Shin Pain- What goes wrong

It’s New Year’s Day. You have a hangover, but you vow to start jogging again tomorrow to carry out your resolution to get fit.

You head out for a run every day of the next week. You are picturing how hot you will soon look in your swimmers, and after a day or two off, you pound the pavement again impressing yourself by going further and further each day. After a couple of weeks, that ache in your shins that you put down to muscle soreness is getting worse––a lot worse. You are so frustrated; you finally feel fitter, yet you are unable to continue the running due to the agonising shin pain. It doesn’t seem fair! The running ends, the New Year’s Resolution dies and you are back to the tired, unfit person you were last year.

Everyone’s story leading to their shin pain is somewhat different, but there are two main threads. They all identify a change in their impact activity and a too rapid progression.

Shin pain can be easily avoided if a few simple impact activity rules are followed.

Anatomy made easy

The main weight-bearing bone in our lower leg is the tibia. It is through the tibia that all of the impact under our feet is transmitted. (The fibula is the other lower leg bone; it is thinner and not directly weight bearing.)

Picture the tibia. Now picture it wrapped tightly in glad wrap. This glad wrap represents the periosteum – a membrane covering the bone. The muscles of the lower leg have a broad attachment to the tibia via this membrane, in a number of different places.

The resilience of muscle attachment points progressively improves as we increase the loads on them. In areas where new pulling or impact creates load, the attachment will become stronger. The critical factor to remember, however, is that these changes in structure can take weeks or months to occur.

What goes wrong

If you make your legs perform with more impact and more quickly than the bones and muscles can adjust, something has to give.

When the muscles attaching to the tibia are loaded repeatedly and often without first building up strength, the area where the muscle attaches on to the  periosteum becomes inflamed and irritated. This causes shin pain. It tends to happen in one of two main places on the tibia––along the inside of the tibia and along the front of the tibia.

Once shin pain has been activated, lesser loads can continue to aggravate the pain. Even a short rest or reducing your running volume is often not enough to resolve the pain. Shin pain can be extremely persistent and difficult to settle, which is why prevention in the first place is crucial.