Shin Splints for 4 years???

Question
In early 2009, I began running regularly. I had not previously been a runner but did work out regularly (bike, elliptical etc). Over the next 6 months,
I trained and completed a half marathon. I never had any pain or issues during this time. Two months after the half marathon, I was running
4-5 miles about 5 days a week and my calves would begin to tighten and cramp during the runs. I'd have to stop and stretch then continue on.
This cramping lasted for about 1.5 months and then my lower inside of my shins began to ache. I continued to run through the pain
for another month or so until it got too painful. The dull ache would become so extreme that it would wake me at night and was painful to walk
down stairs.

My left leg was worse than my right and my left ankle began swelling after runs/exercise or if walked and stood often during
the day. The only thing that helped my swelling was elevation. Along with this swelling, my left inner shin (where the shin splints are, got a hard
lump that I was told is scar tissue from the shin splints). My tibia bone, just next to this shin splint/lump feels like it is missing about an inch of
periosteum membrane, because there is a dip in the membrane at this area and the bone and is sensitive to touch.

I went to an ortho who did an xray and determined that I did not have a stress fracture. He sent me to physical therapy and I've completed
2 different sessions of 6 week physical therapy. The therapist said the hard lump is scar tissue from the shin splints and the cause of the
shin splints are tight calves. After no improvement, my primary care doctor had the following tests done: echocardiogram, abdominal and
pelvic ultrasound, dopplar ultrasound of my legs, lower vein study and a muscle atrophy test of my legs. None of the tests provided results.
My doctor doesn't know what else to do. He recommended stretching and rest.

I've taken the past 2 years off of running and exercise completely in an attempt to heal the injuries. While the pain and swelling has subsided, it
has never gone away. Furthermore, the scar tissue/shin splint lump and sensitive tibia where the periosteum is/should be has never healed.
I've been doing yoga and stretching regularly over the years and started slowly exercising again. If I'm on the bike, there is no issue. However,
after just 20 minutes of elliptical, stair climber etc, I have the same symptoms. I run only 1/2 mile for 3 days a week but still feel like my tibia
is going to snap in that sensitive spot, my left shin aches for 24 hours after any exercise and ankle will swell again.

I'm only 33 and never had any medical issues, pain, or swelling prior to the onset of these symptoms. I worry that shin splints wouldn't last for
almost 4 years; given that I've taken 2 years off to rest. This may sound like a minor nuisance but it's really affecting the quality of life. I love running
and working out and now can only bike. I feel like 33 years old is too young to have such chronic symptoms with no diagnosis. I have been
thinking about going back to the doctor and requesting an MRI to look at the soft tissue. Any insights you may have would be greatly appreciated.

Answer
Liza, I'm sorry I've been slow to respond. I've been doing a little research for you. Obviously, if I professed to have all the answers after one a few paragraphs of information you'd be skeptical. You've obviously attempted to see the right people and do the right things for your pain. First, I'll tell you a few things that could be going on and that need to be considered. Second, I'll tell you the type of people I recommend seeing.

Chronic exertional compartment syndrome may be the original cause of your pain. This, however, normally goes away with some rest. Fascial herniations may be involved as well. Again, however, these often go away with rest. There could also be chronic pain associated with stress fractures. I know you had x-rays, but while x-rays do pick up some stress fractures, it is not uncommon for them to miss them either.

Whatever be the case I suggest you see a physical therapist (PT) that has the credentials SCS (sports certified specialist) after his/her name. An SCS PT will have greater knowledge of sports and running injuries that most PTs will not have. It may not matter what the anatomical cause of your pain may be. Depending on the clinical impairments he/she finds treatment may work. However, if there is no progress there I suggest having an MRI and CT scan done. MRIs are better to assess the muscles and fascia while CT scans are better to assess the bone.

If you would like to do some research into PTs in you area and send me their names, credentials, and even websites I could recommend who I would see.