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I went running the other day and my shin started hurting and I don't really know what to do. So I went to the internet to hopefully try to find a solution to this problem. This is a really common statement that runners will make, "I went for a run and my leg hurt and now I'm at these crossroads of what to do."

Now, when we start to have some shin pain, one of the things that we need to figure out is what is the tissue that is giving us pushback?

Let's go back to high school anatomy. Now, if we look at all the things that exists from our knee down, we see that there's a lot of stuff. We have muscles, we have tendons, we have fascia, arteries, veins, bones. There's a lot of stuff. I want to specifically hone in on the bone and the muscle and how these two tissues work together.

Our bones provide a sturdy structure for our muscles to work and our muscles help slow our foot down every time it hits the ground. So they have to work a lot when we're running. If we look along the inside of our shin bone, we see that there's a group of muscles that blend into that area and their main job is to slow our foot down every time our foot contacts the ground when we run. They have to work a lot. For most people, when they're experiencing shin pain, if they're only experiencing pain, that's most likely what we're dealing with. This typically gets referred to as shin splints or medial tibial stress syndrome. Those are fancy words for saying my leg hurts. It's important that we figure out what tissue is involved, because if it's the bone, we probably have to stop running. If it's the muscle, there's a good chance that we can continue to train, maybe with some modifications.

One of the first tests that someone will do is they will palpate the area that hurts. Does this hurt? Does this hurt? Does this hurt? And what they're trying to figure out is if it's the bone or the muscle that's involved. If it hurts for me to palpate or touch the bone versus the muscle, a lot of people think that's going to give us information that's helpful. And while palpation can be something that we use, it's not great. I've had lots of runners that come in that have palpable tenderness over their shin, their bone, and they don't have a bone stress injury. I've had lots of runners that have palpable tenderness on the muscle and not the bone, and they ended up having a bone stress injury. So we can use that as a very small part of how we figure out how to handle these situations, but it's not definitive if someone is tender over one spot versus the other.

Now, if the bone is what's involved, normally that's going to continue to worsen and as we run. It doesn't get better with activity. This is the opposite of what we see with muscles. Often if the muscle is what's involved, we're going to be able to warm up a little bit. Maybe it hurts at the start of my run, but over time my feet get under me and then I'm feeling okay after that.

The second thing that we have to look at is what is the location of the person's symptoms? If that person's symptoms are very focal in nature, the symptoms are five centimeters or less in length, there's a higher chance that that's the bone that's involved. If the symptoms are of a greater length, if they're above five centimeters, if I can press on the muscles on the inside of my shin and it's painful for bigger than five centimeters, there's a higher likelihood that it's the muscle that we're dealing with.

And the last thing is if it's bilateral in nature. So if we're experiencing pain that's only on one side versus pain that's on two sides, there's a higher chance that it's the bone. So if someone is having focal pain that's present in a very specific spot that worsens with things like running, standing, and other weight bearing activities, there's a higher likelihood that this is the bone that we're dealing with. If someone's symptoms warm up with activity, they're broader in location and they're present on both sides, there's a higher likelihood that this is the muscle that's involved. So we're pretty confident that it's the muscle that we're dealing with.