Ouch....Shin Splints!

Have you ever suffered from shin splints? If so, you will know how painful and debilitating they can be. It is a condition that probably many of you can identify with, but maybe know very little about.  Maybe you have never experienced them, which is great because you don’t want to!! 

In this episode we define shin splints to give you a better understanding of the condition and then discuss the potential risk factors for their development. We also look at some nutritional and lifestyle changes you could make to help prevent the development of this condition…be it for the first time or them occurring AGAIN!! 

SHOW NOTES

(03:10)

Defining shin splints:

The medical term for shin splints is Medial Tibial Stress Syndrome (the Tibia being what is commonly known as the shin bone) and the American Medical Association defines them as: ‘Pain and discomfort in the leg from repetitive running on hard surfaces or forcible, excessive use of the foot flexors (which are the muscles located along the top of the foot stretching down towards the toes). They are thought to be exercise-induced and cause pain along what is known as the posteromedial tibial border (pain being felt on the inside of the shin at the lower end ie towards the foot). They are thought to be caused by repetitive loading stress during running and jumping and provoked on pressing over a length of around 5 centimetres. 

(09:29)

Pain is the principle symptom of Shin Splints, but there are others including:

• Oedema (fluid collecting around the painful area)
• Tenderness of area when pressure applied

Just to highlight here: if shin splints are not acknowledged and addressed, they might lead to a stress fracture of the tibia, and once a stress fracture occurs, it could mean significant more time for recovery and time away from running. 

BUT, remember shin pain doesn’t always mean shin splints, there are many other conditions that may cause shin pain including:

• Sciatica – referred pain
• Deep vein thrombosis – medical intervention would be imperative here
• Muscle strain
• An infection
• Trapped nerve

So have any shin pain the pain checked out to determine the true cause. 

(15:23)

There are many risk factors for shin splints, some of which are within our control, and others that are outside of our control. 

Some of the non-modifiable risk factors (ie outside of our control) include:

1. Age - older runners thought to be more susceptible
2. Sex – more prevalent in women
3. Height
4. Hyperpronation – inwards or outwards
5. Navicular drop – linked to foot arch height and foot pronation.  It is suggested that a navicular drop greater than 10 mm nearly doubles the likelihood of developing MTSS. This increased arch height may result in reduced absorption of ground forces. Also, individuals with an increased navicular drop are at higher risk of MTSS because there is a decrease in tibial rotation, which is thought to be an important factor in absorbing impact forces.
6. Joint laxity – loose joints
7. Strength of and balance between flexors and extensors of the foot

(22:31)

Some of the modifiable risk factors ie ones within our control therefore could be changed include:

1. Weight – overweight/obese – During running, the tibia bends and bows as a response to activity, which causes microtrauma. This is ok and natural and is necessary to strengthen, build, and adapt the bone.  BUT where an individual is overweight or obese the load may exceed the micro-trauma threshold of the tibia resulting in shin splints. 
2. Body fat – high fat to muscle ratio
3. Fitness level – beginners more prone
4. Sports-related factors – running too fast for your potential, making training errors, increase in training (distance/intensity/duration)
5. Type of running e.g. hill running
6. Running terrain e.g. road running
7. Diet – optimal and anti-inflammatory approach

(31:29)

FEMALE FACTORS:

1. Women experiencing more hormonal fluctuations 
2. Women experiencing more biomechanical abnormalities. 
3. Different running kinematics (effects on joints of running – esp ankle/knee/hip)
4. Female nutrition is also thought to be linked to an increase in prevalence possibly due to the fact that more females tend to suffer from disordered eating and eating disorders….although this was not confirmed in any of the literature I read. 
5. Women may be more prone to overstriding – especially if training with men – this was suggested in a study looking at naval recruits where the women and men train together.   

(37:05)

Thinking about some nutrition and lifestyle factors to help prevent shin splints occurring.

Lifestyle Factors to consider include:

1. Foot and gait analysis - as a preventative measure. Many specialist running shops will complete gait analysis, which will help you choose the correct running shoes for your running style e.g. if you overpronate inwards or outwards 
2. Choose running shoes appropriate for your running terrain e.g. road running, trail running …do you run mostly on road? On trails? On rocky ground? On sand maybe if you live by the sea? The appropriate running shoe could be supportive of your running mechanics 
3. If you run on different surfaces -swap your shoes to support the terrain
4. Body composition: Aim to achieve, an appropriate weight for your height 

Nutritional factors to consider include:

1. Energy availability -ensuring you eat appropriately for your training load
2. Optimal Vitamin D intake – insufficiently is linked to: increased bone turnover, potential accelerated bone loss, and increased fracture risk as well as increased risk of shin splints occurring 
3. Optimal Calcium intake – for bone health. Vitamin D is required for optimal absorption, and utilisation of calcium, so if vitamin D levels are compromised, so will calcium levels be limited. It is really important to have those two in balance and at optimal levels.
4. Anti-inflammatory diet – Mediterranean style of eating is the gold standard anti-inflammatory food plan. 
5. Including anti-inflammatory nutrients in the diet regularly e.g. 

• Essential fatty acids (predominantly found in oily fish)
• Curcumin (found in turmeric) 
• Gingerol (found in fresh ginger)
• Bromelain (an enzyme found in pineapple)

(51:51)

KEY TAKEAWAYS:

1. The medical term for shin splints is Medial Tibial Stress Syndrome). They are thought to be exercise-induced and cause pain along what is known as the posteromedial tibial border (pain being felt on the inside of the shin at the lower end towards the foot)
2. Between 13.6% to 20% of runners are thought to experience shin splints at some point and it is thought to be more prevalent in middle to long distance runners as well as sprinters,
3. Pain is the key symptom. Initially being felt at the beginning of the run and disappearing as the run progresses, but then reappearing following exercise. 
4. BUT….as the shin splints worsen the pain persists DURUNG the run AND for several hours afterwards. 
5. If left unaddressed and untreated shin splints could develop into a stress fracture
6. There are many risk factors for the development of shin splints, some of which are within our control and others which are outside our control
7. It is important to address the ones within in our control to help reduce the risk of them developing e.g. weight/body composition, gait (although this may not always be modifiable), training (too far, too fast), running terrain (sand, trails)
8. Females are at increased risk of developing shin splints, although the reason for this has not been fully determined
9. There are many nutritional and lifestyle factors you could consider to prevent their development e.g. an anti-inflammatory diet, optimal intake of the nutrients Calcium and Vitamin D, weight loss, foot/gait analysis.
10. Finally, remember……..if shin splints do occur they are thought to be largely benign and self-limiting

Related Episodes:  

Eating Enough to Run?

Heart Healthy Running

Endurance Running and Immune System

Disclaimer:

The suggestions we make during this episode are for guidance and

advice only, and are not a substitute for medical advice or treatment.

If you have any concerns regarding your health, please contact

your healthcare professional for advice as soon as possible.

Aileen Smith and Karen Campbell met at as nutrition students (Institute for Optimum Nutrition, London) and became lifelong friends and nutritional buddies! Both have a love of running and a passion for nutrition, delicious food and healthy living.

Together they host RUNNERS HEALTH HUB. A place for like-minded runners who are looking for simple ways to support running performance, energy, endurance, and general great health.

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Aileen and Karen

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