by Eric Winder, DC    

Relief for shin splint pain can be simple, but sometimes it requires professional help. This ailment of runners (and some walkers) might simply be fixed with a change of shoes or learning how to stretch correctly. However, other cases can be stubborn, continuing to hurt even after the sufferer halts all running activity. In this article, we will look at why this pain will often persist and how it can be relieved.  

Shin splints are caused by excessive force on both the lower leg muscles and their attachments. This results in microtears or inflammation in those muscles and attachments, which can be intensely painful. The pain can continue for many hours after running or walking. As a result, a might feel pain when they first begin to move in the morning, due to injured muscles stiffening overnight. Those who have shin splints often have to stop running while they heal, which can take weeks or even months without adequate intervention.  

The cause of shin splints is often simple and easily fixed. For instance, a runner might realize they jumped too quickly into a strenuous running program on hard pavement. After taking two weeks off, buying shoes for hard surface running and following a more incremental training schedule, that runner will be able to run pain-free and never look back.    

Another runner might find their shoes show a foot pronation wear pattern and use shoe inserts or try out another shoe to correct the pronation, therefore resolving the pain. These examples illustrate the three simplest causes of shin splints: Doing too much activity, too soon; running or walking extensively on hard surfaces with inadequate shoes; and pronation, or collapsing of the ankle and foot arch.  

Most shin splint patients I see have already tried correcting the above problems. They improved their shoes, altered the pace of their training, took breaks if necessary, and began to stretch before and after their running or walking routine—but they still have pain.  In these cases, we need to look at other problems that cause excessive strain of the leg muscles.    

For these cases, I find there is generally some kind of imbalance in the muscles of the sufferer’s lower back, hips or thighs. These issues cause a loss of perfect control of joint alignment and stability while the person is in motion, which causes their leg muscles to work harder while compensating for the problem. This overstresses the leg muscles and results in painful shin splints. Let’s examine two cases that illustrate this problem.  

A patient, whom I will refer to as Tammy, had been a long-distance runner in high school, but experienced shin splint problems when she tried to resume running in her 30s. She thought the pain would resolve once her body acclimated to running. However, it only continued to worsen.  She took weeks off, then tried to ease back into running at a slower pace, but still the pain relentlessly persisted.  

She changed shoes, wore arch supports and became a diligent stretcher—all to no avail. She was upset and frustrated to see how something that came so easily in her teenage years could be so difficult now. As it turned out, Tammy had tight hip flexor muscles and weak, underdeveloped glutes. This was not from a lack of stretching and exercise, but rather, the result of restrictions in her lower back and hips in the connective tissue called fascia.   

This tissue provides the position sense for muscular balance. A series of treatments to release the restrictions, combined with low-level laser therapy to reduce inflammation and promote healing in the leg muscles, corrected the muscle imbalance. This allowed Tammy to resume running completely pain-free in four weeks’ time.  

A second patient, whom I will refer to as Michael, was a high school student whose track-and-field career was at risk due to intense shin splint pain. With the help of his team’s athletic trainer, he tried both the application of ice and stretching. He even underwent more intense treatment with a physical therapist, but nothing could resolve the pain.    

A teammate referred him to our office, and on examination, it became clear the problem was a serious imbalance between Michael’s overly tight quadriceps in the front of his thighs and underactive hamstrings in the backs of his thighs. However, the source of his problem was unusual. The restricted fascia that caused this imbalance was in his neck, due to mild whiplash in a car accident earlier that year.   

Neck posture can affect posture in the rest of the body, although many individuals are not aware of this fact. When we treated and released the restrictions in his neck, Michael’s thigh muscles relaxed in front and toned up in back, improving muscular balance and decreasing the force on his calf muscles. As a result, we were able to eliminate the lower leg stress that had originally caused his shin splints. 

Michael’s pain disappeared over the course of the next six weeks. Treating the root cause of the problem allowed him to heal even though Michael continued to run (and frequently win) in competitive meets during the entire course of treatment.  

For those suffering from shin splints, it is important to first consider the obvious solutions. Wear the correct shoes or inserts for ankle support if necessary, and slow down the pace of training. But if those simple fixes are not enough, consider the role of fascia in shin splints. Fascia is the source of position sense in the body, which makes muscular balance possible. Restricted fascia can cause muscular imbalance and pain. If you cannot resolve shin splints on your own, consult an expert in posture and muscular function who can also address problems with fascia restriction.    

Eric Winder, D.C., uses gentle manual therapy and rehab techniques to help patients with a wide range of pain and injury problems. Dr. Winder has offices in Sarasota and Osprey. For more information, call 941-957-8390 or visit https://gentlebay.com/