you injure yourself, and it is you who does the injuring, blood vessels at the injury site expand. The extra fluid or edema causes pain. Do not mask this pain with Tylenol. Blood is needed to bring in repair materials but too much inflammation constricts blood flow, and can interfere with healing: combat the swelling with ice. Use ice for 15 minutes each hour for two days.

Ice decreases inflammation, preventing many sore spots becoming injuries. Hosing your legs with cold water after a run has the same effect--it can ease significant fatigue, plus it’ll bring your body temperature down. You can use real ice to cool the inflamed area or use frozen peas or other vegetables or use gel packs, including Velcro wine chillers which can be fastened to your legs. Within minutes of taking off the ice pack, blood will rush to your injured area and bring in nutrients to help with healing.

Because heat brings in more blood and fluid, use warmth only after all the swelling has subsided.

A compression bandage takes skill to apply. A lightly wrapped ace bandage is usually more effective. Don’t allow either of them to restrict circulation to your toes.

Elevating the achy limb for an hour or two at a time helps to decrease inflammation also, but your main partner is ice or ice substitutes.

Still hurting after multiple ice applications and elevation? Take an appropriate dose of NSAIDs to reduce the inflammatory response.

Heavy exercise raises the level of free radicals, which can make your muscles sore. Finnish researchers have shown that taking 2,000 milligrams of vitamin C before, during and after a 10K race speeds recovery. Vitamin E works too. Use this combination for 5 or 6 key sessions per month to avoid the side effects from too much vitamin intake.

As a rule, muscle strains at the back of the legs are from running too fast, or overstriding. You will need to rest and you need to slow down.

Cutting out speedwork for a few days of active rest, and putting your muscles through a comfortable range of motion will bring nutrients to the muscle and stimulate repair. You will also maintain fitness. Massage can increase circulation, bringing nutrients and oxygen to cramping or damaged muscles to speed healing or at least make the ache more comfortable for you. Massage can reduce pain and stress levels, but try not to use it to enable you to get straight out to the track again and restrain the original torn muscle. The American Massage Therapy Association is at

Muscle tears are graded from first-degree strains with little muscle damage and no restriction in range of motion; to second-degree with more damage and swelling; to third-degree with complete rupture of the muscle unit and severely limited movement. Generally, the more it hurts, the greater is the area of muscle tissue strained. A third degree strain will often need to be seen by an injury specialist, to help you overcome the pain and potential for lasting damage if not properly and patiently rehabbed.

The major muscle tear will require you to stop running; minor tears, if not hurting when you run, will heal with active rest. But:
* Run 30 seconds per mile slower than usual;
* Avoid long two sevens instead of a 14;
* Avoid tend to run too fast down them.
* No speed running.
* Don’t overstride.

The combination of easy running and RICE for the acute phase of about two days, then stretching and massage later, and an anti-inflammatory if appropriate, should help your muscle recuperate.

Practice good running form before you do speedwork again. Wear appropriate shoes. If you use lightweight racers for speed sessions, do copious stretching of the calf and Achilles to prepare them for the lower heel. Ease into the fast running after your warmup, stretching, drills and striders. Do fewer reps for the first couple of sessions back.

Stress fracture of the shin bone (the tibia) 

A stress fracture pain is likely to be a continuous pain and restricted to one spot. Do not run.

If you feel pain when you put pressure on the Stress or hairline fractures don’t show up on x-ray until healing is well under way, but they can be confirmed quite early by a bone scan. The dilemma--a fracture requires six to eight weeks’ non-impact exercise to heal. Use non-running exercise to maintain muscle tone until you’ve confirmed if you have a fracture. Pool running, elliptical training and cycling are the best exercise options.


Other common runners injuries:
Runners Knee Injuries
Common foot injuries & cures

Related articles:
Why do runners get stress fractures?
Retuning to running after stress fracture or other major injury
Stretching for runners
Stretching before running or only after? 

Thanks David Holt for the permission to reprint this article
Text copyright © by David Holt -

This article has informational purpose and  isn't a substitute for professional advice.

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