This article was first published January 10, 2003. Minor changes were made over several years. More significant improvements were begun in August of 2007, when this change log was started, and it went through intensive development into an advanced tutorial in the spring of 2009.
A major feature of my tutorials is that I actively update them as new science and information becomes available. Unlike regular books, and even ebooks — which can be obsolete by the time they are published, and can go years between editions — this tutorial is updated at least once every three months and often much more. I also log updates, making it easy for readers to see what’s changed. This tutorial has gotten 37 major and minor updates worth logging since I started logging carefully in late 2009, and countless more minor tweaks and touch-ups.
Science update (Oct 5 '15, section #3.6) — Added information (and cited a case study) about a fascinating example of a rare cause of stubborn shin pain. See section #3.6, Possible explanations for extremely stubborn shin splints.
Correction (Dec 22 '14, section #2.8) — Reduced confidence in the results of a major study of special footwear (Knapik, the subject of the last update). See Boot Blooper for more information. See section #2.8, The great pronation fizzle.
New item (Sep 23 '14, section #4.13) — Added a brief but very well-researched review of platelet-rich plasma injection. See section #4.13, Brief debunkery of several other therapies that you should be skeptical of.
Minor update (May 15 '14, section #3) — Added a fun sidebar about a bizarre source of shin pain. See section #3, Diagnosis: How do you know which kind of shin splints you’ve got?
New section (Apr 2 '14, section #2.6) — A new section mostly based on a particularly striking new treatment story from a reader. See section #2.6, A couple trigger point stories.
Science update (Dec 23 '13, section #2.8) — Added another bad-news citation, and type of evidence. See section #2.8, The great pronation fizzle.
Science update (Dec 11 '13, section #3.3) — I didn’t really ever expect a science update about tuning-fork diagnosis. But here it is! See the concluding footnote. See section #3.3, From high-tech to low-tech: the tuning fork test!
Minor update (Mar 29 '13, section #4.1) — Upgraded risk and safety information about Voltaren Gel. See section #4.1, You and “vitamin I”: anti-inflammatory meds, especially Voltaren® Gel.
Expanded (Nov 29 '12, section #3.4) — Added much more detailed self-help information for trigger points. See section #3.4, Confirming the role of muscle knots in shin pain by treating them.
Science update (Nov 20 '12, section #4.9) — Weak but interesting new evidence on natural running and injury prevention. See section #4.9, Should you run naked? On faddish running styles and running shoes (or the lack thereof).
Minor update (Dec 13 '11, section #4.2) — Addressed some common fears about the threat of getting out of shape while resting. See section #4.2, The art of rest: the challenge and the opportunity for patients who have supposedly “tried everything”.
Updated (Oct 16 '11, section #4.8) — Added new references to fascia science, regarding the alleged relevance of fascial contractility to compartment syndrome. This is also supported by a substantial new free article, Does Fascia Matter? See section #4.8, Stripping: a popular massage techique for the shins.
Minor update (Sep 28 '11, section #4.10) — Added reference to Kong et al, about the effect of shoe wear. See section #4.10, Running softly and the impact of impact: the not-so-significant connection between stress fractures and how jarring your running gait is.
Update (Aug 22 '11, section #4.10) — Now officially endorsing Oesh shoes. See section #4.10, Running softly and the impact of impact: the not-so-significant connection between stress fractures and how jarring your running gait is.
Minor update (Jul 29 '11, section #1) — Added a reference about the poor overall quality of online information about common injuries. See Starman. See section #1, Introduction.
Major update (Jun 21 '11) — Major improvements to the table of contents, and the display of information about updates like this one. Sections now have numbers for easier reference and bookmarking. The structure of the document has really been cleaned up in general, making it significantly easier for me to update the tutorial — which will translate into more good content for readers. Care for more detail? Really? Here’s the full announcement.
New section (Jun 17 '11, section #4.10) — Another substantial addition to the tutorial, the third in recent history. See section #4.10, Running softly and the impact of impact: the not-so-significant connection between stress fractures and how jarring your running gait is.
New section (May 3 '11, section #4.8) — Another beefy new section for this tutorial, the second addition lately. See section #4.8, Stripping: a popular massage techique for the shins.
New section (Mar 20 '11, section #4.9) — Finally, long overdue, a new section on this topic (for all the running injury tutorials). See section #4.9, Should you run naked? On faddish running styles and running shoes (or the lack thereof).
Important new info (Feb 8 '11) — Where’s the fire? Recently I published a major new article about repetitive strain injuries (like shin pain), in which I explain that these injuries are rarely actually inflamed. Instead of being “on fire,” excessively stressed tissues tend to break down without inflammation — a kind of rot. This significant fact of biology is not yet given proper attention in this tutorial, and it should be. I learned the science of this myself only just recently, and it is going to take me a while to revise all of the tutorials and articles that are affected by it. Meanwhile the new RSI article is available, free to all, and I have also mentioned and linked to it where necessary throughout all tutorials. For the full scoop on inflammation and repetitive strain injuries, see: Repetitive Strain Injuries Tutorial: Five surprising and important facts about repetitive strain injuries like carpal tunnel syndrome, tendinitis, or iliotibial band syndrome.
Minor upgrade (Dec 2 '10, section #2.4) — Upgrade to the description of popliteal artery entrapment syndrome (PAES), which is often confused with compartment syndromes. See section #2.4, A more detailed looked at the six common types of shin pain.
Minor upgrade (Dec 2 '10) — Repaired an alarmingly large batch of typographic errors. Amazing what slips through!
New cover (Aug 6 '10) — At last! This e-book finally has a “cover.”
Minor update (Apr 7 '10, section #4.4) — Added results of a study of surgery for stress fractures in elite dancers. See section #4.4, Surgery for shin pain.
New section (Oct 1 '09, section #4.1) — An important new section on anti-inflammatory medications, notably including discussion of Voltaren® Gel, a worthwhile treatment option for shin splints only recently got into my radar. You can read about Voltaren in a free article as well as here in the tutorial, but the tutorial covers the topic specifically as it relates to each of the different kinds of shin splints. See section #4.1, You and “vitamin I”: anti-inflammatory meds, especially Voltaren® Gel.
Major bibliography update (Jul 2 '09) — Major bibliography update. The PainScience.com bibliography has long been the largest of its kind. It contains an incredible amount of surprisingly readable information about musculoskeletal health science, and it is now possible for visitors to search and sort the bibliography with powerful new features. For instance, every source about shin pain referenced in this tutorial can now easily be displayed in a single search, with a variety of options.
Major upgrade (May 31 '09, section #4.11) — Major miscellaneous improvements to the section today. See section #4.11, Stretching is probably mostly ineffective for all kinds of shin splints.
Minor update (May 18 '09, section #4.13) — Added nutraceuticals to the section. See section #4.13, Brief debunkery of several other therapies that you should be skeptical of.
New section (May 17 '09, section #4.13) — Starting off with just a few items. More will be added in time, but there’s four good ones to start. See section #4.13, Brief debunkery of several other therapies that you should be skeptical of.
New section (May 17 '09, section #3) — No notes. Just a new section. See section #3, Diagnosis: How do you know which kind of shin splints you’ve got?
Huge upgrade (May 7 '09) — About a dozen new sections, many more footnotes, and widespread editing for clarity and thoroughness. Today this tutorial is now officially “extremely detailed,” like the other advanced tutorials on PainScience.com, and went up for sale.
New section (Apr 5 '09, section #3.2) — New section to explain and highlight evidence from Gaeta about the high prevalence of microscopic bone damage found in long-distance runners. See section #3.2, MRI and CT scanning may be helpful.
New section (Apr 5 '09, section #2.7) — No notes. Just a new section. See section #2.7, Bone tired: medial tibial stress syndrome is probably about bone fatigue, not inflamed soft tissue.
New section (Mar 16 '09, section #4.12) — No notes. Just a new section. See section #4.12, Strengthening is probably also a completely ineffective therapy.
Major upgrade (Aug 15 '08) — Several major revisions and corrections.
Update (Jan 27 '08, section #1.5) — Added colorful anecdote from the Canadian wilderness to illustrate the seriousness of acute compartment syndrome. See section #1.5, Danger! Please do not try to run through shin splints! Acute compartment syndrome can be extremely dangerous!
Major update (Aug 6 '07, section #3.1) — Clarified diagnostic information significantly by integrating important information gleaned from Edwards et al See section #3.1, A diagnostic algorithm (you know it’s good if it’s an “algorithm”).