February 5, 2015

Injury Insight: Medial Shin Pain (Guest Blog Post from The Endurance Athlete Center)

Guest post by Meg Pezzino, DPT, The Endurance Athlete Center

Shin splints can really put a damper on your run, and your spirit if the pain just won’t quit. Shin pain can often creep into your run unexpectedly and then be a HUGE nuisance to get rid of. Many times it sneaks in with a change of terrain, increase in mileage, or shoe change, but sometimes it seems as though it pops up out of nowhere.

The Scoop on Shin Pain

Shin pain doesn’t necessarily mean you have “shin splints.”  Shin splints are actually called medial tibial stress syndrome, and the term is a broad based term that describes that nasty pain that sneaks in between your inner ankle and inner knee. Though many times the pain is just an irritation in the inner leg, pain in the lower leg can actually be caused by several different things.


The most common cause we see of shin pain is irritation of the tendons at the inner ankle, usually caused by a flaw in run form. For short, we can call these tendons Tom, Dick And Nervous Harry. If any of the 3 muscles ”“ posterior tibialis, flexor hallucis (big toe flexor) or flexor digitorum longus ( little toe flexors) are angry, they can irritate the tibial artery or nerve. This can cause more pain as well as possible numbness, dull achy pain, and tingling.

1medial ankle

What if it’s NOT “shin splints”?  Here are some injuries to look out for!

Stress fracture, or a small crack in your tibia bone, can mimic many of the symptoms of shin splints. If you press your fingers all the way up the inside of your shin bone, and find a spot on the bone that is very sensitive, it may be a sign that you need imaging to rule out fracture. Now, move off your bone into the muscle belly on the inside of the knee, working your way down from your knee cap to your inner ankle bone. If that is tender, it is likely the muscles being cranky.

Compartment Syndrome is another biggie that can be masked as “shin splits”. The muscles in the outer lower leg swell and create a closed compartment, which creates painful pressure in the leg. Usually the biggest symptom is pressure that builds over time. In bad cases, surgery may be necessary to decompress the area.

Here at the EAC we see and treat shin pain regularly. But it’s important to identify WHY you are having shin pain.

Here are some of the causes that we frequently see

1) Overpronation ”“ that ankle is just collapsing in too quick or too much and puts a ton of pressure on the muscles of the inner ankle

2) Over supination with pushing off ”“ using the inner ankle muscles too much instead of your big calf muscle and stressing out the tendons

3) Second toe is significantly bigger than the first. This sounds silly but makes a big difference. When your second toe hits first, the big toe is always playing catch up and can really agravte  the big toe flexor along the inner ankle/shin

4) Change in terrain such as increase in hills

5) New shoes that change your foot pattern

6) Weak gluteal muscles

So what can you do to ease your shin pain?

1) Take a few days off after it happens and ice those shins

2) Re-evaluate what has changed in your run
-Did you switch shoes?
-Did you switch shoes?
-Are your shoes old and you need a new pair?
-Did you increase your mileage?
-Did you change your terrain?

3) Check our your ankle range of motion.
-Are your calves tight?
-If you try and squat as low as possible can you keep your heels on the ground

4)Check out your run form
-Have a friend video your foot work and come in for a run analysis

Most importantly don’t try and run through it! As runner’s we tend to think pain can go away, but remember that pain is our body’s way of telling us to sometimes take a second and figure out WHY we are in pain. As a runner who tried for years to push through shin pain, I can tell you that ignoring it caused more harm than good. So instead of pushing through it, figure out why it’s happening in the first place!


Brought to you by:

Meg Pezzino, DPT
Check out Meg’s profile HERE.

This blog post was courtesy of The Endurance Athlete  Center.  To learn more about the EAC and the services they provide, please visit their website at  http://enduracenter.com/.