A Shin Splint Primer for Hikers and Trail Runners

September 15, 2015
Howard E. Friedman, DPM
New York-New Jersey Trail Conference

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A Shin Splint Primer for Hikers and Trail Runners

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Backpackers on AT Bear

Shin splints are a common problem for cross country runners and military recruits during basic training. Both groups are putting a repetitive, high impact load on their legs, sometimes carrying increased weight. The same is true for a backpacker, hiker, or trail runner ramping up her daily or weekly mileage.

The term “shin splints” is used in the vernacular to describe any exercise-induced pain occurring below the knee and above the ankle. The term is usually used to describe pain along the “shin” bone or muscles in the lower leg. The term is slowly being replaced with “medial tibial stress syndrome.”

The exact cause of shin splints is still not wholly agreed upon by experts. Most do agree, however, that the source of pain can occur either in the actual leg bone, the tibia, or in the soft tissues attached to that bone. Furthermore, the shin splint may affect either the “inside” of the lower leg—that is, the area of the leg that faces the other leg—or it can affect the outer part of the leg.

Where Is the Pain?

If you can point with one finger to a specific area of the shin bone that is painful, the condition is likely caused by repetitive trauma of the tibia causing an inflammatory response of the bone cells (osteocytes). This stress reaction of the bone can lead to a stress fracture if no precautions are taken. Stress fractures are incomplete breaks of the bone and are usually painful even with minimal activity. Most stress or pre-stress injuries to the tibia occur along the inside of the leg bone but can occur on the outside of the calf as well.

If your pain extends along several inches of the lower leg and not directly along the shin bone, the shin splint is most likely the result of either a micro tear of the muscle fiber attachments to the tibia or a tear of the fascia tissue that covers the muscles. A less likely but more serious condition can occur if the muscles in the lower leg start swelling and the calf becomes steadily more painful. This condition is called a compartment syndrome and requires urgent care. Fortunately, this scenario is less common.

Treatment

Whether it is “bone” pain or “soft tissue” pain, treatment is similar. First, stop your physical activity until the pain resolves. This typically requires about three to four weeks for healing. Do not hike or run through the pain. You may cross-train, however, with activities such as swimming, rowing, or other upper body exercises. In the case of a pre-stress fracture of the tibia, ignoring the pain can lead to a stress fracture and require four to six weeks or more of healing time to resume even low impact activities, and take a few months to resume hiking or trail running. Additional treatments include icing the painful area, wrapping the leg with an ace wrap or compression sleeve, taking oral anti-inflammatories, or even using a cane or walking boot. Some athletes familiar with shin splints may treat themselves, but it is common to seek medical care for this condition.

How to Prevent Shin Splints

If your shoes are worn down significantly on one side of the sole, replace the shoes. If you have a flat foot or high arch foot, you may benefit from placing an arch support in your shoes or boots—even when at home. In addition, shorten your stride when hiking or running, taking shorter but more frequent steps; if running in an urban setting, vary your running surface. Consult with your physician to find out if you have low bone density or are deficient in vitamin D. And don’t forget to incorporate a daily regimen of calf stretching and strengthening exercises to help decrease the stress on your foot and leg during hiking or running activities