Shin Pain from Cycling

author : AMSSM

comments : 1

Since this summer I have been battling shin pain in both legs. I limited the running because I assumed that was the cause.

Member Question

Hello. Since this summer I have been battling shin pain in both legs.  I limited the running because I assumed that was the cause.  I have been getting A.R.T treatments with ultrasound regularly with limited improvement in symptoms.  I have iced/rolled/calf and shin stretched, etc. I have not run for three weeks but realized that I was still having generalized soreness in the area.  One day after a trainer session, I noticed the pain again.  So, I googled shin pain from cycling and found out it is possible and probably common.  This summer, I also got a new triathlon bike including a fit, and this is when the pain started happening.  So, I pulled out a large mirror the other day and watched my pedal stroke, and low and behold, I was dorsiflexing my ankles/activating my shin muscles at the top part of my pedal stroke especially on harder intervals.  When I was running, I never felt the pain while running, I backed off for fear of them turning into something bad.

So with some effort, I am cleaning up my pedal technique and I even contacted my bike fitter to make sure things were still on par.  What felt like toe down to me was actually cleaner and I was no longer flexing my shins on the up stroke.

So, my question, are all shin pains equal?  When can I resume a slow run build again? Is this shin pain not as traumatic as the running type - fascia pulling away from bone etc., which could result in stress fractures while running? Is it still an overuse injury? 

Answer from Michael Cassat, MD
Member AMSSM

Good Question!

First of all, I'm glad you are feeling better! As to when you can resume a slow build, I think in this case your injury was likely related to an overuse of the tibialis anterior muscle, and a build can be resumed slowly once you are pain free.

Definitely all shin pains are not equal. Let’s start with a review of your likely injury, and progress to two other more serious causes of shin pain. In your case, this history and mechanics of your pedal stroke likely point to an overuse (strain) of the tibialis anterior muscle. This is the muscle on the front and outside of your shin bone (tibia). The tibialis anterior muscle is used to lift the front of the foot up. To activate this muscle, you can attempt to walk across the floor on just your heels. When a muscle is overused, it can either be injured in the body of the muscle, in the muscle-tendon junction, or in the tendon itself. Tears can range from very small (microscopic) to complete. Small microscopic tears are the adaptation that we seek with over-reaching during training, and are related to delayed onset muscle soreness. These should be better in 2-3 days after an extra hard workout and need no extra treatment. Larger injuries usually are associated with longer duration and more severe pain. These injuries need longer recovery, until pain free, and then a very slow and methodical increase in training load in return to competition.

Stress fractures are a second cause of shin pain. Repetitive stress to the nutrient layer around the bone (periosteum) can cause changes in the remodeling of the underlying bone, which could in theory make it more susceptible to a stress fracture. In the case above, there was likely damage to the periosteum, but there would likely have to also be repetitive stress to the bone (i.e., running) while the periosteum was in an injured state to result in fracture. Continued cycling or swimming however should be safe in terms of fracture risk as it applies little to no force to the bone that could result in fracture.

The third and much less common reason for shin or calf pain is exertional compartment syndrome. This condition is found when the surrounding tissue around the muscle exerts greater pressure to the muscle and its blood supply then the force of the blood supply can overcome. This results in a lack of blood flow to the muscle group, which in mild cases is perceived as pain, and in more serious cases can threaten not only the health of the muscle, but the limb itself. Exertional compartment syndrome typically begins during exercise, and improves when the activity is stopped, unlike your overuse injury, which usually starts during or even after the exercise session, and continues until healed.

It sounds like things are back to normal after your adjustment in fit, and now that your pain is gone I think it is safe to progress your training load in a slow controlled fashion, as long as you remain pain free. Best of luck!                                   

Michael Cassat, MD
Primary Care Sports Medicine
Twitter:@drmichaelcassat
www.drcassat.com

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date: January 20, 2014