Q: When I run, my lower shin aches -- is this shin splints?

A: Also known as medial tibial stress syndrome, shin splints presents as a dull ache or pain on the inside of your lower shin, mostly over the muscle attachment to the bone.

Participants in soccer, cross country, track and field, marathons and the weekend 5K are all at risk. Most experience shin splints after a few workouts or after one "intense" workout.

The pain will occur early in a run, but if left untreated, over time the pain will last longer and increase in severity.

Each shin absorbs twice your body weight every time your foot hits the ground during running, leading to a thousand impacts per mile.

Some runners have weak ankle dorsiflexors. These muscles normally work to pull the foot upward and slow the foot as it drops.

Weak muscles lead to a "slapping" foot and "pulling" on the shin where these muscles attach to the bone. The injured area is most likely where these muscles connect to the bone.

Some athletes have a tendency to over-pronate (turn outward) where they often seem to have flat feet. This causes stress and pull of the muscles that connect to the shin.

The opposite is also a problem -- very rigid feet don't allow energy to be absorbed.

It is important to increase running mileage and intensity slowly.

Shoes should be of good quality and designed for your type of foot. They should be replaced about every 500 miles.

Run on softer surfaces. Decrease hill workouts when possible. A running analysis to avoid hard heel strike and improve running technique is often of value.

Rest and modified activity are important. Decrease workouts by 30 percent to 50 percent. Cross train by biking or swimming.

Initiate ice massage and stretching of the lower leg muscles. Strengthening of ankle muscles is vital. Compression wraps and taping can help.

Address any foot alignment problems with inserts or orthotics. Gel inserts or pads can help.

Severe pain, increasing pain, swelling over the shin bone and pain with walking can be signs of a stress fracture. Also, numbness and significant weakness of the leg can be a sign of exertional compartment syndrome. These should be evaluated by a physician.

BRIAN F. JEWELL, M.D.
Orthopedic Surgery