Runner's Forum: Shin pains?

Shin pain is a tough one.  I am a rehab physician, and I think of shin pain as a continuum or an accumulative phenomenon, beginning with intermittent shin splints while running, progressing to shin splint pain with walking, then pain at rest, and finally in stress fracture.  One week of pain is unlikely to be a stress fracture, unless you incurred a sudden change in training load.  But it could be a signal to you to change something, or incur the wrath of the dreaded stress fracture if you don't correct the biomechanical problem.  In other words, don't ignore it, but you probably don't need to freak out...yet.

Last spring, I was training for the Bolder Boulder 10K over a 4-month period, and I was plagued by what I thought was shin splints.  They did progress from pain during running, to pain at rest, and pain with local pressure over the tibia.  I had symptoms bilaterally, but worse on the left.  I ended up taking a month off to cross train (mostly in the pool and on the bike), and symptoms went away. (Incidentally, I probably should have ordered a bone scan to confirm whether this was an actual stress fracture, but I have a high-deductible health plan and was determined not to shell out money.)

Obviously, since you are not my patient and I cannot examine your shins via the MapMyRun forum, my advice to you is, first, if you suspect a stress fracture, you should stop running and get it checked out by your physician, preferably a physician who is a runner.

Here is what I did to treat my symptoms:

1.  Back down on your training load.  Do not increase mileage by more than 10% each week, and take a light week every fourth week if possible. 

2.  Place a cold pack or bag of frozen corn/peas over the front of your shins after every run for 10 minutes.  Use a wet cloth as a barrier between your skin and the cold pack-- its easy to frostbite skin on the front of the shin.  An alternative is ice massage:  place several styrofoam cups of water in your freezer until they freeze solid.  After your run, grab one (or two) and tear the bottom of the cup off, exposing the ice, and apply to the point of maximal tenderness.  Keep moving as you massage the area with the ice until it is numb and reddened (but not much longer...again avoid frostbite!)

3.  Stretch your gastroc AND soleus muscles before and after your runs and before you go to bed at night.  Try several different techniques to make sure you stretch all heads (medial and lateral) of the gastrocs, and don't forget the soleus.

4.  Get those new shoes!  Don't delay-- you need good support regardless of your foot/ankle type.  They say not to log more than 300 miles.  I have found that my severe overpronation makes my shoes prone to wear, and I have to retire them at 150-200 miles.  Ouch! $$$  I suggest going to a good shoe store that specializes in running shoes and have them do a biomechanical analysis of your gait and get their suggestions for shoes.

Here are a few "poor man's bone scan" tests for stress fracture-- warning they are very unreliable.  Stress fracture is more likely if: (1) You can reproduce the pain when you hop up and down on one foot, (2) you can reproduce the pain with local application of a tuning fork (sensitive to vibration), or (3) pain is well-localized to the junction of the proximal 2/3 and distal 1/3 of the tibia (or the proximal 1/3 and distal 2/3 of the tibia), typically along the medial border. 

Whether it is stress fracture or not, backing off is probably the smartest thing to do, even though that is not the advice you want me to give you.  :)

Hope this helps!

Many thanks for that information drchele.

I am a new runner 57 yrs old and currently around 28lbs overweight. I have started the walk 1 min, run 1 min training technique and have built up to 2 miles over 5 weeks. I also train a day miss a day and run/walk on a treadmill in bad weather. The last week I have developed shin splints which are extemely painful but only when running. I found your reply very useful...thanks again

Ash

Thanks Drchele for the info!

 I took your advice and I bought a new pair of Mizuno Wave Nirvana 2's that I bought on eBay. 

I've been cross training with swimming to maintain my fitness level (I'm up to 30 laps!) 

I'm going to try out running 10K and see how it goes.. :)

 Thanks again!

- Will