I’ve been battling chronic shin splints for the past year or so and I’m at my limit with it. I’ve tried just about everything I can think of, but I’ve read that surgery is possibly an option. It is called a “posterior fasciotomy”. Does anyone have any experience with this, or any insight in general? What are recovery times? How easy is it to find a doctor that can do this? What is my long term athletic prognosis?
General Information:
I started this battle with shin splints when I started running almost 2 years ago. I had no idea what I was doing, and still had the high school football mentality of “If it hurts, its because you are a pussy, run though it”. I upped my volume way to fast, and it wasn’t long before I had a whole host of injuries to deal with. I fell away from running as I got serious about racing mountain bikes. About a year ago I started running seriously again. Went from no running, to 6 miles 3x a week. (stupid, I know better now). Not long later, shin splits came up. I took time off, it went away. After a month or so off, I started training with a triathlon team, and I tried to keep up with their mid season mileage, that lasted about 2 weeks before I could barely walk due to shin splints. From that point on, I’ve barely been able to run this past year. My run volume has been incredibly low these past 6 months. I started out running 5 min per run 4x a week in summer, adding 2 min every two weeks. I am now up to about 20 min per run 3-4x a week. Everything was going well for a while, then BAM, shinsplints comes back for no apparent reason. I took time off and got new shoes, I felt like I was getting over it pretty well. Then, these past two weeks, I had a good crash in a mountain bike race that did some damage to my lower right leg. And again, shin splints is back with a vengeance and I can’t run without pain anymore.
I’ve done the ice and stretch thing, it helps with the immediate pain, but shin splints doesn’t really go away. Recently, I’ve been getting micro-current and heat therapies, which don’t seem to be having much of an effect either. I’m getting really frustrated with this, please tell me there is a miracle cure that I’ve overlooked.
In the hundreds of patients I’ve seen with “shin splints” I’ve never once recommended, or even thought about, surgery for them. It is generally an overuse, partially biomechanical, issue. Would be akin to suggesting surgery to heal a stress fracture.
A posterior fasciotomy could be entertained for exertional compartment syndrome (and you diagnosis needs to be clear). I assume you have been in physical therapy with your description, but have you had GOOD running analysis? Compartment pressure test?
I really hate the term “shin splints” because it can actually be so many different injuries. It can be an anterior tibialis overloading, flexor digitorum longus overuse, tibial bony stresses, and on and on. I’ve even seen some of these muscular problems in the lower leg occur with a low level neural irritation that was otherwise asymptomatic. I’d second the physical therapy and running analysis with a qualified professional. You might be surprised what myofascial release can accomplish if done appropriately along with some run form changes to keep the muscle forces better controlled.
So I’ve been hanging out and reading this site for a while, but I felt the need to add my opinion to this question. First I would discourage you from seeking a surgical cure for this. In addition to the imperfect and often futile results of the particular procedure you describe, there is a relatively high likelihood that future athletic performance will be impacted. So, what can you do …
Unfortunately there are no miracle cures that I know of and there are a long list of bore inducing therapies. First, I’m assuming your problem is actually microfractures of the tibia and not something else that is giving you the same symptoms. You’ve tried time off … but it often requires a LONG time before adequate bone remodeling occurs. While you have folks who can recover in a period of weeks after this, severe cases require measuring rest in months. Often the number nine comes up … as in it takes nine months for these microfractures to “heal.” Tidbit to remember number two: even after healing, the bone will not actually be as strong as it was prior to the fracturing … for a longer time … read years. So, time is the king of this treatment.
What else you can do … strengthen the surrounding muscles. Try gentle strength training of the muscles of the anterior leg … you can actually do this by sitting and placing some weight on your toes … lift your toes up off the ground keeping the heel down … increase the weight over a period of weeks to months and don’t strength train until after you’ve had enough rest (see above) that the pain is gone.
Lastly, change running style … shifting your gait from heel-strike to midfoot strike and shortening your stride can often allow the strengthened anterior compartment muscles of the leg to compensate and “cushion” the stress through the bone.
Hope this helps … and don’t give up but treatment of bad shin splints takes time!