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Chronic Shin Pain

Jan 12th, 2014

Alex asked The Guru for the following Physiotherapy Advice:

I am a 17 year old runner. I ran a 37:30 10k in March but since April have been suffering with chronic shin pain. It comes and goes, is so variable and I’ve had to wait for the pain to reside several times before starting training again- I’ve always come back really gently but every time it came back it was worse. I was cleared of stress fractures and a knee x-ray showed I have osgood-schlatters but that doesn’t bother me too much as it’s mainly the shin pain that gets me. It sort of ‘lingers’ for a few weeks every time it comes back, getting worse when walking around and easing off after rest. During this period I do no cycling or running- I’ve never had pain during the activity. I have biomechanics issues which are no doubt the cause as well as weak calf and tibialis muscles and tight calf muscles but these are apparantely linked. I am currently resting- a 6 week rest in the Summer eased things enough to be able to start gently again but within 2 weeks I had to stop. Now I am mainly pain-free walking around and have rested 6 weeks. Stretching and strengthening brings the pain back for a day or so but I’ve been told I need to do it as I have MTSS. I’m not sure if I’m doing more damage by doing hip strengthening either. I’m 6 foot 4 and still growing which I’ve been told is part of the problem. I have tried sports massage too which has helped. I went to the NHS Podiatrist this week and should get orthotics through in about 4 weeks to correct my imbalances but have been told they won’t help.

My gait changes regularly when I walk on it’s own. The pain is more of a dull ache with occasional sharp stabs on the inner side of the tibia. When the pain is bad, it hurts to squeeze the bottom of my tibia near the ankle.

Being unable to even cycle (gently as I always have!) or strengthen my muscles is driving me mad. I don’t have faith that long rest periods alone will solve the issue- 6 weeks in and I’m still not feeling much better- and I pulled my hamstring in the pool last week. I’ve been everywhere and tried everything- I’m running out of options and patience now.

Can you give me any insight? It’d be great to find someone who I trust at long last.

Thanks, Alex

Jan 12th, 2014

The Guru Responded:

Hi Alex

That is an awesome split!

You are unfortunately in a relatively dire situation of lots of tooing and frowing, and you really need good input from a multi disciplinary team. There are no shortcuts.

I entirely agree with you at your age and height and biomechanical issues, prolonged rest,stretching will not be the end answer nor will be just getting stronger.

You will definitely need a functional, weight bearing stability program to crack on with over a period of months with a really slow, but controlled and paced integration back into running.

You need to look first of all for a sports med doctor – either in the NHS or private who works closely with GOOD physios and podiatrists.

You need them all to have a grown up conversation where all their voices carry the same merit – you’re the important person here.

I also think it would be prudent to have some compartmental studies done to have a look at the pressure build up and dispersal in your shins and calfs – MTSS can be easily confused for compartmental syndrome.

Hang in there and stay in touch

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