If your shin hurts after running, sprinting or after a new and intense training, you might have a condition called shin splints or medial tibial stress syndrome.
Shin splint is a condition where the muscles, tendons, and bone tissues attached to the shin bone (called the tibia) become inflamed. This causes a sharp or dull and throbbing pain along the inner side of the shin bone during and after exercise.
It usually occurs due to overuse and sudden changes in your activity, such as increased intensity, duration, or frequency of your training or workout. Also, if you have flat feet or are using incorrect or worn-out footwear, you have a higher chance of getting shin splints.
The Basics of Tissue Healing
The body is capable of healing itself naturally after an injury. Any damaged soft tissue structure undergoes the three stages of healing and repair. The duration of the healing process depends on the severity of the injury, age and general health and lifestyle of the affected individual.
Acute Inflammatory Phase
Immediately after an injury, the first thing that the body does is to maintain homeostasis by stopping the bleeding by increasing the platelets in the area. These colorless cells in the blood create a fibrin clot that acts as a plug to stop the blood flow, protect the wound, and serve as a scaffold for the clot.
Once a clot is formed and the wound is closed, the blood vessels widen to increase the oxygen-rich blood flow to the area. This delivers the necessary chemicals and cells to begin the healing and repair process.
The inflammation causes the injured part to become painful, swollen, red, and warm. As the swelling increases, the pressure inside builds up, irritating the nerves and causing further pain.
This stage begins immediately after an injury and can last for three to seven days. Rest, ice, compression, and elevation of the injury above the heart are essential during this stage to minimize the pain and control the swelling.
Subacute / Fibroblastic Repair / Proliferation Phase
After the initial influx of cells and inflammation subsides, the proliferation phase begins. Fibroblasts, which create collagen (the basic component of tissues’ structural framework), increase in the area. As the collagen increases, so do new blood vessels. The newly created disorganized collagen fibers form the initial granulation or scar tissue.
The proliferation phase is when you will begin to feel like you are already recovering, and you might want to start resuming your usual activities or training program. However, the collagen fibers are still disorganized, weak, and not as flexible as the normal tissue at this stage.
They cannot withstand the same level of stress. There is a greater chance you may reinjure yourself if intense exercises are done at this stage, and they may delay your progress.
This phase usually begins on day four and can last up to six weeks.
It is important during this stage to perform controlled strengthening and flexibility exercises to gradually restore movement and safely prevent weakening of the muscles or soft tissue mobilization for better scar tissue formation.
Maturation / Remodeling Phase
Tissue healing continues in the remodeling phase. The collagen fibers become more organized, and the scar tissue becomes stronger. The focus of this phase is to replace the weak scar tissue with one that has improved collagen arrangement and stronger bonds between them.
This phase starts at 2 to 3 weeks post-injury and can last for months or years, depending on the extent of the damage.
You should achieve a full range of motion at this stage, and you can now do resistance exercises.
Why Does My Injury Take Longer to Heal?
Shin splints usually heal with simple conservative treatment. Healing usually lasts from two to six weeks, depending on the severity of the injury.
For faster healing and return to normal activities, make sure that you follow the advice of your doctor and your physical therapist. Before you go back to your usual activities or training program, you should not feel any pain in the affected leg anymore.
The presence of pain could indicate that the injury has not yet healed entirely, and pushing your leg beyond its limits might only slow down the healing process or even cause reinjury.
Always perform warm-up and cool-down exercises before training and gradually increase the intensity, duration, and frequency of your exercises.
If you have followed your doctor’s advice and adhered strictly to your physical therapy sessions but achieved very little improvement, your injury might need to be reassessed. There might be another cause of the pain, such as a stress fracture – characterized by small breaks in your shin bone.
Other possible causes include tendonitis (inflammation of the tendon), or chronic exertional compartment syndrome in which excessive pressure develops within the muscles during exercise.
Dr Aarti is an MBBS (Bachelor of Medicine and Surgery) from Baroda Medical College (The Maharaja Sayajirao University, Baroda). Dr. Aarti has also completed her Masters of Medical Science and Technology from the prestigious Indian Institute of Technology, Kharagpur.