The 2 Types of Shin Splints That You May Develop

Shin Pain

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  • Medial tibial stress syndrome (MTSS) is a type of shin splint characterized by pain in the medial (or inside) of the shin bone
  • Exertional compartment syndrome refers to pain in the anterior compartment (outside portion) of your shin, and is usually caused by a sudden increase in exercise intensity

Shin splints can occur in two different ways, depending on where the pain occurs. The following information will help you differentiate between them.

Medial Tibial Stress Syndrome

Medial tibial stress syndrome (MTSS) is a type of shin splint characterized by pain in the medial (or inside) of the shin bone. The pain gradually develops as you progress further into your run, and can reach a point where you have to stop and recuperate. In addition, you may feel your shins becoming tender or painful to the touch. Resting for around 15 minutes can help the pain subside.1

The source of the pain is the soleus muscle, which is found deep inside your gastrocnemius (the bigger, bulkier muscle at the back of your shin). The muscle starts at the upper part of your tibia and fibula, running down toward the ankle and ends at the Achilles tendon, the strongest tendon in your entire body. Its main role is to increase the angle between the foot and the shin by pulling the heel upward.2

The soleus muscle plays a crucial role in many leg-related movements, such as running, walking and maintaining your balance. Once it becomes fatigued and overused, the muscle tightens. As the muscle tightens, pain inside the shin develops that is unique to this type.3

Exertional Compartment Syndrome

Exertional compartment syndrome refers to pain in the anterior compartment (outside portion) of your shin, and is usually caused by a sudden increase in exercise intensity. The pain is described to be deeper and more intense compared to MTSS. Resting for 15 minutes is also not enough to help the pain subside, compared to MTSS.4 There are four muscles involved that form this compartment:5

  • Tibialis anterior: Most of this muscle is found in the front of your shin, originating from the medial cuneiform down to the base of the first metatarsal. It is responsible for the dorsiflexion and inversion of the foot.
  • Extensor digitorum longus: This muscle is found below the tibialis interior, originating from the lateral condyle of the tibia and converging to a tendon in the dorsal surface of the foot, which splits into four smaller tendons that go into the toes. That being said, this muscle is mainly responsible for the movement of all toes (excluding the big toe), as well as dorsiflexion of the foot.
  • Extensor hallucis longus: Originating from the medial surface of the fibular shaft, this muscle is located deep in the tibialis anterior and the extensor digitorum longus. It extends all the way down into a tendon that ends at the big toe. The muscle aids in the dorsiflexion of your foot as well as moving the big toe.
  • Fibularis tertius: This muscle may not be present in all individuals, and is sometimes considered to be part of the extensor digitorum longus. It starts at the medial surface of the fibula and goes down into the foot, ending as a tendon that attaches to the fifth metatarsal.

These four muscles work together to help lift your feet off the ground while running. As they contract, greater blood flow goes to this area, which increases their size. If the size becomes big enough, it can cause pain in the shins and make your foot drop while running.6

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Shin Splints Prevention

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