Toothache Pain in Leg aka Shin Splints

Got toothache pain in your lower leg?

Or is it more like one of those fat pet rats, gnawing your shin bone like a corn cob?

It's probably shin splints — the scourge of (new) runners. 

Also known as medial tibial stress syndrome, it's triggered by doing too much, too soon.

Now, there are other causes of that dull, heavy throb. But shin splints is by far the most common.  

Toothache Pain in Leg

A bad dose of shin splints gnaws and makes walking upstairs burn. 

I know this because I've suffered with lower leg toothache myself. 

(Forgive me Father, for I have sinned. But this was long before I was a Podiatrist)

Shin splints strikes people new to exercise.

​Call it too much, too fast. 

Now, when I say "exercise", what I really mean is impact activity.

Basically anything where your foot makes hard contact with the ground. This could be running, skipping or parkour.

(Or Romeo-style jumps from your secret lover's window as her husband comes home early) 

Couch to 5k ​Curse

When the running bug gets hold of you, it doesn't grasp lightly. 

It gets you in a cop-tier arm lock — but this time it's pleasurable.

You live running, you think running, you literally breathe running. 

​The toothache like pain in leg cases I see usually go something like this:

1. You start a new exercise regime and everything's going great. 
2. A few weeks in, you notice a mild lower leg soreness the day after a run.
3. ​Your shin starts to hurt to touch when you press down on it.

But you soldier on. After all, this shin pain eases after warming up.

​10 mins in and you've forgotten about it. ​

Toothache (But in Your Leg)

Over time, it creeps into the run itself. And hurts more the day after. 
​
In the end, the "mild ache" is now a jarring throb on every step and even walking causes it. 

​Unhealed, shin splints grow to an unrelenting pain that happens even when resting.
​(And forces you to take time off exercise.)  ​

​Your Shin - Strong Yet Sensitive

​The front of your lower leg, aka shin, is built on a foundation of two large bones:

• The tibia
• And the fibula (NOT fibia)

​The tibia, the biggest of the two, is one of the strongest, hardest bones in the body.

​(You may have seen Thai boxers kicking palm trees with it)

The slighter fibula is on the outside of your lower leg. 

​Muscles, tendons and ligaments attach to these bones which help you walk, run and jump.

Yet despite all this strength, your shin is packed with sensitive nerves. 

​As you've no doubt found out when you hit it on something in the dark. ​​Or run for weeks on end on concrete. 

​Shin Splint Symptoms

​The classic symptom is a burning, dull ache at the lower half of the tibia. It can hurt one shin or both.​

• ​In most cases, the pain is worse on the inner side

• ​Some liken it to giant toothache in their shin
• Others get a feeling of "tightness"

​
When you first get shin splints, it's usually worse at the start of your session. It then fades as you warm up before coming back with a vengeance as you cool down.

As shin splints progress, the ache lasts throughout.​

​Shin Splint Causes

Irritation to the surface of the big tibia bone causes shin splints.

This is what happens:​

1. Pounding hard pavement puts a heap of stress on the muscles that attach to the shin.
2. To ward off the new demand, these muscles try and disperse force down to your tibia bone. 
3. The bones' surface, called the periosteum, becomes raw and sore as a response.

​
​This is why it hurts to press down on. All the muscle clamped to your shinbone is being ripped across the bone. 

​​The biggest cause of this?

Exercising too much and too soon. 

​Your muscles, tendons and bone haven't had time to adapt to the sudden increase in stress. Hence medial tibial stress syndrome. ​

Shin Splints and Running​

When you run, each footstep creates a force several times your body weight.

After trainers absorb the impact, your lower leg muscles come into play. They eat up as much leftover energy as they can. 

When these muscles are under-conditioned (or overworked) the jarring transfers to the tibia.

Excessive stress inflames the surface of the bone and the muscles attached to it.

Aggravating Factors 

​Running Surfaces

​The ground you run on has a big effect. 

​Unforgiving surfaces like concrete create much more stress — even for well-cushioned shoes. 

Downhill running makes shin splints worse. Your leg muscles have to work overtime to resist gravity. 

Bad Foot Wear

​Wearing old or wrong shoes is a huge contributor to shin splints.

Human feet weren't designed/evolved/created to run on hard concrete. They need all the cushioning they can get. 

More support, for the arch or heel, helps absorb some of that tremendous shock from the hard ground. 

For example, shin splints is very common in military recruits. While physically fit, they leap and march in footwear they're not used to. 

Tight Shin Muscles

​​Everyone knows you should stretch muscles after exercise.

The shin area is often overlooked. It comes way down on the list after calf and quad stretches.

But not a lot of people know: as well as powering movement, muscles have another important role. ​They absorb shock.

And guess what. A longer, more nimble muscle dampens shock better.

Frequent hard exercise shortens muscles. ​When a muscle is shorter, it's less flexible.

This means it's less able to absorb shock compared to one that's supple and elastic. This is important given the amount of force transmitted up through the lower leg.

Foot Mechanics

This subject could consume an entire blog post on its own, so I'll keep it brief.

​Each person's foot hits the ground in a different way. Now pronation is the body's own shock-absorbing mechanism.

But over pronation can be as damaging. 

​Adequate cushioning is vital and so is the correct type of shoe for your foot strike. 

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​Similar Conditions

​Most cases of shin pain are from shin splints. But there are similar conditions with similar symptoms.

​These are:​

1. Shin stress fractures 
2. Compartment syndrome
3. Anterior tibial tendonitis

Shin Stress Fracture

A shin stress fracture is a small crack in the tibia bone from heavy repetitive force. ​The pain usually gets worse during exercise.

​It can also happen suddenly, unlike shin splints.

Shin stress fractures can be difficult to identify.

It shares several symptoms with shin splints. and due to bone involvement, usually requires an x-ray to diagnose.

​Compartment syndrome

Compartment syndrome occurs when muscles, nerves and blood vessels swell during exercise.
​
Covering these is a thin yet strong layer of tissue called a fascia.

This fascia doesn't stretch easily, and as shin muscles expand, the fascia resists. The resulting clash leads to compartment syndrome.

The symptoms are again like shin splints, but there may also be numbness and even a loss of feeling.​

Anterior tibial tendonitis

The tibialis anterior muscle runs down the front shin. It's that shapely muscle you can see if you flex your foot back towards you. 

Now as well as this flexing, the tib anterior plays a massive role when your foot lands on the ground.

It lowers it under control. 

Anterior tibial tendonitis occurs when the muscle gets red raw from use.

It's quite a rare condition. It takes a lot to exhaust this powerful muscle, but at its worst, the tendon can rupture leading to a “drop foot.” ​​

​Shin Splint Treatment

​​As horrible as it is, shin splints is almost always resolved with:

• Ice
• Rest 
• Insoles 
• Stretching​

Treatment should start right away with ice and an immediate break from training.  

​Then, introduce a stretching program and at the very least decide if it's time to buy new trainers. 

Ice 

​The first step to managing shin pain is to address the burning inflammation.

Icing is the undisputed king at cooling shin splints. It's cheap and very effective.
​
The ice pack itself doesn't matter. What's important is to apply to the aching area for up to ten minutes several times a day if needed.

​You'll know right away it's working. Your shin will be comfortably numb. 
​
It's particularly important to do this right after exercise. ​Acting fast to reduce inflammation aids the healing process. 

Rest

After managing the pain symptoms, it's crucial to let the area heal. 
​
Allow at least several days from any activity involving impact. ​When you start back, begin at much less intensity.  Avoid hard surfaces as much as possible. 

It can be tempting to jump straight back into exercise when the pain has reduced. 

But shin pain returns fast without proper rest. This could be a few weeks.
​Stubborn cases may force a change to non-impact exercise for a while. 

Trainers and Insoles

Don't skimp on running trainers. It's best to get two medium-priced pairs and alternate them. 

For insoles, there's no need for anything fancy as a general rule.

​As a Podiatrist, I would (assuming you need them) look to provide arch and heel support. This would be to give your foot a hand in shock absorption. 
​
Now, this is general advice. Some people need specific arch and heel support for their own running style. ​​

​Stretches for Shin Splints

​​Stretching encourages healing blood flow. It also makes your legs better at dealing with concrete. 

​Recovery - Be Patient (Not a Patient)

It can be very tempting to jump right back into it after a few sessions pain-free.

• Err on the side of caution. Be patient and take more time off than you think you need. Plan and stick to rest days. 
• Keep sessions shorter than before. A good rule is not to add more than 10 percent of miles per week. This gives your shins lots of time to recover and strengthen. 
• Stick to flat, soft surfaces. Grass and track are your friends. This allows the legs to adapt to the new stress.
• Embrace cross-training. Spinning/cycling aren't the same as running (obviously) but do a great job at keeping your CV fitness up.