Q+A: Why these shin splints after five years?

Q I’ve been running for five years with very few injuries, but recently I’ve been experiencing pain in both shins. The pain is on the inside of my legs, just off-centre. I tried resting for three weeks as suggested by my GP, but the problem returned as soon as I started training again. I’m a moderate overpronator, and I’m within my recommended weight band. What can I do?

A Shin pain is extremely common in runners, and shin splints is the very broad term used to cover a number of possible diagnoses. The vast majority of these are caused by a biomechanical abnormality. One of the most common explanations is overactivity in the muscles that lie on the inside of the shin. These muscles produce the outward turning movements of the ankle. They also act to stabilise the rear foot as it rolls inwards (pronates) when the heel strikes the ground. It sounds like these muscles could be overactive. This can cause overpronation and lead to damage, and hence shin pain, in the tibialis posterior muscle.

In the short term, I’d recommend that you decrease the amount of running you’re currently doing and make sure that you carefully stretch your gastrocnemius (main-calf) and soleus (lower-calf) muscles. In the long term, though, you need to address the underlying causes of the problem, so visit a chartered physiotherapist for a thorough physical examination. I would also recommend a slow-motion video analysis of your running technique. An appropriate course of physiotherapy to improve your core stability and lower-limb alignment may also be useful, and orthoses can sometimes help as well.

Nick Critchley, chartered physiotherapist and exercise physiologist at the Medifit Health & Fitness Centre, London