My shins hurt when I run. Should I stop?
May 3, 2018 7:15 AM Subscribe
IKYANMD. I get muscle pain in my shins when I run. I don't think it's shin splints - I think it's chronic compartment syndrome, affecting my tibialis anterior. Do I need to stop running (for a while? forever?), or can I push through it?
I've just finished week four of Couch to 5K - so I'm running/walking for ~30mins, 3x per week - split about 60/40 in favour of running at this point. After the first week of the programme I was shattered, and could barely climb the stairs. Since then it's got a lot easier, but the pain in my shins - which was always there, from week one - now feels pretty bad when I'm running. Maybe a 4 on that pain scale of 1 to 10, where 10 is unbearable agony. Not quite enough to stop me running, but it hurts. The pain stops as soon as I stop running. After I stop, I can feel that my legs have done some work, but they don't hurt. I can climb the stairs with no issues. But less than 5mins into the next run, it's back.
I'm running about 50/50 on tarmac and across fields. Before starting C25K, I bought an OK pair of shoes (Asics Gel Pulse 9). I had my gait checked out - it's neutral. I'm brand new to running, but I have half-decent cardiovascular fitness from cycling - which obviously has way less lower leg impact.
I read about shin splints, and it doesn't seem like that. Pain is in the wrong place - not on the inside of my tibia, but right on the muscle that's directly on the outside of that bone. Both legs the same. About half way up between ankle & knee. So, reading around, it seems like maybe chronic exertional compartment syndrome.
Have you had this, or something like it? What did you do? Do I need to stop running? For how long? Do I need different shoes, new insoles, or a different route? What do you think of my chances of getting through a 5k park run any time soon? Thank you...
I've just finished week four of Couch to 5K - so I'm running/walking for ~30mins, 3x per week - split about 60/40 in favour of running at this point. After the first week of the programme I was shattered, and could barely climb the stairs. Since then it's got a lot easier, but the pain in my shins - which was always there, from week one - now feels pretty bad when I'm running. Maybe a 4 on that pain scale of 1 to 10, where 10 is unbearable agony. Not quite enough to stop me running, but it hurts. The pain stops as soon as I stop running. After I stop, I can feel that my legs have done some work, but they don't hurt. I can climb the stairs with no issues. But less than 5mins into the next run, it's back.
I'm running about 50/50 on tarmac and across fields. Before starting C25K, I bought an OK pair of shoes (Asics Gel Pulse 9). I had my gait checked out - it's neutral. I'm brand new to running, but I have half-decent cardiovascular fitness from cycling - which obviously has way less lower leg impact.
I read about shin splints, and it doesn't seem like that. Pain is in the wrong place - not on the inside of my tibia, but right on the muscle that's directly on the outside of that bone. Both legs the same. About half way up between ankle & knee. So, reading around, it seems like maybe chronic exertional compartment syndrome.
Have you had this, or something like it? What did you do? Do I need to stop running? For how long? Do I need different shoes, new insoles, or a different route? What do you think of my chances of getting through a 5k park run any time soon? Thank you...
Response by poster: Yeah, acute compartment syndrome is something different. I don't have that. Nor do I ever want it. But, it's listed as one of the possible complications of what I think I might have. So, I'm not looking to take any risks with that.
posted by rd45 at 7:33 AM on May 3, 2018 [1 favorite]
posted by rd45 at 7:33 AM on May 3, 2018 [1 favorite]
I am not a doctor or physician but I've never heard of someone who was getting started running who didn't have the pain you describe. Most people cheerfully call it shin splints because they've heard the word, but as you've noted, it's not.
One day about 4-6 weeks into my running career, it just cleared during a run. It was like when you have a stuffy nose and it clears. It was glorious, and it didn't really recur after that. YMMV.
posted by ftm at 7:36 AM on May 3, 2018 [4 favorites]
One day about 4-6 weeks into my running career, it just cleared during a run. It was like when you have a stuffy nose and it clears. It was glorious, and it didn't really recur after that. YMMV.
posted by ftm at 7:36 AM on May 3, 2018 [4 favorites]
Mine on the other hand did not clear. The connective tissue started to tear off my tibias; doctor said I was lucky it didn't tear the bone along with it. I did have to stop. It sucked. It might have been avoided with better stretching / vitamin D / softer surfaces.
posted by fingersandtoes at 7:40 AM on May 3, 2018 [4 favorites]
posted by fingersandtoes at 7:40 AM on May 3, 2018 [4 favorites]
If I were you, I'd stop and consult a healthcare provider (orthopedist or physical therapist). There's plenty of other training you can do meanwhile to maintain fitness without aggravating the injury, including cycling. It could be the shoes, yes - I need to replace mine every couple months or I start to notice pains (running about 25 base miles a week). It could be the hard surface. It could be stress fractures or something else. I'd take some time off and really ease back in gradually in a month or so, like repeat the program and see if you still have pain doing week one. If not, then run week one a couple weeks and try week two. No pain? Do it a couple weeks and so on, reducing running if you encounter pain. There are plenty of 5ks in the future; you don't need to be hurting to run one. Walk one instead this year, maybe.
posted by OneSmartMonkey at 7:45 AM on May 3, 2018 [6 favorites]
posted by OneSmartMonkey at 7:45 AM on May 3, 2018 [6 favorites]
I've had similar shin pain in the same place, call it what you will. What did the trick for me was switching to minimalist shoes with near-zero drop. The lack of drop and heel padding forces you to run more on your toes and reduces the stress on yours shins. The pain will shift to your calves, at least for a few weeks, but it's worth it in the long run.
posted by Lazlo Hollyfeld at 7:47 AM on May 3, 2018 [2 favorites]
posted by Lazlo Hollyfeld at 7:47 AM on May 3, 2018 [2 favorites]
Oh, that said, I would stop running until the pain clears completely, probably a couple of weeks.
posted by Lazlo Hollyfeld at 7:48 AM on May 3, 2018
posted by Lazlo Hollyfeld at 7:48 AM on May 3, 2018
I've had a similar pain while skating for over 4 years. I've seen 3 GPs, 3 physios an a sports injury specialist about it. No firm diagnosis, some say tendinopathy, some say compartment syndrome, some say nothing at all. The sports injury specialist said it had elements of compartment syndrome but wasn't that simple and referred my to physio who ignored everything the specialist said and said it was simple tendinopathy and I should quit skating for 6 weeks then build back up again slowly (which i didn't do because the pain was worse after a rest and at its worse, would come on within a couple of minutes so I didn't see how it was really possible to build up slowly). Probably not the smartest plan but I now skate with wearable TENS machines on both legs.
I did once go away for about 6 weeks last year after a sports massage but similar massages haven't had the same effect.
I will say it has got better and massage to relieve the built up tension/tightness does help. I would see a physio or sports injury specialist to see about getting an accurate diagnosis. If it is chronic compartment syndrome, my understanding is the surgery is fairly straight forward, recovery time is 6-12 weeks an has an excellent success rate.
posted by missmagenta at 8:28 AM on May 3, 2018 [1 favorite]
I did once go away for about 6 weeks last year after a sports massage but similar massages haven't had the same effect.
I will say it has got better and massage to relieve the built up tension/tightness does help. I would see a physio or sports injury specialist to see about getting an accurate diagnosis. If it is chronic compartment syndrome, my understanding is the surgery is fairly straight forward, recovery time is 6-12 weeks an has an excellent success rate.
posted by missmagenta at 8:28 AM on May 3, 2018 [1 favorite]
Best answer: Generally running through pain isn't advised. If something new springs up, and it's a 1-2 on a 1-10 scale, it might be worth seeing if it clears up in a km or two (maybe with a stop to walk and test range of motion of joints / dynamically move your legs a bit).
As you say the pain clears up quickly after running, it could be compartment syndrome. I'm assuming by "outside" you mean the anterior/lateral side of the leg? Shin splints can be on the lateral side (even though they're usually on the medial side), and as noted above by others lower leg pain is where most new runners get pain. As you're probably read, this pain tends to linger a bit.
As you've probably noted from your own research compartment syndrome is slow to be diagnosed, but there's muscle pressure tests that can be done to definitively diagnose. As it generally takes many months to get to this point either the test is extremely painful/damanging (needles placed into the muscles in the 4 main lower leg chambers to measure pressure), the equipment is specialized enough that generally doctors/clinics don't have it, or it's rare enough that docs shoot anywhere else.
As you're a cyclist, this could eventually effect your cycling even if you give up running if it is compartment syndrome. Because of that it's probably worth looking to see if you can get this test done. You might have better luck with a sports doctor than your normal GP, but I'm not sure what your insurance situation is.
Whether you want to seek a diagnosis immediately, or wait a bit, at the level of pain you're describing I would definitely advise that you stop running for at least 2 weeks (consider ~4+ if this is shin splints at a pain level of 4). Strongly reconsider what levels of pain that you're willing to run though; tired/sore muscles from doms are perfectly OK to run through. Any other pain that isn't transient doesn't bode well.
During these 2-4 weeks, if you want to assume it's compartment syndrome there's not really much you can do. Foam rolling might help some. If you want to try working under the theory it might not be compartment syndrome, then foam rolling, ice (cold pack or ice wrapped with a damp cloth for 20 minutes applied up to every 2 hours), self-massage (dig into any tight areas with thumbs/fingers while alternatle plantarflexing and dorsiflexing), stretching the calves (lower and upper (note, it takes about 12 weeks+ to actually see improvements from stretching)), and some strength work in the calves (for both dorsiflex-based movements as well as the more standard plantarflex based movements). Lastly, 1-legged balance (without your hips dropping or supporting knee driving inwards) is also pretty important and generally lacking in new runners.
If after 4 weeks of honest work towards this with no running to further bother things and the pain still starts up in the same way, then there's that much more evidence that you might want to seek a post-exercise muscle pressure test.
posted by nobeagle at 8:49 AM on May 3, 2018 [1 favorite]
As you say the pain clears up quickly after running, it could be compartment syndrome. I'm assuming by "outside" you mean the anterior/lateral side of the leg? Shin splints can be on the lateral side (even though they're usually on the medial side), and as noted above by others lower leg pain is where most new runners get pain. As you're probably read, this pain tends to linger a bit.
As you've probably noted from your own research compartment syndrome is slow to be diagnosed, but there's muscle pressure tests that can be done to definitively diagnose. As it generally takes many months to get to this point either the test is extremely painful/damanging (needles placed into the muscles in the 4 main lower leg chambers to measure pressure), the equipment is specialized enough that generally doctors/clinics don't have it, or it's rare enough that docs shoot anywhere else.
As you're a cyclist, this could eventually effect your cycling even if you give up running if it is compartment syndrome. Because of that it's probably worth looking to see if you can get this test done. You might have better luck with a sports doctor than your normal GP, but I'm not sure what your insurance situation is.
Whether you want to seek a diagnosis immediately, or wait a bit, at the level of pain you're describing I would definitely advise that you stop running for at least 2 weeks (consider ~4+ if this is shin splints at a pain level of 4). Strongly reconsider what levels of pain that you're willing to run though; tired/sore muscles from doms are perfectly OK to run through. Any other pain that isn't transient doesn't bode well.
During these 2-4 weeks, if you want to assume it's compartment syndrome there's not really much you can do. Foam rolling might help some. If you want to try working under the theory it might not be compartment syndrome, then foam rolling, ice (cold pack or ice wrapped with a damp cloth for 20 minutes applied up to every 2 hours), self-massage (dig into any tight areas with thumbs/fingers while alternatle plantarflexing and dorsiflexing), stretching the calves (lower and upper (note, it takes about 12 weeks+ to actually see improvements from stretching)), and some strength work in the calves (for both dorsiflex-based movements as well as the more standard plantarflex based movements). Lastly, 1-legged balance (without your hips dropping or supporting knee driving inwards) is also pretty important and generally lacking in new runners.
If after 4 weeks of honest work towards this with no running to further bother things and the pain still starts up in the same way, then there's that much more evidence that you might want to seek a post-exercise muscle pressure test.
posted by nobeagle at 8:49 AM on May 3, 2018 [1 favorite]
You need to get a diagnosis in person before it's possible to determine the appropriate intervention. Seriously. Don't damage your body for life because you don't think you need a doctor. You do not have the tools available to determine if this is compartment syndrome. Stop running until you know it is safe.
posted by windykites at 8:52 AM on May 3, 2018 [6 favorites]
posted by windykites at 8:52 AM on May 3, 2018 [6 favorites]
My shin splits also cleared up when I switched to zero-drop shoes with minimal cushioning.
YMMV as everyone's feet are different.
See an orthopedist – they'll be able to help.
posted by fraula at 10:50 AM on May 3, 2018 [1 favorite]
YMMV as everyone's feet are different.
See an orthopedist – they'll be able to help.
posted by fraula at 10:50 AM on May 3, 2018 [1 favorite]
I used to have this pain.
I know opinions vary on stretching pre- or post- run, but by stretching the fronts of my shins, I was able to get rid of the pain.
In stocking feet, stand behind a couch or low counter - something you can put most of your weight on. Go up on your tip-toes, then on one leg, roll your toes over so you're making a foot-fist. I.e., the tops (toenail side) of your toes are touching the floor.
Transfer most of your weight to the couch via your arms, and bend your knees so your ass moves away from the couch. Feel the stretch in your shins on the foot-fist side.
Switch feet, repeat.
Once you get the feeling right, you can do it on both feet at the same time.
posted by notsnot at 11:40 AM on May 3, 2018
I know opinions vary on stretching pre- or post- run, but by stretching the fronts of my shins, I was able to get rid of the pain.
In stocking feet, stand behind a couch or low counter - something you can put most of your weight on. Go up on your tip-toes, then on one leg, roll your toes over so you're making a foot-fist. I.e., the tops (toenail side) of your toes are touching the floor.
Transfer most of your weight to the couch via your arms, and bend your knees so your ass moves away from the couch. Feel the stretch in your shins on the foot-fist side.
Switch feet, repeat.
Once you get the feeling right, you can do it on both feet at the same time.
posted by notsnot at 11:40 AM on May 3, 2018
Best answer: I had chronic compartment syndrome in my late teens and this sounds a lot like it. I had surgery on both legs when I was 17 and went on to play college soccer, so I definitely recommend that.
I was told that deep massages for the area could theoretically help, along with calf stretching - but for most people they don't. I think nobeagle has it right - take three weeks off, do lots of stretching, static strength work, and massage, start again from week 1 of c25k and if it comes back (specifically the "goes away as soon as I stop" aspect) then go to a sports doctor. I'd probably spend some of the time off running looking for recommendations for a doctor - go to your local running shop and ask them, or call around at places that take your insurance, etc.
Also, if it is compartment syndrome, I'm pretty sure there's no danger that you're making it worse by continuing, except if you start trying to run funny to make it hurt less and then injure yourself somewhere else. I waited about six months for my surgery to fit it in around the doctor's schedule and my senior year schedule, and during that time (with the doctor's approval) continued playing soccer and racing cross-country, I just didn't really do any training because it hurt.
(I can't run much these days but that's just middle-age, old injuries, and lack of fitness - the compartment syndrome never came back).
posted by the agents of KAOS at 5:44 PM on May 3, 2018 [1 favorite]
I was told that deep massages for the area could theoretically help, along with calf stretching - but for most people they don't. I think nobeagle has it right - take three weeks off, do lots of stretching, static strength work, and massage, start again from week 1 of c25k and if it comes back (specifically the "goes away as soon as I stop" aspect) then go to a sports doctor. I'd probably spend some of the time off running looking for recommendations for a doctor - go to your local running shop and ask them, or call around at places that take your insurance, etc.
Also, if it is compartment syndrome, I'm pretty sure there's no danger that you're making it worse by continuing, except if you start trying to run funny to make it hurt less and then injure yourself somewhere else. I waited about six months for my surgery to fit it in around the doctor's schedule and my senior year schedule, and during that time (with the doctor's approval) continued playing soccer and racing cross-country, I just didn't really do any training because it hurt.
(I can't run much these days but that's just middle-age, old injuries, and lack of fitness - the compartment syndrome never came back).
posted by the agents of KAOS at 5:44 PM on May 3, 2018 [1 favorite]
I have had this issue - or something very similar to what you describe - on and off since I started running two years ago. I haven't had it diagnosed either, though. It set me back numerous times in my training program and I can manage it by building up mileage really slowly. So I second the advice to cut back your training - you may not have to stop entirely, but go back to the very beginning of your C25K program and see if the pain lasts. If it does, be sure to see a doctor.
For me, at its worst, the pain got unbearable while running and my foot started 'sleeping'. When I took a break, the muscles on the outside of my lower legs were incredibly tense, seemingly swollen, and painful to the touch. I could barely flex my foot up- or downwards. It always took a few minutes to get back to normal. As far as I know, these are symptoms of chronic compartment syndrome too, but as I'm now pain-free (albeit running a lot less) I haven't had it checked out...
Some tips:
- If possible, have your shoes fitted - or checked out - in a specialist store and be sure to mention the issue
- Compression socks apparently can help, but did nothing for me
- Make sure your laces aren't too tight
- Reduce your running speed (advice applicable for any running issue)
Also, starting to run always comes with many pains and aches. Don't panic. But slow down.
posted by Desertshore at 12:51 AM on May 4, 2018 [1 favorite]
For me, at its worst, the pain got unbearable while running and my foot started 'sleeping'. When I took a break, the muscles on the outside of my lower legs were incredibly tense, seemingly swollen, and painful to the touch. I could barely flex my foot up- or downwards. It always took a few minutes to get back to normal. As far as I know, these are symptoms of chronic compartment syndrome too, but as I'm now pain-free (albeit running a lot less) I haven't had it checked out...
Some tips:
- If possible, have your shoes fitted - or checked out - in a specialist store and be sure to mention the issue
- Compression socks apparently can help, but did nothing for me
- Make sure your laces aren't too tight
- Reduce your running speed (advice applicable for any running issue)
Also, starting to run always comes with many pains and aches. Don't panic. But slow down.
posted by Desertshore at 12:51 AM on May 4, 2018 [1 favorite]
Response by poster: Thanks for all the great advice. I'll take a pause in my training. I made an appointment at my local sports injury / physiotherapy clinic, and we'll see where we go from there.
posted by rd45 at 1:25 AM on May 4, 2018
posted by rd45 at 1:25 AM on May 4, 2018
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It does not sound like your pain is severe enough to warrant this diagnosis.
posted by slipthought at 7:31 AM on May 3, 2018 [1 favorite]