Shin Pain When You Run

Shin pain in runners gets one label. Shin splints. That is a location, not a diagnosis, and three different problems live there. One responds to changing how much you run. One gets worse if you train through it. One needs a medical assessment rather than hands-on care.

Two questions that sort it

How big is the sore area, and what does the pain do as the run goes on? Spread your fingers over the shin. Tenderness along several inches of the inner edge of the bone is a broad area. A spot one fingertip covers, with the bone either side fine, is a point. Then ask whether the pain eases as you warm up, gets worse the further you go, or builds as pressure and vanishes when you stop. Those two answers separate the three problems below.

The diffuse ache along the inner shin

This is the common one and what most people mean by shin splints. The ache sits along the inner edge of the shin bone, usually over a hand's width, and it is sore to press across that whole stretch. It grumbles at the start of a run, often quiets down as you warm up, and comes back afterwards.

It is an overload picture. The bone and the tissue attaching along it are absorbing more than they have adapted to, and the trigger is almost always a change: distance that went up quickly, a return after time off, a switch from grass to road, or worn shoes. There is barely any flat ground on St. Thomas, and running downhill on concrete loads the lower leg hard on every step.

Bone pain on one small spot

A different picture: the pain sits on a spot one fingertip covers, it does not ease as you warm up, it gets worse the further you go, and lately it has started hurting when you walk around the house. Pressing that point hurts far more than the bone either side of it.

That raises the question of a stress fracture. Pain that worsens through a run rather than settling, and that has begun to bother ordinary walking, is a see-someone-first situation. It needs imaging, and it must not be trained through.

Tight, building pressure in the lower leg

The third pattern is pressure rather than soreness. The lower leg feels tight or full, it arrives at a predictable point in the run every time, and it settles within a few minutes of stopping. Some people get numbness in the foot, or the foot starts slapping the ground. Between runs the leg feels normal.

That raises the question of exertional compartment syndrome, where pressure builds inside a muscle compartment during exercise. It needs a medical assessment rather than load management, so it belongs with a physician.

The calf and foot matter too

A stiff ankle, a calf that cannot control the landing, or a foot that collapses through mid-stance all change how force travels up the shin, so an exam checks below the sore area too. Heel pain underneath the foot is on plantar fasciitis and heel pain. Pain in the cord at the back of the ankle is on Achilles tendinitis. Front-of-knee pain on descents is on knee pain going down stairs.

What actually helps the overload version

Reduce the load rather than stopping altogether. Complete rest settles the pain and does nothing for the tolerance problem behind it, so it usually returns the week you start again. Cut back to a level that does not leave you sore the next morning, keep your fitness with something that hurts less, and build back gradually once the shin is quiet day to day.

Change one variable at a time so you learn something. Look at your shoes and the miles on them, look at what you are running on, and take the steepest downhills out for a while. Custom orthotics are one option among several when the foot is part of it. Anything more specific should follow an exam.

How we sort it out at Tradewinds

At Tradewinds Chiropractic & Wellness in Charlotte Amalie, St. Thomas, the exam maps where the bone is tender and how large that area is, tests the ankle and foot, and watches you walk. Digital x-rays are taken on site when a stress fracture is on the table. Dr. Keys is the Chair of the Virgin Islands Board of Chiropractic Examiners, a member of the Virgin Islands Chiropractic Society, and the International Chiropractors Association representative for the U.S. Virgin Islands. If it is a load problem, care is hands-on work through the calf and foot, joint work where the ankle is stiff, and a plan for getting your running back. If it points at bone or at pressure, we refer you. Runners can also read athletes and sports injuries.

When you should see someone else

Go to the nearest emergency room, or call 911, if your lower leg becomes severely painful, tight, numb or pale and does not settle once you stop and rest. Acute compartment syndrome is a limb-threatening emergency and it does not wait.

See a physician promptly, rather than booking an exam, if:

• You cannot put weight on the leg.
• The pain sits on one small spot on the bone and now hurts with ordinary walking, not just running.
• Your calf is swollen, warm or red, which raises the question of a clot.
• You have a fever along with the leg pain.

Getting seen

Call (340) 690-4994 to book an exam. We take walk-ins and same-day appointments. We are in the VI Medical Foundation Building, Suite 202, 9150 Estate Thomas, St. Thomas, USVI 00802. Hours are Mon, Wed, Thu: 10:00 am to 1:00 pm and 3:00 pm to 7:00 pm. Tue, Fri: 7:00 am to 2:00 pm. Closed Sat and Sun. New patient forms are on the forms page to print and fill in. Tradewinds Chiropractic has more than 180 five-star Google reviews.

Questions patients ask

What are shin splints?

Shin splints is a nickname for pain along the shin, not a single diagnosis. The most common thing behind it is an overload ache along the inner edge of the shin bone, sore over a broad area, worse at the start of a run and again afterwards. Two other problems get called shin splints too: a stress fracture, which gives bone pain on one small spot that worsens the longer you run, and exertional compartment syndrome, which gives building tightness that eases within minutes of stopping. They are managed differently, so the label is worth sorting out.

Why do I get pain in my shins when I run?

Usually because the load went up faster than the lower leg adapted. A jump in distance, a return after time off, a change from soft ground to road, and worn shoes are the usual triggers. On St. Thomas, downhill running on concrete is a common one. The ache is spread along the inner shin, eases as you warm up and returns afterwards. Pain that instead gets worse the further you go, on a spot a fingertip covers, is a different problem and needs an exam.

The front of my lower leg hurts when I run. What does that mean?

Where exactly it sits and how it behaves through the run narrows it down. A broad, achy band along the inner edge of the bone that settles once you warm up points at overload. One tender point on the bone that gets worse mile by mile, and has started hurting when you walk, points at a possible stress fracture and needs imaging. Tightness and fullness that builds at the same point in every run and drains away when you stop points at pressure inside the muscle compartment and needs a medical assessment.

How do I know if my shin pain is a stress fracture?

The pattern is fairly consistent. The pain is on one small spot you can cover with a fingertip rather than spread along the bone, it gets worse as the run goes on instead of easing, and over time it starts hurting during ordinary walking. It often follows a jump in training. That combination needs an x-ray before anyone works on it, and it should not be run through.

Should I stop running with shin splints?

For the ordinary overload version, usually not completely. Total rest calms the pain but does not build the tolerance you were short of, so it tends to come back. Cutting the load to a level that leaves you comfortable the next morning, changing one thing at a time, checking your shoes and easing off the steep downhills gets further. If the pain is on one point of bone, is worse the further you go, or hurts when you walk, stop and get it examined instead.