Shin splints are one of the most common running injuries, but actually the term refers to several different causes of shin pain and is not really a diagnosis, more a description of pain which can have multiple different causes. The most common causes of shin splints are poor hip rotation, over pronation of the foot, flat feet or dropped arches - though high arches can also cause shin splints - and poorly cushioned or worn out shoes.
In fact, physiotherapists and sports medicine specialists don’t tend to use the term as it can be too vague, and may instead refer to it as MTTS - Medial tibial stress syndrome.
What are shin splints?
In most cases, shin splints are an overuse injury. Beginners are most susceptible as their leg muscles haven’t been used or stressed in the same way before, but equally, runners returning from injury can be at risk if they increase their mileage too quickly.
Continuing to run in worn-out shoes or those with too little cushioning can also contribute to shin splints, as can over-pronation and too much running on hard surfaces.
As a rule, shin splints feel like a nagging pain, concentrated in the front of your leg along the tibia. Pain is usually experienced during and after exercise, and when you press on the area.
What’s causing shin splint pain?
Shin splints can be really frustrating as the pain can stop you from running entirely, and the exact cause can be hard to pinpoint. Broadly speaking, the pain is usually either muscular, or bone-related and it is important to make sure you have a proper diagnosis as to which one you are experiencing.
Shin splints can arise when the key muscles and tendons that control the slow lowering of your foot at each step and maintain the longitudinal foot arch are put through their paces. These are the tibialis anterior and the tibialis posterior - although they control the foot action, they run up into the lower leg, which is why you feel the pain there. Most soft tissue injuries are caused because the supporting muscles are too weak to do the job they’re designed to do, so as you increase mileage, or run on harder surfaces or overused shoes, they start to break down.
Tibial stress fractures are also overuse injuries, and they can occur when the muscles are too fatigued and weak to properly absorb the shock of running. The workload is transferred to the bones, which can cause a tiny crack. Stress fractures can be misdiagnosed as shin splints. The key difference is that the pain from muscle injuries can sometimes lessen or fade as the muscle warms up, whereas a fracture will get worse as you run. If have a very localised point of pain on the shin, it may be worth seeing a doctor and getting an X-ray to rule out a fracture. Treatment is usually four to six weeks off from running completely, depending on the severity of the fracture.
Exertional Compartment Syndrome (ECS)
This is a much rarer condition, and can occur in any part of the lower leg. It’s characterised by a tightening in the shin that worsens during exercise – some patients report that their legs feel so tight they might explode. 80% of ECS cases are in the front part of the shin, and the leg is normally pain free except during activity.
What are the symptoms?
The symptoms of shin splints include an aching, throbbing or tenderness along the inside of the shin (although it can also radiate to the outside) about halfway down, or all along the shin, from the ankle to the knee. This discomfort is due to the inflammation of the muscles and tendons on the inside of the front of the lower leg. Another symptom is localised pain when you press on the sore area.
Pain from shin splints is usually most severe at the start of the run, but often lessens and can even go away completely during a run, once the muscles are loosened up. This is an easy way to distinguish between shin splints and a stress fracture of the shin bone, which will continue to hurt and even get more painful during a run.
What’s the best treatment for shin splints?
Many runners will experience mild shin soreness at one time or another, which may well be at a tolerable level of discomfort. Podiatrist David O’Brian says, “If shin splints hit you at the beginning of a season, a certain amount of running through it will help the body adapt.” That said, if shin splints are a persistent problem, or cause acute pain, you shouldn’t run through it.
If you have persistent shin splints try the following:
Ice the inflamed area for 15 minutes, three times a day and take anti-inflammatories like ibuprofen (though always consult a doctor first if you have existing health conditions)
Ice the shin area immediately after running.
To hasten recovery, cut down or stop running altogether. The typical recovery time is two to four weeks.
If the injury doesn’t respond to self-treatment and rest, see your GP or physio to rule out other causes. A physio can also help you work on any weaknesses that have caused the problem so that it doesn’t reoccur.
They might also recommend custom-made insoles to control over-pronation. A 2020 study of existing research found that foot orthotics can help if the cause is arch-related, though the authors note that research isn’t conclusive and more is needed.
While recovering from shin splints, you should try non-impact exercises such as swimming, or using an elliptical or cross trainer. You can also try walking and cycling in a low gear, without standing up on the pedals.
Can I run if I have shin splints?
It’s not recommended, as you can end up just prolonging the problem or making it worse. At the very least you should cut down on your running and limit both duration and intensity. Our RW physio recommends you also try a treadmill with the incline set to five – the incline means the forefoot has less distance to travel to the floor, meaning the muscles have less work to do. Run for five minutes, then do some of the stretches below. Repeat this up to five times as long as you have little or no pain. As the pain reduces, increase the duration of the runs then start to remove some of the breaks.
What are the best stretches for shin splints?
Stretches with an exercise band:
Work on the tibialis anterior and Tibialis Posterior by using an exercise band. Loop one end of the band around something that won’t move, like the leg of a sofa. Stretch the band, then loop the other end around your foot. Move your foot up and down, and from side to side using the resistance of the band to exercise the different muscle groups.
Stretches without an exercise band:
Heel raises from a step: Stand with both feet on a step, heels hanging off it. Lower your heels as much as possible, then raise up onto your toes. Repeat for a total of three sets of 20 reps, twice a day.
Calf stretches with straight and bent knee: These are two separate stretches which work the gastrocnemius and soleus respectively, so you should feel the stretch in different areas of the calf. Hold each for 30 to 60 seconds, repeating four times per day.
Toe raises: Stand with your back flat against a wall, and your feet roughly a foot away from it. Raise your feet up and down for three sets of 20 reps, then sit on your knees to stretch the anterior shin. Do these in the afternoon only.
How to prevent shin splints
Whether you have just shaken off shin splints, or are just starting out and want to make sure you avoid them, you can try the below:
Change your shoes: It’s also important to check your shoes as incorrect footwear can itself be an underlying cause. If you can, it’s worth having your gait analysed at a good running shop as they can check if your shoes are right for you - and if they’ve done a lot of miles, consider getting a new pair. You might need a shoe that limits your pronation or to try orthotics that offer some arch support.
Up your calcium and vitamin D intake: Try taking 1,300 milligrams of calcium and 400 micrograms of vitamin D per day. Easy ways to get this without taking a supplement are eating more milk and yoghurt. Taking a vitamin D tablet daily is recommended by the NHS.
Follow the 10 percent rule: Never up your weekly mileage by more than 10 percent, whether you are building up or returning from injury.
Train your hips and core: Weaknesseses or imbalances in these areas are linked with shin splints as well as many other common injuries, so strengthening them will make you a stronger runner, and improve your footstrike and body mechanics.
Shorten your running stride: If you tend to overstride it can place unnecessary forces through your body. So shortening it slightly while increasing your footstrike cadence may help you generate better stride mechanics, because you’ll be putting a lot less load on your feet, shins and knees. Count your footstrikes on one side for 1 minute – a good number to aim for is 85 to 90 strikes of one foot per minute.
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