Shin splints, a generic label used to describe shin pain, is not an appropriate diagnosis. Rather it is a symptom of an underlying condition. Effective recovery lies in an accurate diagnosis and correctly applied treatment.
The two most common causes for shin pain are overuse and stress fractures.
The recurring theme leading to overuse injuries is excess training with inadequate recovery. This combination causes scar tissue to build up in the muscles on the front of the shin and deep in the calf. Accumulated scar tissue can cause shin pain as well as lead to muscle imbalances, over-pronation, or other biomechanical problems.
First, examine all training variables – running surface, shoes, intensity, workout type, hills, weather conditions, etc. For example, running on cement with worn out shoes creates more stress on your body than running on a trail with newer shoes. The repeated pounding of the running cycle results in muscle fatigue and overuse, leading to higher forces applied to the leg’s muscles and bones.
A common shin splint pathway: calf muscle tightness or scar tissue forces muscles on the front of the leg to work harder, resulting in pain (a.k.a. shin splints). In this case, if treatment was only directed at the painful muscles on the front of the shin, the underlying problem would be missed. Appropriate treatment would be to break up scar tissue in the calves therefore reducing the added tension on the muscles of the shin.
Shin splints can be confused with stress fractures because pain is often in the same location. Stress fractures occur when load on the bone causes it to break down faster than it can rebuild. This usually happens with high mileage, especially if mileage increases too rapidly. Low mileage can also cause stress fractures when there are other problems involved. These problems can be existing scar tissue in the surrounding muscles. Dietary deficiencies and metabolic disorders also lead to stress fractures in low mileage situations.
Once a stress fracture is diagnosed (often by MRI or other imaging techniques) rest is the typical recommendation. Further investigation should be used to determine if the stress fracture occurred because of scar tissue accumulation, training errors, malnutrition, or metabolic disorders. If the causative factor is not determined, another stress fracture is likely when activity is resumed.