PREVALENCE OF SHIN SPLINT IN RECREATIONAL MARATHON RUNNER

Abstract

Background: It is essential to find out the presence of shin splint in recreational marathon runners to prevent the injury from causing more damage. This study was conducted to identify shin splint in recreational marathon runners in Krishna Hospital, Karad. This study was designed to provide meaningful insight into the cause of shin splint in recreational marathon runners. Objectives of the study were to find out the impact of shin splint in recreational marathon runners and to assess the severity of shin splint in recreational marathon runners of age group 20-30 years both males and females in Krishna Hospital, Karad.
Material and Methods: 190 recreational marathon runners who fit in the criteria were given Runner’s Questionnaire and were asked to fill it.
Result: There was marked significance pain was present during(p=0.04) and running throughout(p

Full text

Int J Physiother 2020; 7(1) Page | 37
ORIGINAL ARTICLE
IJPHY
ABSTRACT
Background: It is essential to nd out the presence of shin splint in recreational marathon runners to prevent the
injury from causing more damage. is study was conducted to identify shin splint in recreational marathon runners
in Krishna Hospital, Karad. is study was designed to provide meaningful insight into the cause of shin splint in
recreational marathon runners.
Objectives of the study were to nd out the impact of shin splint in recreational marathon runners and to assess the
severity of shin splint in recreational marathon runners of age group 20-30 years both males and females in Krishna
Hospital, Karad.
Material and Methods: 190 recreational marathon runners who t in the criteria were given Runner’s Questionnaire
and were asked to ll it.
Result: ere was marked signicance pain was present during(p=0.04) and running throughout(p<0.0001) in
recreational marathon runners.
Conclusion: It was concluded from the present study that there is a prevalence of shin splint in marathon runners. Shin
splint was found more in females (55.3%)than in males (44.7%). Based on the duration of pain and shoe surface was
found to be more prevalent to cause shin splint in marathon runners.
Keywords: Shin Splint, Recreational marathon runners, Pain, Shoe surface, Medial tibial stress syndrome.
Received 13th December 2019, accepted 05th February 2020, published 09th February 2020
www.ijphy.or g
10.15621/ijphy/2020/v7i1/193672
CORRESPONDING AUTHOR
Int J Physiother. Vol 7(1), 37-41, February (2020) ISSN: 2348 - 8336
PREVALENCE OF SHIN SPLINT IN RECREATIONAL MARATHON
RUNNER
¹Prina. Y. Patel
*2Namrata Patil
*2Namrata Patil
Assistant Professor, Department of Paediatrics,
Faculty of Physiotherapy, Krishna Institute of
Medical Sciences Deemed To Be University,
Karad, Maharashtra, India.
email: dr.namratakcpt@gmail.com
¹Final year, Faculty of Physiotherapy,
Krishna Institute of Medical Sciences
Deemed To Be University, Karad,
Maharashtra, India.
is article is licensed under a Creative Commons Attribution-Non Commercial 4.0 International License.
Copyright © 2020 Author(s) retain the copyright of this article.

Int J Physiother 2020; 7(1) Page | 38
INTRODUCTION
Shin splint is most oen used to described as exertional leg
pain. ere are mainly two types of shin splint that occur
which are a) Anterior shin splint refers to as dysfunction
of the anterior leg compartment or surrounding structures
b) Medial tibial stress syndrome refers to as exercise due to
pain associated to distal two-third of the leg [1].
Recreational runners are increasing in number and
are mostly participating in marathon runners. Mostly
recreational runners having training intervention has
important implications for that design of training protocol
[2]. Improper foot biomechanics such as static pronated
foot, lower standing foot angle, varus rearfoot and forefoot,
maximum pronation, and increased navicular drop is
associated with medial tibial stress syndrome among
runners [3]. In most of the studies, recreational runners
have medial tibial stress syndrome, mostly or second
most frequently diagnosed injury. Pain is present during
exercise in mild cases, and in severe cases, pain is present
during rest [4]. e posteromedial muscular weakness is a
consequence of muscular overuse and chronic fatigue [5].
Cause of anterior shin splint is not completely understood;
overuse or chronic injury of the anterior compartment
muscles, fascia, bony, and periosteal attachment. Causes
of medial tibial stress syndrome are traction periostitis
of soleus or exor digitorium longus muscle origin and
increased heel eversion [1]. Some studies suggested that
Medial tibial stress syndrome is a consequence of repetitive
stress imposed by impact force that eccentrically fatigue
the soleus, which creates repetitive bending and bowing of
tibia [2].
Detmer classied medial tibial stress syndrome based on
etiology, i.e., Type 1: included local stress fracture, Type
2: periostitis/periostaligia, and Type 3:was due to deep
posterior compartment syndrome [4]. A study showed no
connection of myofascial attachment of the deep crural
fascia, soleus, exor didgitorum longus and tibialis in the
posterior border of tibialis in which the pain appeared as
Medial tibial stress syndrome [5].
A large study showed no connection of the deep coral to
the coral fascia, long exor digitorium, and tibialis in the
posterior border of the tibia, in which the pain appeared as
a tibial stress syndrome.
Medial tibial stress syndrome should be dierentiated
from chronic exertional compartment syndrome, stress
fracture, popliteal artery entrapment syndrome, and
various neuropathies [4]. A navicular drop with feet
shoulder-width apart was measured, which was found
to be signicantly associated with Medial tibial stress
syndrome [5]. One of the most oen causes of Medial tibial
stress syndrome is increased valgus force on the rear foot
and excessive pronation [4].
People with higher Body mass index and the individuals
who used prior orthotic devices for a prolonged period
were found to be more prone to develop Medial tibial stress
syndrome [5]. Other studies suggested that over two times
more likely to incur Medial tibial stress syndrome injury
in runners who had experienced previous running injury
[3]. Women appear more frequently to have this diused
tenderness over the posteromedial aspect of the distal third
of the tibia, as compared to men[4].
Positive conrmation of Medial tibial stress syndrome
can be done by bone stress marker, advances in computed
tomography, magnetic resonance imaging technique, and
dual-energy absorptiometry [5]. Shock-absorbent insoles,
pronation-control insoles, and graduated running the
program have been proven to be a preventive method of
Medial tibial stress syndrome [2]. Running on an uneven
platform and hill running should be prevented whereas
to minimize rearfoot valgus and to correct the excessive
pronation, pes cavus or pes planus appropriate shoe wear
is an essential tool to use [4]. e lower limb musculature
stretch has been consistently proven not to prevent Medial
tibial stress syndrome [2].
Flexibility and the strengthing regime should be initiated
to correct any muscle imbalances; Non-steroidal anti-
inammatory drugs and Anti-inammatory modalities
can also be used for rehabilitation of Medial tibial stress
syndrome [4]. Person conditioning, which is included as
one of the graduated running programs, is accepted as
one of the preventive measures for many injuries [2]. For
an athlete which severe limitation of physical activities,
frequent recurrence, or no response to available therapy,
an operative method has been suggested [4]. e
runner’s questionnaire is used to evaluate the shin splint
in recreational marathon runners. e purpose of the
present study is to determine the individual having shin
splint in a recreational marathon runner, which is usually
misdiagnosed and can cause more damage to the area.
Overuse injuries result in repetitive microtrauma, which
leads to damage in cellular and intracellular degeneration.
is is most likely to occur due to change in mode, intensity,
or duration of the timing.
Common overuse injuries of the lower leg include
tendinopathy, stress fracture, chronic exertional
compartment syndrome, and shin splint. e incorrect
method of training or lack of proper training is the leading
cause of this injury. An adequate light upon the correct
regime can prevent this injury.
For a recreational marathoner, injury this early and oen
can hamper that individual’s performance and daily
activities. If the marathoner is enlightened about the injury
and its cause, prevention can cause betterment in his
performance hereaer.
Considering the above facts, the present study was planned
to determine shin splint in recreational marathon runners
in Krishna Hospital, Karad. e current study objectives
were to nd out the impact of shin splint in recreational
marathon runners and assess the severity of shin splint in
recreational marathon runners.

Int J Physiother 2020; 7(1) Page | 39
MATERIAL AND METHODS
e present cross-sectional observational study was
conducted at KIMS for three months. A total of 190
subjects were selected by using simple random method.
e subjects were included in the present study of both
males and females with the age group 20 to 30 years. e
subjects who participated in cross country runners, long-
distance runners, and who are not willing to participate in
the study were excluded from the present study.
Data collection procedure:
Procedure: 190 subjects aged between 20 to 30 years, both
male and female, were selected randomly for the present
study. Individuals who are not willing to participate and
who participated in cross country runners and long-
distance runners were excluded. Written consent was taken
from subjects those willing to participate. Institutional
Ethical Committee approved was obtained (Ref No:
0481/2018-2019) before the beginning of the study. e
assessment was done based on the Runner’s Questionnaire
lled by the subjects.
Statistical Analysis:
Descriptive statistics such as mean, SD, and the percentage
was used to present the data. Association of shin splint with
various variables was assessed by using the Chi-square test.
A p-value of less than 0.05 was considered signicant. Data
analysis was performed by using Microso Excel and SPSS
v16.0
RESULTS
Majority of the subjects were belongs to age group 23-25
(46.3%) followed by 26-28 (31.1%), 20-22 (21.1%) and
29-31 (1.6%). In the present, male and female subjects
were almost the same. In the present study, the prevalence
of shin splint in marathon runners was 132 out of 190
i.e.69.5% (Table - 1).
Table 1: Basic characteristics
Characteristics Number Percentage
Age
20-22 40 21.1
23-25 88 46.3
26-28 59 31.1
29-31 3 1.6
Gender
Male 95 50.0
Female 95 50.0
Shin splint
Yes 132 69.5
No 58 30.5
Majority of running interest was multisport (32.65%).
82.6% having pain during running and 81.1% having pain
aer running (Table - 2).
Table 2: Distribution of subjects according to sports-
related parameters
Parameters Number Percentage
Duration of running
1-5 46 24.2
6-10 63 33.2
11-15 75 39.5
>15 6 3.2
Running interest
Fitness and fun 58 30.5
Multisport 62 32.6
Racing for Improvement 15 7.9
Recreational and social 55 28.9
Pain during running
Yes 157 82.6
No 33 17.4
Running throughout
No 33 17.4
Same 65 34.2
Better 41 21.6
Wor s t 51 26.8
Pain aer running
Yes 154 81.1
No 36 18.9
Out of 190 recreation marathon runners with shin splint,
a maximum of 88 (48.5%) were in the age group of 23-25
years, and a minimum of 2 (1.5%) were in the age group of
29-30 years. ere was no statistical association between
shin splint and age (p=0.56). Maximum of getting shin
splint in recreational marathon runners were Females
(55.3%), and remaining were males (44.7%). ere was
a statistical association between a shin splint and gender
(p=0.03) (Table - 3).
Table 3: Association of shin splint with socio-
demographic data
Variables Shin splint (%). χ2 value p-value
Yes No
Age
20-22 28 (21.2) 12 (20.7)
1.16 0.56
23-25 64 (48.5) 24 (41.4)
26-28 38 (28.8) 21 (36.2)
29-31 2 (1.5) 1 (1.7)
Gender
Male 59 (44.7) 36 (62.1) 4.86 0.03
Female 73 (55.3) 22 (37.9)
Maximum 49 (37.1%) was in duration between 6-10, and
a minimum of 3 (2.3%) was in duration between >15.
ere was no statistical association between shin splint
and duration of running (p=0.16). In turn, it shows that
the occurrence of shin splint was not dependent on the
duration of running.

Int J Physiother 2020; 7(1) Page | 40
Maximum was Multisport 47(35.6%), and minimum were
Racing for improvement 9(6.8%). ere was no statistical
association between shin splint and duration of running
(p=0.43).
Maximum people have pain during running 114(86.4%),
and the minimum has no pain during running 18(13.6%).
ere was a highly statistical association between shin
splint and pain during running (p=0.04). It shows pain
during running plays a signicant role in shin splint.
Maximum was at worst 50(37.9%), and the minimum was
at not present 18(13.6%). ere was a highly statistical
association between shin splint and pain throughout
running (p<0.0001).
Maximum people have pain aer running 111(84.1%), and
minimum people have present with no pain 21(15.9%).
ere was no statistical association between shin splint and
pain aer running (p=0.11) (Table - 4).
Table 4: Association of shin splint with sports-related
factors of the respondents
Variables Shin splint (%). χ2 value p-value
Yes No
Duration of
running
1-5 32 (24.2) 14 (24.1)
3.67 0.16
6-10 49 (37.1) 14 (24.1)
11-15 48 (36.4) 27 (46.6)
>15 3 (2.3) 3 (5.2)
Running interest
Fitness and fun 41 (31.1) 17 (29.3)
2.73 0.43
Multisport 47 (35.6) 15 (25.9)
Racing for Im-
provement 9 (6.8) 6 (10.3)
Recreational and
social 35 (26.5) 20 (34.5)
Pain during
running
Yes 114 (86.4) 43 (74.1) 4.19 0.04
No 18 (13.6) 15 (25.9)
Running
throughout
No 18 (13.6) 15 (25.9)
60.31 <0.0001
Same 26 (19.7) 39 (67.2)
Better 38 (28.8) 3 (5.2)
Wor s t 50 (37.9) 1 (1.7)
Pain aer run-
ning
Yes 111 (84.1) 43 (74.1) 2.60 0.11
No 21 (15.9) 15 (25.9)
DISCUSSION
e present study was found that the current prevalence of
shin splint among recreational marathon was 69.5%. e
previous research has reported the onset of pain during
early sports events, aer the sports events, during the whole
sports events, during the initial steps from the bed always,
etc. [9]. e present study shows the same nature of the
pain and as well as there has been pain aer the running.
e current research says that there is an occurrence of shin
splint in both the gender. Some studies stated that females
are at signicantly higher risk of developing medial tibial
stress syndrome than males, as females have typically later
onset of menarche and suer commonly from menstrual
disturbance. Bennell (1996) et al., in a prospective
study of 53 female athletes, found the age of menarche,
menstrual disorder, lower bone mineral density, leg length
discrepancy, a less lean mass of the shank and a lower-
fat diet were a signicant risk factor for a stress fracture
in females [10]. e present study has stated that the shin
splint is seen in age groups around the adult. ere has
been a close relationship between sports events and sports
injuries, and among them, a shin splint is very common
in sports injury in the lower leg [11]. Regarding the risk
factors of shin splint, this study found no any signicant
association with socio-demographic data characteristic of
this study such as age, gender, and anthropometrical factors
such as height, weight, body mass index, etc. and also with
lifestyle-related factors such as smoking, maintenance of
diet plan, water intake, etc.. In contrast, other study found
association with gender and body mass index [12]. Again
present study suggested that gender was associated with
causing shin splint and not with other factors for causing
shin splint.
Regarding the risk factors of shin splint, the present study
found a signicant association with the pain while running
(p=0.04) and running throughout (p<0.0001), ndings
were comparable with research done by Middelkoop 2008
[13]
Musculoskeletal pain is associated with the amount of
weekly training and the number of years of running in
recreational runners [14-16]; this relationship was not
found in the present study, maybe because of the sample
was homogeneous in the amount training and the number
of years running. Other factors, such as the use of dierent
running shoes and preferred running surface, the non-
treadmill, and the stability of the thigh muscles, have been
identied as triggers for injuries and can also be related to
muscle pain[15,17]. However, in the present study, these
factors were not evaluated.
Clinical implementation of present research:
Based on the high prevalence of shin splint, the pain that is
observed in this population, it is important to take action
on the recreational marathon by conducting education
aims to promote more information about the risks and
consequences of renewal. It can help reduce the incidence
of overuse injuries and contribute to the development of
injury prevention strategies. However, this hypothesis
should be conrmed in future studies.
CONCLUSION
It was concluded from the present study that there is a
prevalence of shin splint in marathon runners. Shin splint
was found more in females than in males. Based on the
duration of pain and shoe surface was found to be more
prevalent to cause shin splint in marathon runners.
Further, it is also essential to give more emphasis on the

Int J Physiother 2020; 7(1) Page | 41
recreational marathon by conducting education aims to
promote more information about the risks.
Acknowledgment
We acknowledge the guidance and support of the faculty
of physiotherapy.
AUTHORS CONTRIBUTION
Prina Y. Patel conducted the study by working on protocol
preparation, collecting samples, literature review for
this manuscript, developed introduction section of the
script, together with the discussion of the study ndings,
collected data and analyzed the data. Namrata Patil guided
in providing a description of the background information
and draing the article.
CONFLICT OF INTERESTS
e authors declare that there are no conicts of interest
concerning the content of the present study.
SOURCE OF FUNDING: self
REFERENCES
[1] Brotzman B. Clinical Orthopaedic Rehabilitation
(2003)-S. Brotzman, KE Wilk.
[2] Craig DI. Medial tibial stress syndrome:evidence-
based prevention. Journal of athletic training.2008
May;43(3):316-8.
[3] Plisky MS, Rauh MJ, Heiderscheit B, Underwood
FB Tank RT. Medial tibial stress syndrome in high
school cross-country runners:incidence and risk
factor. Journal of orthopaedic and sports physical
therapy.2007 Feb;37(2):40-7.
[4] Wilder RP, Sethi S. Overuse injuries:tendinopathies,
stress fractures, compartment syndrome, and shin
splints.Clinics in sports medicine.2004 Jan 1;23(1):55-
81.
[5] Newman P, Witchalls J, Waddington G, Adams R. Risk
factors associated with medial tibial stress syndrome
in runners: a systematic review and meta-anaylysis.
Open access journal of sports medicine. 2013;4:229.
[6] Harding S, Swait G, Johnson IP, Cunlie C.Ulitisation
of CAM by runners in the UK: A retrospective
survey among non-elite marathon runners. Clinical
Chiropractic. 2009 Jun 1;12(2):61-6.
[7] Ryan M, Elashi M, Newsham-West R, Taunton J.
Examining injury risk and pain perception in runners
using minimalist footwear. Br J Sports Med. 2014 Aug
1;48(16):1257-62.
[8] Yeung ss, Yeung EW, Gillespie LD. Interventions for
preventing lower limb so-tissue running injuries.
Cochrane Database of Systematic Reviews. 2011(7).
[9] Sultana S, Mondal R, Madumita RC, kamrujjaman M,
Khalil MI, Banik PC. Shin splints among sports persons
of dierent reputed clubs in Dhaka city. 2016;3(2):
[10] Bennell KL, Malcolm SA, omas SA, Reid SJ,
Brukner PD, Ebeling PR, Wark JD. Risk factors for
stress fractures in track and eld athletes: a twelve-
month prospective study. e American journal of
sports medicine. 1996 Nov;24(6):810-8.
[11] Pinshaw TD. e nature and response to therapy of
196 injuries seen at a runners’ clinic. South African
Medical Journal. 1984 Feb 1;65(8):291-8.
[12] Giandolini M, Horvais N, Frages Y, Samozino P, Morin
JB. Impact reduction through long-term intervention
in recreational runners: mid-foot strike pattern versus
low-drop/low-heel height footwear. European journal
of applied physiology. 2013 Aug 1;113(8):2077-90.
[13] Middelkoop, Marienke & Kolkman, J & Ochten, John
& Bierma-Zeinstra, Sita & Koes, Bart. Prevalence
and incidence of lower extremity injuries in male
marathon runners. Scandinavian journal of medicine
& science in sports. 2008;18: 140-4.
[14] Lopes AD, Costa LO, Saragiotto BT, Yamato TP,
Adami F, Verhagen E. Musculoskeletal pain is
prevalent among recreational runners who are about
to compete: an observational study of 1049 runners. J
Physiother. 2011;57(3):179-182.
[15] Knechtle B, Assadi H, Lepers R, Rosemann T, Rüst
CA. Knechtle B, Assadi H, Lepers R, Rosemann T, Rüst
CA. Relationship between age and elite marathon race
time in world single age records from 5 to 93 years.
BMC Sports Sci Med Rehabil. 2014;31(6).
[16] Meeusen R, Duclos M, Gleeson M, Rietjens G,
Steinacker J, Urhausen A Prevention, diagnosis and
treatment of the Overtraining Syndrome. ECSS
position statement ‘task force’. Eur J Sport Sci.
2006;6(1):1-14.
[17] Macera CA, Pate RR, Powell KE, Jackson KL,
Kendrick JS, Craven TE. Predicting lower-extremity
injuries among habitual runners. Arch Intern Med.
1989;149(11):2565-2568.