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Marathon Training Injuries pt 1: Shin Pain

It’s that time of the year again when those with great intentions have started to prepare for the London marathon. There are many programmes out there to direct you towards your goal but given the distances you need to cover the risk of injury is fairly high and pain in the shins, the bone at the front of the lower leg (below the knee) is a frequent complaint.


There are two areas that people complain of;

1. pain to the muscle on the outside of the bone (tibia) and

2. pain to the inner edge of the bone.

They are two different things and I will explain a bit about each.


The muscle to the outside of the bone is called Tibialis Anterior. Its role is to pick up the front of the foot so that you do not catch your toes on the ground. It is also responsible for controlling the lowering of the foot once your heel has hit the ground so you do not ‘slap’ the foot down hard. The former is called a concentric contraction as the muscle gets shorter. The latter is an eccentric contraction i.e the muscle gets longer but in a controlled manner.


The area to the inner edge of the shin is called the medial tibia and the condition’s medical name is medial tibial stress syndrome. It is here that one suffers from ‘shins splints’. The common area that gets irritated is typically just below half way down and is it here that 3 muscles interact: one of the calf muscles from the back of the leg called the soleus, another called tibias posterior and the final one which is a deep muscle that curls the toes.


Tibialis Anterior Pain or Compartment Syndrome

The medical condition for this area is called chronic exertional compartment syndrome. This is where the muscle, as it works, becomes engorged with blood. Normally the connective tissue around the muscle expands to accommodate this engorgement but sometimes it doesn’t and there is a build up of pressure within the muscle which causes pain.


The symptoms can include

  1. aching, burning or cramping pain;

  2. tightness in the muscle;

  3. numbness or pins and needles;

  4. weakness; you may even find it difficult to lift the front of the foot and

  5. in the worst case scenario, the connective tissue may burst or herniate and the muscle bulges out.

The pattern is typical in most people: It begins consistently after a certain time, distance or intensity of effort. It worsens as you exercise; it eases within 15 minutes of stopping the activity and over time the recovery time after exercise may get longer.


The risk factors for this condition are

  1. Age. So although anyone can get it, it tends to occur more in athletes under 30.

  2. The type of exercise: so repetitive impact like running increases the risk and finally overtraining with either too much intensity or frequency can increase the risk.


Treatment for compartment syndrome by an osteopath can include ensuring that the joints of the foot and ankle have a good range of motion so you do not have to work hard to pick the foot up. Deep massage work to soften and stretch the soft tissues involved. Prescribing exercises to both strengthen and loosed the muscle and connective tissue. Finally advice on how to alter the training so that you can still stay fit but reduce the use of the legs while you are waiting to respond to the effects of the treatment and other advice.


Shin Splints

This condition is a one of overuse. It typically occurs in athletes who have recently intensified or changed training routines or programmes. The increase overworks the muscles tendons and bone tissue. The causes are repetitive stress on the tibia and the connective tissues that attach muscle to bone.


Symptoms start as tenderness along the inside edge of the shin bone (tibia) and there may be some mild swelling. Initially the pain is felt at the start of an exercise bout but eases after a while. This progresses to being felt once you stop your session. Later if begins to last longer into the session until, if left untreated, lasting the entire session and even extend into periods of rest. You may notice changes to the edge of the bone and in the worse case scenario this condition can develop into a stress fracture.


Risk factors include

1. being a runner starting a new programme

2. An sudden increase in duration, frequency or intensity of exercise.

3. Running on uneven terrain like hills, or running on hard surfaces like concrete.

4. In military training.


If you go and see an osteopath for treatment you will probably be advised the following:

  1. Stop your training or at least change it to reduced or non-weight bearing

  2. Massage and ice the muscles on the edge of the shin and also along the side of the leg down behind the ankle and under the foot.

  3. Stretch these same muscles

  4. Develop muscular resilience for the muscles involved through heel and toe walking as well as skipping (later in the rehab phase)

  5. Beginning you running with some side skipping as well as step overs and backwards jogging all of which continue to develop the conditioning and resilience of the muscles.

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