Shin splints, also known as medial tibial stress syndrome, are classified by pain in the inner part of the lower leg and are one of the most common injuries to develop in runners. Medial shin pain is most often caused by repetitive pounding on hard surfaces, introducing an undue stress on the bones, muscle, and lower extremity joints. Shin splints can be a nagging and ongoing injury; however, they can usually be treated in a conservative way with a few simple changes in your training pattern and strengthening/stretching program.
- Gradual onset of anterior or medial shin pain
- Tenderness upon palpation (inner aspect of lower leg)
- Mild edema or redness
- Too much, too soon: Sudden increase in training frequency, duration, or intensity.
A general rule of thumb to avoid shin splints and any overuse injury is to never increase your training routine more than 10% a week.
- Old and run down shoes: A good running shoe typically lasts about 400-600 miles before breaking down. When your sneakers break down, more force is emitted throughout your joints because the shoes aren’t supporting your arch or absorbing the continuous impact that they once were, exposing your body to an increased risk of injury.
- Training on a hard, inclined surface: In particular, descending hills are a source of shin splints, secondary to the positioning of your foot when running downhill. When running downhill, your initial impact with the ground is in a plantar-flexed position (forefoot striking) which puts unneeded stress on the anterior muscles in your shin rather than distributing forces evenly through the joints and soft tissue.
- Previous history of shin splints combined with failure to treat your previous bout of shin splints properly before returning to a high level of activity.
- Faulty running mechanics up the entire kinetic chain. Flat or rigid arches and over-pronation may unevenly distribute pressure on the leg, resulting in shin splints. Also, weakness in the stabilizing muscles of the hip and core may result in an overuse injury such as shin splints.
- Utilize the “RICE” principle when treating shin splints.
- Rest: Avoid high-impact activities (such as running and jumping). Use this time to cross train (swim, elliptical, bike) and give the legs a period to recover from the repetitive pounding.
- Ice: Ice for periods of 15-30 minutes for 2-3 times a day.
- Compression: Sleeves or ace bandages providing a compressive force may help ease your symptoms.
- Stretch your calves, hip flexors, quads, and hamstrings
- Participate in core, hip and lower extremity strengthening exercises
- Foam roll your anterior tibialis and gastroc soleus muscles to loosen the tissue, break up any adhesions, and encourage blood flow to the area
- Take anti-inflammatories to help diffuse any swelling or inflammation
- Invest in orthotics or arch supports to help disperse the impact of the ground force more equally and place you in a better alignment
- Seek medical help if pain persists to rule out a more serious injury, such as a stress fracture or compartment syndrome.
- Get a running analysis to evaluate any biomechanical faults and receive recommendations on how to alter your running form to avoid excessive stress on your bones, joints, and soft tissue.
How to Avoid Shin Splints:
- Warm up with dynamic stretching prior to working out
- Don’t increase the intensity, frequency, and duration of your training too quickly
- Run on softer surfaces
- Select footwear or get fitted for inserts to accommodate to your specific foot type
- Avoid over-striding during running
- Remember to cross train, strength train, and stretch
Tracey Llewellyn is a doctor of physical therapy at HSS Sports Rehab at Chelsea Piers Connecticut. She received her Doctorate in Physical Therapy from Hunter College and Bachelor of Science in Exercise Science from Manhattan College. Tracey is certified in the Selective Functional Movement Assessment (SFMA) and is a Graston Technique provider. She is a former Division 1 soccer player and is especially passionate about sports medicine, injury prevention, return to play, and running analysis.