Causes of shin splints explained by Sundial physio James Masterson

Jewel runs Brighton Marathon
Jewel runs Brighton Marathon

Shin splints is a common sports injury in runners and sports people but it is often mis-diagnosed and poorly treated. If left untreated shin splints can cause ongoing and progressive pain and disability sometimes requiring surgery to correct. Here Sundial physio James Masterson sheds some light on this painful condition.

Shin splints was a medical term used to describe pain along the middle border of the shin bone (tibia) commonly experienced by runners. However, the term shin splints can be misleading and is generally avoided by clinicians as there can be a number of reasons why a person may experience pain in their shins. Some of the most common and more specific medical terms used for shin splints are medial tibial stress syndrome (MTSS), medial tibial periostitis and medial tibial traction periostitis. This exertional lower leg injury usually develops in people who take part in repetitive activities and sports such as running.

Other reasons for lower leg pain on exertion could be:

  • Stress fractures occur when muscles become fatigued and can’t absorb repeated shock, they transfer the stress to their bony attachment which can then result in a small crack or fracture of the bone.
  • Compartment syndrome is a painful condition where pressure of the muscles in the lower leg builds within their confined compartments. When this pressure increases it causes a decrease in blood flow which prevents nourishment and oxygen reaching the nerves and muscle cells.

Cause shin splints

Why does Shin Splints happen?

Shin splints or Medial Tibial Stress Syndrome (MTSS) occurs during physical activity and results from too much force being placed on the thin layer of connective tissue (periosteum) which covers the shin bone (tibia) and attaches the bone to the muscle tendon. The muscles which may contribute to this problem are the ones in the calf and inner side of the tibia. These muscles flex the big toe and push the ball of the foot down. These work hard every time you take step and even harder when you run.


Common problems which lead to Shin Splints (MTSS):

Recent increase in exercise intensity or duration.
• Biomechanical irregularities i.e. poor posture and problematic walking or running pattern such as over-pronation.
• Inflexibility and tightness of muscles.
• Change in exercise terrain i.e. running on hard surfaces or up and down hills.
• Muscular fatigue.
• Wearing the wrong type of footwear.

What are the symptoms of Shin Splints?

MTSS pain is often described as a recurring dull ache in the middle two thirds of the shin bone (tibia). Pain is worse in the mornings and after exercise, although the pain may often decrease or disappear altogether during a warm up or beginning period of exercise. Climbing stairs or weight bearing can aggravate symptoms and muscle tightness, thickening and lumps can be felt along the area of pain. Swelling may also be present and the individual can normally locate the exact site of where pain exists.

Next article: How to treat Shin Splints

How to prevent running injuries? – Runners MOT

Knee pain, muscle strain, tendon pulls, bursitis, ligament sprains and all sorts of other aches and pains are a constant reminder that marathon training and actually running it can be a hazardous business. One in five people who enter for the Brighton Marathon will not complete it because of injury. We aim make sure you are not one of them.

For the next few weeks we are offering a free Runners MOT especially aimed at runners in the Brighton Marathon and the half marathon. We want you to be fit, strong and ready to run.

Our physios will check you out top to bottom concentrating on your footwear and leg and foot movements. We will check all the usual things like over-pronation but also things that often over-looked like jamming of the hinge joint of the ankle which changes stride length. We will look at knees, hips and backs too. At the end of our Runners MOT you will have an in depth risk profile of the likelihood of future running injuries and a plan for prevention.

So don’t let a niggle turn into a pain, call to make an appointment.

Foot, Knee or Hip pain – A Simple Solution

If you ever get foot knee or hip pain on standing or walking for a while, then you’ll know the misery that this can cause.

Fortunately, there is a simple solution.

Here at Sundial we use Superfeet orthotics to help ease the discomfort. In this short video Brighton chiropractor Matthew Bennett talks about the causes of foot knee and hip pain associated with over-pronation. If you want to know more about this click here:–

If you would like to know if you would benefit from wearing Superfeet orthotics then pop in for a free check with one of our physios or chiropractors here in Brighton.

Do orthotic insoles help with knee pain in runners? Leading Brighton Chiropractor answers

Knee pain is common in runners and a common cause is the patella or knee cap. Pain caused by the patella is often called patello-femoral syndrome or PFS for short. The pain can be severe enough to stop runners going out but also occurs in other sports people and non-sports people alike.

Chiropractor and physio treatment in Brighton

The research on PFS treatment is poor. The studies that have been done are often of poor quality and come up with conflicting results for all sorts of treatment and this can be confusing not only if you are a runner looking for something to help but also if you are a physio or a chiropractor treating these common knee problems.

One of the recent reviews (1) looking at all the evidence for orthotics in the treatment of PFS, sometimes called Runners Knee, found little difference between the groups given orthotics and those given flat insoles which were supposed to do nothing. The other trial which met the criteria compared physio exercises and orthotics. Again not much difference was found between the 2 groups. Delving deeper into the 2 trials reveals why the orthotics groups did not do so well as groups in other trials – but more of that below.

Another study (2) into patello-femoral pain found that orthotics may indeed help. In fact more than three quarters of the runners involved improved. The authors concluded that orthotic or orthoses as they called them may have had a significant effect. This study was excluded from the larger review because it did not meet all the inclusion and exclusion criteria. For example some of the patients were only 12 years old and the study was not a randomised controlled trial.

The difference with this small study and the previous review is that the runners were analysed much more carefully. Their feet, ankles and knees were measured and an orthotic prescribed if they had the right sort of problem.

Chiropractic treatment may help

There are many different causes of PFS. One cause is thought to be over-pronation or excessive flattening of the arch after the heel strikes the ground. If you have over-pronation and it is contributing to PFS then you may respond well to the correct orthotic. If you have PFS from another cause, a weak thigh muscle for instance an orthotic will be a waste of time. In this case a pelvic joint manipulation by a chiropractor may help as in this study (3).

A correct diagnosis of the knee pain is essential for the correct treatment to be applied. A thorough examination should reveal the cause of the problem so that the right treatment can be applied. Too often clinicians use a one size fits all approach that is doomed to fail. This may well also explain why some studies don’t show an improvement whereas others do.

Orthotic buying advice

You can spend a fortune on a custom made orthotic and except in rare cases it is completely un-necessary. Other trials comparing custom made orthotics, often costing several hundred pounds, with much cheaper off-the-peg versions fail to show a difference in the outcome of symptoms.

We have found Superfeet insoles an effective and cost-effective option. They cost between £25-32 and are available on an unconditional money back guarantee from the manufacturer. So even if you don’t have faith that they might work for you it is worth giving them a try but only if you over-pronate. Many running and hiking shops as well as clinics sell them.

For more information you might like to look at a presentation given in June 2011 to the European Chiropractors Conference in Zurich here

Matthew Bennett DC

Sundial chiropractor working with Brighton and Hove Albion and previously with the British Alpine Ski Team.


1.Hossain M, Alexander P, Burls A, Jobanputra P. Foot orthoses for patellofemoral pain in adults. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD008402. DOI: 10.1002/14651858.CD008402.pub2.

2.The Lower Extremity 5(2): 95-102, 1998. Copyright © 1998. Reprinted with permission from Elsevier and the American College of Foot and Ankle Orthopedics and Medicine. Journal of the American Podiatric Medical Association

3. Journal of Manipulative and Physiological Therapeutics Volume 22, Issue 3, March-April 1999, Pages 149-153

4. A comparison of rearfoot motion control and comfort between custom and semicustom foot orthotic devices. Davis IS; Zifchock RA; DeLeo AT. Journal – American Podiatric Ass, Sep 1, 2008; 98(5): 394-403