Q: I have begun running again after several years of no running due to several serious fractures (1995 spiral fracture of right Tibia and Fibula and 1996 fracture of right Acetabulum, and 3 right metatarsals). I am currently running about 3 miles per day 4 to 5 times per week. I thought if I had any problems it would be with my right leg, however I am having pain in my left leg - it started as pain or cramps in the left calf, now it has spread to the front lower area on the inside edge of my leg - I have been icing after every run but the discomfort is still there - it has not been so bad that I can not run but there is tenderness to touch the front lower left tibial area. I am not sure if this is a shin splint or a muscular injury and I am not sure how to determine this. How does one know if they have a shin splint? Should I kept running and icing or will this require me to stop altogether? Any help would be appreciated.
A: Pain in the lower leg may be due to a stress fracture, shin splints, muscle strain/tendonitis or chronic exertional compartment syndrome. The term shin splints refers to discomfort along the inner edge of the tibia (the large shin bone). Typically the area of tenderness is at least a few inches in length. It is felt to be due to irritation of the lining of the bone, where the muscles attach. This is treated with ice, stretching, strengthening of the muscles on the front of the leg and modifying training, based on severity of symptoms. Adding arch supports to your running shoes may be helpful if you have flat feet; if you have high arches, try adding cushioned insoles.
A stress fracture is an area of bony weakness due to repeated stress (i.e. running). The most common site for a stress fracture in a runner is the lower part of the tibia. Typically the pain is well localized. Impact, when your foot hits the ground, is painful. Initially, you may be able to run through the pain, but repeated stress causes greater damage, so the stress fracture becomes a complete fracture. This is an injury that requires some time off from running; some people are able to run wearing an air stirrup. Otherwise, non-impact cross training for 6-8 weeks is the standard. X-rays and possibly a bone scan are needed to make this diagnosis. There are a number of muscles that run along the inner aspect of the tibia, the most significant of which is the Posterior Tibialis. This may be irritated if a runner over-pronates (foot rolls in too much) or by an increase in training - distance and/or intensity. This responds well to exercises (flexibility and strengthening), ice, decrease in training, and correction of any abnormal running mechanics.
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Chronic exertional compartment syndrome is a condition which causes pain in the shin while running. The muscles are divided into compartments by a sheet of membrane. With exercise, the muscles will increase in size; in some cases this increase is greater than the membrane can tolerate. The membrane acts like a tourniquet, cutting off the blood supply. The pain is so severe that you will stop running. As the muscles return to normal size, the pain completely resolves. Usually, this runner has a normal exam in the office, because symptoms only occur during exertion. This does not sound like your problem, since you are able to continue running. It is often difficult to differentiate shin splints from a stress fracture on exam. I recommend that you see a sports medicine professional to determine if you have a stress fracture. Another option would be to presume that you have a stress fracture and train in the pool or on the bike for 6 weeks. Then GRADUALLY begin running again. Correct any abnormalities in gait and training program (avoid increasing distance or intensity too quickly).
--Dr. Cathy Fieseler
