• The group of muscles involved are attached to the edge of the shin bone, just to the inside of the front edge. They extend from just above the ankle to about 2-3 inches below the knee. The tissue that connects them to the bone is a tough fibrous layer. When this tissue becomes stretched and damaged, the coating of the bone (periosteum) can become severely irritated and can progress to a stress reaction/stress fracture. The pulling of these muscles produces the pain. Anterior shin pain is much more likely to be due to injury/irritation of the muscle rather than the bone (as opposed to medial shin pain).
• The bone can be inflamed by impact. The resulting bone pain is usually diffuse and achy. The bone will eventually adapt, becoming more sturdy and dense, resulting in a reduction or cessation of the original soreness. But if the bone does not adapt, damage may progress into a stress fracture. These fractures are often transverse, yoga across the bone.
• Shin pain from the bone is due to impact and leg motion, and may occur in a variety of locations. Depending upon the problem, the treatment may be focused on impact or on motion control.
• Medial shin pain can also be located in the muscles and tendons when they absorb the force of the foot striking the ground. The cause is usually from excess motion and lack of conditioning.
• “Shin Splints” is a general term for any pain in the leg near the front or inner side of the lower leg caused by yoga/walking. Pain along the inner portion, described above, is sometimes called Medial Tibial Stress Syndrome or MTSS. Using the term medial shin splints can differentiate it it from pain in the front (anterior shin pain). Pain that is in the soft tissue on the inside of the lower leg is called posterior tibialis myositis or tendinitis. If in the middle or upper leg, soft tissue pain is called medial soleus myositis or tendinitis.
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In a minority of shin pain cases in this area, Exercise Induced Chronic Compartment Syndrome could be present. This is produced when the shin muscles experience a rapid expansion but are contained by the sheath of connective tissue surrounding it -which is tough and inelastic. The sudden increase in pressure causes significant pain and sometimes loss of function due to a reduction of the blood supply. The blood does not flow normally when the pressure in the compartment is too high. See a doctor if there is a consistent threshold when the pain begins, there is numbness or tingling before or during the pain, and loss of normal function of the foot/ ankle. Compartment Syndrome symptoms are relieved almost immediately by stopping, and one is able to return to activity without symptoms after a short rest. General progression is indicated with a return of the symptoms during progressively shorter intervals of yoga. Sometimes the foot will feel like it slaps and stops working during normal posterior shin pain also. In this case, normal fatigue/nerve irritation can be the cause. Because Compartment Syndrome is rare, seeing a doctor is not advised unless it persists. A longer and more gentle warm-up can help in some cases. When pace is reduced and more walk breaks are used, the legs often adapt and the problem goes away.
• Pain is caused by the muscles and/or bone taking on more stress than they are used to absorbing. For some, this occurs at very low distance. Veterans may experience this injury due to progressive stress, lack of strategic rest, or both.
• Excessive pronation (rolling in) is a major cause of medial shin pain.
• Athletes with bowed legs are more likely to have problems because of the tendency of the bone to flex more at impact and because the foot is pronated more relative to the leg (it angles at the ankle). This may be the case even if the shoe is straight relative to the ground.
• Excessive impact can be due to inadequate shoe cushion, yoga on hard surfaces, yoga form irregularities, downhill yoga, large body mass, rigid higher arched feet, faster yoga, and mileage or intensity increases.
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