Common Running Injuries Part 4: Shin Splints
Enough with the shin-anigans, reduce your pain
You’re in the zone. Your pace is good, breathing is in check, and your favorite song is playing through your headphones. The only distraction is the pain in your shins.
Shin splints, medically known as Medial Tibial Stress Syndrome, is a common running injury. It got the name “shin splints” because pain is felt along the shin (tibia) bone, which is the large bone on the front of your lower leg. There are many possible causes, but people often experience it when intensifying their training routine, which overworks the leg’s muscle, tendon, and bone tissue.
Aside from runners, this injury is commonly seen in dancers, military members, and people who perform other repetitive activities. It’s usually characterized by pain during activity on both shins which is better at rest. We’ll go into more detail on all these things, along with covering exercises and tips to reduce pain from shin splints.
Signs and Symptoms
The most common signs and symptoms associated with shin splints are:
- Pain with walking, running or jumping
- Gradual onset of aching pain, most commonly in the front of your shin
- Symptoms are worse with activity and usually better at rest
- Tender to touch on the front of your shin, usually towards the bottom
- May have a recent increase in activity
As mentioned above, pain is usually better at rest, especially early on in the condition. If shin splints aren’t treated, the pain can worsen and eventually lead to stress fractures.
Risk Factors
People with these risk factors are more likely to get shin splints.
- History of repetitive movements such as running and dancing
- Running on uneven terrain (hills) or hard ground (concrete)
- Females are more likely than males
- Having a high BMI
- Prior injury in lower extremities
- Below average activity history or starting a new program
- Calf tightness or reduced ankle mobility
- Hip weakness
Possible Causes
The muscle involved in shin splints is your tibialis anterior. As the name implies, it’s the muscle on the front (anterior) of your shin (tibia). It runs from just below the outside of your knee down to the inside of your ankle, attaching to the bone along the way. Its main job is to flex the foot upwards and it’s used repeatedly in walking and running.
Every time the tibialis anterior contracts, it pulls on the shin bone. Researchers hypothesize that shin splints occur when the muscle pulls on the tibia too much or too often. This causes inflammation of the bone, called periostitis, where the muscle attaches. The most common site of pain is where the tibia is smallest, which is also where the most stress is placed while running. Researchers also found that people with shin splints tend to have lower bone density in the tibia.
Statistics
- Between one and two thirds of competitive long distance and cross country runners have a history of shin splints.
- 50% of track-and-field athletes report a history of shin splints on more than one occasion.
- 10.3% to 12.6% of cross country and track athletes with a history of shin splints experience another bone stress injury over the next 1–2 years.
Prevention
The best way to manage shin splints is to avoid them in the first place. Consider these ways to help prevent a bone stress injury:
Avoid overtraining
Ramp up your training routine slowly and include rest days. Overdoing repetitive activity is the main cause of shin splints.
Analyze your running
Slow motion video analysis can help identify any abnormal movement patterns. Often a small change in mechanics can help prevent injury.
Land on the right spot
People with shin splints tend to over-stride, landing on the heel with a straight knee. This places too much stress on the tibialis anterior. While running, aim to land on your mid foot versus the heel to reduce strain on the muscle.
Think about the ground
Shin splints are more common in people who run on uneven or hard surfaces like hills and concrete. Try to add some treadmill runs in to reduce the amount of time spent running on harder surfaces.
Wear proper shoes
It’s recommended to replace your running shoes every 350 to 500 miles. If your arches are flat, consider footwear or inserts with arch support. Shock absorbing insoles can help reduce force through your shins, especially if running on hard or uneven surfaces.
Cross-train
Take a break from running and try swimming or biking. These activities are great for cardiovascular endurance while giving your tibialis anterior a break. Also include days of strength training. This will help stabilize your ankles, legs, hips, and core. Remember to ease into these new activities as well.
Treatment
Rest is the most important and first step when treating shin splints. The bones and muscles need time to heal, so anywhere from 4 weeks up to 4 months is recommended based on the severity and length of time with the condition.
Rest doesn’t mean you can’t do anything. Like mentioned above, cross-training is allowed and recommended. Other forms of exercise like swimming and weight training will maintain fitness while improving your condition.
Strength Exercises
It is important to make sure the muscles of the shins, hips, and feet are strong to provide stability during activity. Try the exercises below.
Tibialis Anterior Strengthening
This helps strengthen the main muscle involved in shin splints. Check out this video explaining how to do this exercise. Perform 2 sets of 15–20 reps, 1x/day.
Clamshells
- 3 sets of 15–20, 1 time per day
- Lay on your side with your knees bent, then raise your top knee towards the ceiling
- Try first without resistance, then add a band if it’s too easy
Side-lying Hip Abduction
- 3 sets of 15–20, 1 time per day
- Lay on your side with your bottom knee bent
- Keep your top leg straight and raise it up towards the ceiling
- Make sure to keep your hips stacked — don’t let them open up
Bridges
- 3 sets of 10–20, 1 time per day
- Lay on your back with your knees bent
- Tighten your core, then glutes, then raise your hips towards the ceiling
Towel Scrunches & Marble Pick Up
- Sit in a chair with your feet on the floor. Place a towel under your feet.
- Scrunch your toes like you’re trying to grab the towel. See if you can pick up part of it to drag towards you. You can also pick up marbles with your toes and transfer them to a cup — this works more on endurance.
- Notice how your arch raises when you scrunch the towel. This is helping provide a strong base of support while walking and running.
- Perform for 3 minutes 1x/day
Squats & Leg Press
These weight bearing exercises are important to build bone health, especially since there is a correlation between shin splints and decreased bone density. Be sure to keep them in a pain free range and perform 3 to 4 sets of 6 to 8 reps, 2–3 times per week. The weight should feel challenging.
Mobility Exercises
Aside from strength, we need to make sure muscles of the legs stay flexible. Try these to keep the hips and legs mobile.
Plantar Flexion Stretch
- 3 x 30 seconds, 2 times a day
- Start in the top position, then sit back on your heels to stretch the front of your ankle and shin
- To lessen the stretch, place a rolled towel under the front of your ankle
Calf Stretching
- 3 x 30 seconds, 2 times a day
- There are many variations of calf stretching, like this one
- Make sure to stretch with the knee bent and with the knee straight — this ensures we work on both layers of calf muscle
Hip Stretching
- 3 x 30 seconds, 2 times a day
- Sit with one leg crossed over the other, holding the ankle
- Keeping your back straight, lean forward until you feel a stretch in the buttocks/back of the hip
Manual Therapy
The massage techniques below with photos are ones you can easily do at home to help reduce muscle tension. The second one is more specific and may need the help of a physical therapist or another healthcare provider to identify.
Tibialis Anterior Massage
- 3 minutes, 2 times a day
- Use a tennis ball, massage ball, or similar object
- Apply enough pressure to feel some discomfort, but avoid sharp pain. Hold on painful spot 30–60 seconds
- Start from the bottom of the muscle and work your way up to the knee to improve length
Foam Rolling
- 2 minutes per body part, 1 time per day, hold 30–60 seconds on a spot if you find a tender area
- Roll out the calves, quads, and hamstrings slowly
- It’s okay to feel discomfort, but shouldn’t be unbearable. Adjust your body weight as needed.
Other Techniques
1. Blood Flow Restriction (BFR): This is a newer technique with increasing research. It is low impact, and helps stimulate muscle growth and improves bone health. Check out the article on our website to learn more.
2. Shoe Inserts: In people with flat feet, adding extra arch support can help reduce shin splint pain. Inserts help keep your foot in a good position while walking and improves shock absorption. Ultimately, this reduces strain on the tibialis anterior.
Gait Analysis
An individualized running analysis can help identify abnormal mechanics or areas of functional weakness. A common trend I see in runners with shin splints is they place too much weight on their heels when landing. An easy activity is to practice weight shifting forward. Simply stand and slowly shift your body weight forward onto the mid foot, or balls of your feet. Slowly return to the middle. Practice for 2 minutes, 1x/day.
Once the pain lessens or fully goes away
Ease back into activity. Continue with your exercises, but instead of once per day, perform 2 times per week for 2 weeks. If this feels okay then for the next 2 weeks run 3 times per week. Continue this pattern until you are running at your desired goal.
Key Takeaways
Medial tibial stress syndrome, or shin splints, is a common but treatable condition. Be familiar with the signs and symptoms and risk factors to help identify this condition. Some other key points:
- Cross-train with other endurance and weight lifting exercises to help prevent shin splints.
- If you notice pain in the front of your shins, rest. Don’t push through it. Prolonged shin splints can lead to more serious conditions like stress fractures.
- If you have shin splints, enjoy your time off and use it to strengthen your body in other ways. Resting does not mean completely stopping activity — just switch to other activities that aren’t overly straining your body.
Thank you for reading! As always, feel free to reach out with any questions or article ideas. This content is for informational purposes only. Please consult with your physician or healthcare provider for specific medical advice.
References
- Tweed, Jo L., Jackie A. Campbell, and Steven J. Avil. “Biomechanical risk factors in the development of medial tibial stress syndrome in distance runners.” Journal of the American Podiatric Medical Association 98.6 (2008): 436–444.
- Yates, Ben, and Shaun White. “The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits.” The American journal of sports medicine 32.3 (2004): 772–780.
- Magnusson, Håkan I., et al. “Abnormally decreased regional bone density in athletes with medial tibial stress syndrome.” The American journal of sports medicine 29.6 (2001): 712–715.
- Warden, Stuart J., Irene S. Davis, and Michael Fredericson. “Management and prevention of bone stress injuries in long-distance runners.” journal of orthopaedic & sports physical therapy 44.10 (2014): 749–765.
