Shin splints, known as medial tibial stress syndrome (MTSS), are usually categorized by pain along the inside edge of the shinbone (the front of your lower leg).
MTSS typically occurs in runners and athletes exposed to excessive weight-bearing activities and exercise routines such as long-distance running or jumping.
Do your shins hurt when running?
If you are experiencing shin splints, you are not alone. The incidence rate of MTSS is high among runners, ranging between 13.6% and 20%.1Lohrer, H., Malliaropoulos, N., Korakakis, V., & Padhiar, N. (2018). Exercise-induced leg pain in athletes: diagnostic, assessment, and management strategies. The Physician and Sportsmedicine, 47(1), 47–59. https://doi.org/10.1080/00913847.2018.1537861
This challenging condition affects many runners; we will explain the up-to-date science surrounding it and give you an idea of an effective rehabilitation protocol.
Let’s get you back running!
What are The Symptoms And Causes Of shin splints?
Shin splints are considered unrepaired microdamage, resulting in a ‘stress response’ accumulated in the outer edge of the tibia due to excessive loading and inadequate recovery.
While the exact mechanism is unknown, the two prevailing theories are;
#1: Tibial Periostitis
Tibial stress syndrome refers to inflammation in the periosteum surrounding the tibia. The periosteum is a fibrous membrane that covers the tibia.
Stress accumulates within the strong, predominantly type I collagen fibers, connecting the periosteum to the tibia. Inflammation occurs when long or intense high-impact activity eccentrically fatigues the soleus and tibialis posterior muscles.
This results in excessive force due to tibial bending or bowing, contributing to shin splints.
Nonetheless, studies have shown periosteum inflammation to be present in runners suffering from pain and those without. So, inflammation may not be the only cause.
#2: Bony overload
Bony overload injury can occur when excessive loading of the bone tissue causes a stress reaction; if left unchecked, this can result in a stress fracture.
Unlike inflammation, pain caused by a ‘stress reaction’ will likely be localized.
If given enough rest, bones should strengthen in response to loading rather than becoming ‘stressed.’
A stress fracture will likely result in pain when palpating the bone, alongside swelling or bruising.
It is important to note that these causes of pain may not be mutually exclusive from one another.
What Are The Common Symptoms Of Shin Splints?
So, what exactly do shin splints feel like?
You’ve laced up your shoes, getting your music ready, and the sun is shining. What a day to go for a run.
Except… my shin is hurting when running.
A recurring dull ache you felt on your run last week has become known. It runs down the inner part of your tibia, predominantly around the lower two-thirds.
However, this time, the pain is becoming more intense. Even after you finish your run, your shins hurt.
You may have shin splints and want to continue reading this article!
What Are The Causes Of Shin Splints?
The number one cause of MTSS is Training Error.
Training error encompasses several factors, such as excessive mileage, change in intensity, or running surface. Muscles and bones take time to adapt to new loads.
Suddenly, deciding to run 50km or adopting hill sprints 3x a week without giving your body adequate time to adapt will leave it vulnerable.
These goals may be achievable over time, but in the short term, they can result in overuse and subsequent injury.
Podiatry Today represents training error as the ‘cornerstone of preventing MTSS.’2(2024). Podiatrytoday.com. http://www.podiatrytoday.com/article/5031?page=4
Other common causes and risks of shin splints may be;
- Running shoes: Worn-out shoes are less likely to support your foot. Replace your shoes when you notice that they have lost their ‘spring’ or if the shoe’s sole loses its rigidity and becomes bendy.
- Altered biomechanics: Overpronation, increased pelvic drop, excessive internal hip rotation, high arches, and leg length difference can all increase stress on the tibia.
- Muscle Tightness/Weakness – Tightness in the soleus muscle or tibialis anterior can increase stress on the tibia during running. This is due to less force being absorbed by the muscles.
Compare your flexibility on each leg with unilateral leg exercises, such as calf raises, to gauge whether one side is more flexible or strong. - Incidence rates are higher in women:3Newman, P., Witchalls, J., Waddington, G., & Adams, R. (2013). Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis. Open Access Journal of Sports Medicine, 4, 229. https://doi.org/10.2147/oajsm.s39331 Of course, you can do nothing about the primary cause here.
However, addressing biomechanical aspects of running, which are more commonly found in women, such as increased pelvic drop or internal hip rotation, may help reduce stress on the tibia.
Can You Run With Shin Splints?
As MTSS is typically an overuse injury, treatment should be conservative.
Hear me out. I understand that once you’ve grown to love running, it’s tough to stop doing it!
You may run for various reasons, including physical, emotional, and social well-being. The goal is to get you back running consistently as soon as possible.
Shin splint’s severity may vary, so it’s recommended to see your healthcare provider or physical therapist early on to determine how severe your particular injury is.
If the pain is mild and doesn’t increase during or after exercise, you may be able to continue running. Incorporating shock-absorbing insoles (arch supports), orthotics (shoe inserts), and compression socks can reduce the load in the affected area.
If the pain is intense, STOP.
It’s not worth the risk of continuing to aggravate a possible fracture; you may be looking at an extended layoff if you do.
How Is MTSS Treated?
During the acute phase (first 2-6 weeks), focusing on rest and activity modification will pay dividends later. NSAIDs (over-the-counter nonsteroidal anti-inflammatory drugs like Ibuprofen), ice packs or cold packs, and soft tissue therapy can all help to reduce pain during this time.
Activity modification aims to reduce the load on the affected part of the bone while simultaneously maintaining cardiovascular fitness and strength.
Activity modifications for MTSS can include swimming, biking, and strength training. These cross-training activities prevent pounding on hard surfaces and should keep you pain-free.
The specific length of the acute phase will vary for each individual. You are looking to have experienced a relative decrease in pain experienced during physical activity and at rest.
During the subacute phase, runners can increase training intensity and duration as long as they remain pain-free. This will not happen overnight; it is a consistent, gradual reloading program.
An estimate of suitable running volume would be to return to 50% of your previous running distance, intensity, and frequency. But, of course, this may vary between individuals.
Other important aspects of a rehabilitation program for shin splints include:
What Are The Best Exercises For Recovering From Shin Splints?
#1: How To Treat Shin Splints – Strength and Conditioning
Shin splint-focused strength and conditioning aim to reduce the load exerted on the tibia while running.
Strength and conditioning can also include load-bearing exercises to increase abdominal, gluteal, and hip muscle strength.
Consistent gradual loading increases load tolerance, improves running mechanics, and prevents lower-extremity overuse injuries.
Here are a couple of strength-building exercises to try out!
A: Split Squat
- Stand in a split squat stance with the toes on the edge of a step and the other foot behind the knee.
- Slowly lower the back knee until it is just above the floor. Raise the back knee up, aiming to maintain the arch of the front foot
3 Sets, 8-12 repetitions
B: Step Up
Step-ups require a lot of glute activation.
- Step your front leg up onto the step; when your bent leg gets close to 90 degrees, push up through that leg.
- Step down in a controlled manner.
3 sets, 20 repetitions
#2: How To Treat Shin Splints – Stretching
An eccentric calf stretching program should be introduced. Additionally, runners will benefit from stretching their hips and glutes.
Here is a great stretch for you to try out!
A: Calf stretch
This calf stretch is simple and can be done virtually anywhere, as long as you have a wall to lean into.
- Stand facing the wall, place your hands on it, and straighten your back leg. Make sure both feet are firmly planted on the ground, pointing in the direction of the well. Your front leg should be slightly bent.
- As you lean toward the wall, you will begin to feel a stretch in the calf muscle of your back leg.
- Hold this pose for 30 seconds, and then relax.
3 sets, 30-second hold
#3: How To Treat Shin Splints – Proprioceptive Training
Proprioceptive movements play a significant part in neuromuscular education.
This can be utilized by using a balance board or single-legged training.
Improved proprioception should hopefully increase activation amongst muscles used in postural stabilization when running.
Here are a couple of proprioceptive exercises to try out!
A: Single Leg Balance on a Balance Bubble
This is an easy, do-anywhere proprioceptive exercise for runners. You can do it without if you don’t have the balance bubble.
- Stand on one leg on a balance bubble, keeping your knee slightly bent.
- A tip for staying stable is to focus on a still object in front of you.
- Come back down and repeat on the other leg
3 sets, 30-60 second hold
As you improve, try incorporating having your eyes closed.
B: Single-Leg Hops
- Stand on your right leg with your knee slightly bent.
- Gently jump up and down on your right leg, trying to always land in the same spot. Look forwards!
- Start again on the other side.
You can also do three sets of this exercise on each leg.
3 sets, 20-30 hops
As this exercise becomes easier, try incorporating a variation in the hop. You can hop further, side to side. I sometimes write words.
Remember, if you have concerns you may have a sports injury, it’s extremely important to get a physical exam and medical advice to see which plan of action you will need to take, whether it be strengthening, stretching, physical therapy, or all of the above.
In some cases, you may need an x-ray or bone scan depending on the severity of the pain of shin splints you feel.
For more information on pronation, check out this next guide:
