SHIN PAIN WHILST TRAINING FOR THE BEEP TEST, WHAT COULD IT BE?

When jumping back into running for the first time or completing a heavy session many of us tend to experience lower limb discomfort, especially around the anterior and medial lower leg and calves. So, what is this new discomfort, how can I manage it and when should you get help?

WHAT COULD MY DISCOMFORT BE FROM?
Lower limb discomfort when exercising can be frustrating and cause distress when lasting for longer periods of time and occurring for unknown reasons. The following blog will present some common causes for lower limb discomfort during exercise, and more specifically running, to assist you in deciding when to seek help and what strategies you can use to manage the issue.

GENERAL SORENESS/OVERUSE/INFLAMMATION
General shin soreness and inflammation can often derive from overuse, overtraining and/or increasing training load too rapidly. The most frequent cause of shin pain is due to sudden increases in training load causing overuse of the associated musculature (1). What do we mean by this? An example of sudden increases in training loads include going from not running at all to running a few kilometers in one go, without slowly building up your tolerance to the new activity. You wouldn’t go from squatting body weight to attempting to squat 100kg on your first go, so why would you do the same with running?

Symptoms of General Soreness and Overuse Include:

• Pain/discomfort immediately after exercising (2).
• Pain/discomfort during and after exercise that does or does not restrict movement and improves with time (2).

What Can You Do?

• Reduce the intensity, duration, volume, and frequency of workouts to allow healing.​
• Gentle stretching and mobility exercises within the affected area and strengthening of the associated musculature.
• Visit your GP, Exercise Physiologist or Physiotherapist if pain persists and guidance is needed to manage.​​

DELAYED ONSET MUSCLE SORENESS
Delayed onset muscle soreness or DOMS for short, is deep muscle discomfort that generally continues for 24-48 hours post exercise and sometimes can be so severe that it is mistaken for muscle strain and injury (3). DOMS is triggered by increasing physical activity outside your normal range, placing your body under higher stresses and exercise intensities causing the minor aches and pains experienced days later, and/or by eccentrically biased exercises (3). Methods such as stretching, icing and medication have all been suggested to ease the pain once it onsets however there is little evidence in the way of their effectiveness in reducing the DOMS related pain (3).

​What can you do?

• Be mindful of your current physical status and limitations. DOMS is the bodies natural reaction to overload and some what of a safety mechanism to ensure you take adequate time to recover before jumping into another session too quickly. To reduce your chances of developing severe DOMS ensure you know your current limits and try not to work yourself into the ground each session. ​
  

SHIN SPLINTS (MEDIAL TIBIAL STRESS SYNDROME)
Medial Tibial Stress Syndrome, more commonly known as Shin Splints is a musculoskeletal injury caused by repetitive strain commonly seen in running athletes (4). Shin splints are commonly caused by repetitive activities, sudden changes in activity (volume, intensity, duration or frequency), exercising in worn out footwear and bio-mechanical lower limb issues such as poor running mechanics and abnormal arches (5). Other issues that may increase your risk of developing shin splints include poor lower limb strength and stability and decreased range of motion at the ankle (5). Almost all shin pain is commonly referred to as “shin splints” however not all shin pain is actually shin splints as we will discover throughout this blog.

So How Will I Know If I have Shin Splints?
Some common things to look for if you believe you’re suffering from shin splints are:

• Sharp, razor like or dull throbbing pain mid shin (5).
  
• Pain that occurs during or straight after exercise (5).
  
• Pain that is made worse by touching the sore spot (5).
  

What Can You Do?

• If you suspect that shin splints are the cause of your shin discomfort visit your GP or Physiotherapist immediately
  
• From here developing sound lower limb strength through all musculature will be vital to ensure favorable gait and running mechanics
  
• Improving mobility within the ankles if range is lacking
  
• Improving lower limb and pelvic stability
  
• An Exercise Physiologist may assist in the assessment and development of programs to improve each of these areas​​

TENDONITIS
Tendons are the structures that connect our muscles to bone and tendonitis can occur when these structures become inflamed (5). Tendonitis is also caused by overuse of the musculature involved and again this condition is commonly found in runners (6). Shin pain due to tendonitis will often occur at the ankle due to the tendonous attachments within this area, pain can be felt in the lower third of the shin and into the ankle (6).

So How Will I Know If I Have Tendonitis?

• Pain and stiffness within the front of the ankle, there may be swelling and redness associated (6).
  
• Pain that is worsened by activity (6).
  
• Weakness flexion the foot towards the leg (6).

What Can I Do?

• Follow basic first aid principles: Rest, Compression and Elevation
  
• Applying heat instead of ice to the area may promote healing due to increasing blood slow to the area and relaxing musculature however should not be applied within the first 48hours of injury (7).
  
• Engage in light mobility work (moving your ankle through its full range of motion non weight bearing) to maintain range within the joint.
  
• Make an appointment to see your GP or Physiotherapist to assist with the issue.
  

TIBIAL STRESS FRACTURE
Stress fractures are another type of overuse injury that occurs as a result of repetitive stresses to the associated bone (8). Tibial stress fractures will usually be felt mid shin and are present as activity begins and worsen the morning after exercise (8). Stress fractures will also be painful to touch and intensity of pain may vary day to day (8).

So How Will I Know If I Have A Stress Fracture?

• Aching pain felt deep within the shin, tenderness and swelling may be associated (9).
  
• Dull pain that disappears however returns with activity (9).
  
• General feeling of weakness (9).
  
• Pain that doesn’t improve with the RICE protocol (rest, ice, compression and elevation).
  

What Can I Do?

• RICER protocol within 48-72 hours (rest, ice, compression, elevation and referral) (8).
  
• Make an appointment with your GP or Physiotherapist.
  

WHAT INCREASES YOUR RISK OF SHIN PAIN?
Lower limb pain and discomfort may be instigated by a range of variables common throughout everyday life. Some common factors that we can all manage to decrease our risk of lower limb pain and discomfort when exercising are as follows:

• Sudden changes in physical activity (8): limit your sudden increases in activity, ensure you slowly build volume and intensity of exercise each week, don’t just jump back in where you left off.

• Exercising in worn out footwear (8): if you are an avid runner, upgrading shoes every 3-6 months is recommended to support the feet to the best of your abilities (10).

• Flat feet and abnormal arches (8): if you suspect that you overly pronate (roll in) or supinate (roll out) when running, ensure you visit your Podiatrist for a biomechanical assessment to see which shoes are right for you.

• Poor lower limb strength and control (8): book in with an Exercise Physiologist for an assessment of lower limb strength and control to develop a program improving each of these.

• Decreased ankle flexibility (8): book in with an Exercise Physiologist to undergo a range of motion and mobility assessment to develop a program to assist.

• Being Overweight: being overweight can increase the stress through the kinetic chain and increase risk of overload, book in with your General Practitioner or an Exercise Physiologist to assist with management of lifestyle factors (11).

WHEN TO SEE SOMEONE
As you may have read throughout this article, each of these issues are incredibly similar in presentation and mechanism of injury so if you are worried about unusual pains or discomfort that lasts for extended periods of time ensure you book into see a Health Professional to assist with managing the issue. If you are experiencing any of the following:

• Pain that occurs during and lasts till conclusion of exercise (1).
  
• Pain aggravated by touching the sore spot (1).
  
• Sharp, razor like or dull throbbing pain during and/or after exercise (1).
  

​You may be suffering from shin splints and should  make an appointment with your General Practitioner or Physiotherapist to diagnose the issue and assist you with a management plan to get your training back on track.

WRAP UP
Lot's of incredibly valuable information. There is such a wide range of reasons why your shins may hurt and although everyones first thought is that they have shin splints it's generally not always the case.

If you are unsure on how to train to avoid developing shin pain then feel free to get in touch with us here. 

SOURCES
1. Miller J, Russell Z, Clarke A. Shin Pain & Injury [Internet]. Physio Works. 2020 [cited 4 September 2020]. Available from: https://physioworks.com.au/pain-injury/shin-pain/
2. Summit Medical Group. Overuse Injuries [Internet]. Summit Medical Group. 2020 [cited 4 September 2020]. Available from: https://www.summitmedicalgroup.com/news/fitness/Overuse-Injuries/
3. Ingraham P. Post-Exercise, Delayed-Onset Muscle Soreness [Internet]. Pain Science. 2020 [cited 4 September 2020]. Available from: https://www.painscience.com/articles/delayed-onset-muscle-soreness.php
4. Ingraham P. Complete Guide to Shin Splints [Internet]. Pain Science. 2020 [cited 4 September 2020]. Available from: https://www.painscience.com/tutorials/shin-splints.php
5. Michael A. Shin Splints [Internet]. Ortho Info. 2019 [cited 4 September 2020]. Available from: https://orthoinfo.aaos.org/en/diseases--conditions/shin-splints
6. Walden M. Tibialis Anterior Tendonitis [Internet]. Sports Injury Clinic. 2020 [cited 4 September 2020]. Available from: https://www.sportsinjuryclinic.net/sport-injuries/ankle-pain/anterior-ankle-pain/tibialis-anterior-tendon-inflammation
7. The Johns Hopkins University. Ice Packs vs. Warm Compresses For Pain [Internet]. Johns Hopkins Medicine. 2020 [cited 4 September 2020]. Available from: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/ice-packs-vs-warm-compresses-for-pain
8. Sports Medicine Australia. Shin Pain [Internet]. Sports Medicine Australia. 2020 [cited 4 September 2020]. Available from: https://sma.org.au/resources-advice/injury-fact-sheets/shin-pain/
9. Yanke A. Stress Fracture Symptoms [Internet]. Sports-Health. 2015 [cited 4 September 2020]. Available from: https://www.sports-health.com/sports-injuries/general-injuries/stress-fracture-symptoms.
10. Brooks Sport. When to Replace Your Running Shoes [Internet]. Brooks Running. 2020 [cited 4 September 2020]. Available from: https://www.brooksrunning.com/en_us/blog/gear/when-to-replace-your-running-shoes/
11. Winkelmann Z, Anderson D, Games K, Eberman L. Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review. Journal of Athletic Training. 2016;51(12):1049-1052.