Scenario

Technician Vicky is talking to Stuart Graham, an office worker who sometimes pops in during his lunch hour to pick up medicines and toiletries for his family. “The plantar fasciitis has got much better, thanks to that advice you gave me a few weeks ago, so much so that I’ve started running again”, says Stuart. “I’m doing the ‘Couch to 5k’, which builds up quite slowly, but my legs really hurt. Would a bandage or some tape help?”

Vicky asks a few questions and finds out that it is the front of Stuart’s lower legs, rather than the muscles in his upper legs or calves, that are causing him pain, and it seems to be getting worse as he continues with his running programme.

Answer

Stuart may be suffering from shin splints, a problem that can be brought on by running or exercise that involves sudden stopping and starting, such as tennis or dancing. The pain, which is felt in the tibia (sometimes referred to as the shin bone) of both legs, starts as a dull ache but gets more acute as the person continues with the exercise. There may also be swelling or tenderness in the region. Stuart needs to see his GP or – if he is prepared to pay for a private consultation – a physiotherapist or sports medicine doctor. The practitioner may order x-rays or scans, to exclude other conditions that can cause similar symptoms, such as a fracture, but will probably advise some self-help measures, such as:

• Stopping running for a few weeks to allow the injury time to heal, and then building up the level of exercise gradually, stopping straightaway if symptoms recur
• Taking simple analgesics, such as ibuprofen or paracetamol, and applying ice packs or an ice gel, spray or patch to the affected area to help relieve the pain
• Making sure his trainers are supportive enough, provide sufficient cushioning and correct any gait problem, such as overpronation
• Running on a soft surface, such as grass or a treadmill, rather than roads
• Altering running style to take smaller steps instead of over-striding
• Being careful to warm up before exercise and stretch properly afterwards. Physiotherapy treatments such as massage are sometimes used, alongside education on stretching and exercising safely. Applying kinesio tape has not been proved to be effective, according to a number of clinical trials.

The bigger picture

Shin splints is an umbrella term covering any injury to the muscles, tendons or bone in the shin that causes pain. There are several causes, including:

• Small breaks in the tibia, caused by repeated impact (for example, from running on concrete). These are sometimes referred to as stress fractures
• Overuse of the muscles at the front of the leg, sometimes called biomechanical overload
• Inflammation of the tendons that attach the muscles of the shin to the tibia (tendonitis)
• Build up of pressure within the muscles that causes them to swell and leads to compartment syndrome
• Inflammation of the layer of connective tissue that covers the shin bone (periosteum), sometimes known as medial tibial stress syndrome (MTSS).
• Surgery is rarely used for shin splints, but occasionally may be recommended, particularly if the root cause is a stress fracture or severe compartment syndrome.
• Other conditions that can cause similar symptoms include muscle hernia, a nerve problem in the lower back and a blood clot (also known as deep vein thrombosis, or DVT).

Extend your learning

Pain in the lower leg can be caused by a blood clot. Find out what other symptoms may present by reading the information here.

Would you be able to advise someone on how to warm up and cool down before and after exercise? Have a look at: How to warm up and How to stretch so you are armed with the correct information should someone ask.

Specialist running shops sometimes offer advice for runners, including gait assessment and footwear analysis. Ring round to find out if any stores – or running departments within larger sports shops – near your pharmacy offer such a service.