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Shin Splints: Causes, Fixes, Prevention

Updated: Nov 27, 2018

I'm a firm believer that if you know how an injury is caused you can fix it and stop it from happening again. In this article I explain how shin splints develop and what treatment works for it. I also did a livestream on this topic in my Facebook group - you're welcome to join the group if you want more injury advice.

In this article:

  • What causes shin splints?

  • Make sure it’s shin splints

  • How do you fix shin splints?

  • How to prevent shin splints

You can watch the recording of the livestream I did below.

What causes shin splints?


The medical name for shin splints is Medial Tibial Stress Syndrome. I know – It’s a mouth full! But the name actually explains exactly what it is. Shin splints is an overuse injury which develops when too much strain (stress) is put on the inside (medial part) of the shin bone (tibia).


Shin splints can also be described as a stress reaction in the shin bone. When we exercise, our bones and muscles and tendons etc. all develop micro-damage. This micro-damage is normal and needed because it acts as the message to the brain that it has to rebuild your body stronger.

If you give your body enough time between exercise bouts, the micro-damage gets repaired and the bones, muscles ligaments etc. are all stronger than before you exercised. If, however, you train too often and at too high intensities the body can’t repair all the damage and that’s when you can develop overuse injuries like shin splints.

You can overstrain the shin bone or tibia by:

  • increasing your training volume too suddenly e.g. having the summer off and then suddenly jumping into 3 times a week hockey training,

  • doing too many intense training sessions in a week e.g. hill running, track sessions and or tempo runs,

  • having a running style that places more strain on the shin bone e.g. low cadence, narrow gait or over-striding,

  • poor hip control can potentially cause your legs to turn in more during running which can lead to strain lower down,

  • excessive foot pronation (rolling in of the foot) can also cause the legs to turn in more, straining the tibia.

Remember, bones can only grow and recover if they have all the building blocks that they require. So make sure that you’re getting enough Vitamin D and calories in your diet. Your body can only absorb calcium (a building block of bones) if it has enough Vitamin D. There is also strong evidence that suggests that athletes are at a higher risk of having poor bone health and developing stress fractures if they restrict their calorie intake while training hard.


Make sure it’s shin splints


When shin splints first start the pain is often only noticeable at the beginning of an activity but then goes away while you train or exercise. As the condition gets worse the pain may increase and stop you from training. It will then often also hurt during normal daily activities e.g. walking.


It is important to distinguish shin splints from other conditions e.g. stress fractures and exertional compartment syndrome.


You likely have shin splints if the pain is:

  • on the inner border of the shin bone where the muscles attach,

  • the pain stretches over an area of at least 5cm,

  • the pain does not interfere with your sleep,

  • you don’t have any of the symptoms listed below for stress fractures or compartment syndrome.

You may have a stress fracture if:

  • you have a very localised point on the bone that is painful (less than 5cm) to press,

  • you have pain when lying down or resting,

  • you have pain on the front of the shin bone (not the muscles but on the bone).

If any of these symptoms fit you, don’t panic – consult a sports physio or doctor and let them check it for you.


You may have exertional compartment syndrome (where there is too much pressure in the calf during exercise) if:

  • the pain is only really present during exercise and usually settles within a short period e.g. within 15 minutes of stopping,

  • the pain is associated with cramping, burning, tingling or pressure-like calf pain,

  • or your foot feels cold or numb while exercising.


How do you fix shin splints?


Rest from aggravating activities

Remember that shin splints is an over-use injury of the bone where the bone has not been given enough time to recover between exercise bouts. If you continue to do exercise or activities that cause pain, the injury will just drag on. You may also be at risk of developing a full blown stress fracture if you neglect it for too long.


This does not mean that you can’t do any exercise! You must just cut the stuff out that hurts. This usually includes running and jumping activities. You should still be able to swim and cycle or cross train to keep your fitness up.


Strengthen your legs

Start working on your glute max, glute med, hamstring, quad and calf strength. Choose exercises that does not cause any pain and that also develops your stability. Make sure that you include exercises for foot and ankle stability.


Flexibility

Not all my patients benefit from flexibility exercises. Some of them develop shin splints because the muscles around their ankles are too weak and their joints are too flexible. These patients benefit more from strength training and orthotics.


A number of patients do present with extremely tight calves and ankles. I find that these patients often benefit from adding calf stretches and general flexibility work into their rehab programmes.


Orthotics or supportive insoles

If you suspect that your feet roll in or your arches drop excessively when you run or walk, you may benefit from wearing some orthotics in your trainers. These insoles act as a little support for your foot arch and can in theory reduce the strain on the shin bone by not allowing the foot to roll in excessively.


Slowly return to sport

It is always very tempting to jump right back into training once the pain has settled. Please don’t do this. The bone needs to slowly get used to exercise again and you risk flaring it all back up again if you go back to your normal training regime.


This is where it can really help to work with a physio or other sports clinician who can work out a programme that is specific to your sport and takes your goals into consideration.


If you’re a runner or you do running sports, I suggest that you follow a run/walk programme to get the shin bone used to the impact of running. You can find an example of a run/walk programme in this blog post.


How to prevent shin splints

Like so many other sports injuries the research seems to suggest that if you’ve had shin splints in the past, you may be at risk of getting it again in the future. These are the steps I suggest you take to prevent this from happening:

  1. Make sure your legs are strong. Do at least 2 strength training sessions per week.

  2. Plan and log your training! Make sure that you ease into training and that you allow enough recovery time between sessions.

  3. Do you have flat feet or over-pronate? You may benefit from using orthotics and having more stable running shoes.

  4. Have your running style checked. There’s no perfect running style but the research does seem to suggest that certain things e.g. a narrow gait or turning in of the legs etc. can contribute to shin splints. I get my patients to email me a video of themselves running on a treadmill and then look at it in slow motion. There are some very simple but effective cues that you can use to correct your running style depending on what is needed.

  5. Eat enough and make sure your Vitamin D levels are topped up.

  6. Sleep is extremely important for recovery so make sure you get enough!

Let me know if you have any questions. You can also consult me via Skype video call if you’d like a bespoke treatment programme that fit around your goals.

Best wishes

Maryke

About the Author

Maryke Louw is a chartered physiotherapist with more than 15 years' experience and a Masters Degree in Sports Injury Management. You can read more about her here.

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References

  • Agresta C, Brown A. Gait retraining for injured and healthy runners using augmented feedback: a systematic literature review. Journal of orthopaedic & sports physical therapy 2015;45(8):576-84.

  • Bliekendaal S, Moen M, Fokker Y, et al. Incidence and risk factors of medial tibial stress syndrome: a prospective study in Physical Education Teacher Education students. BMJ Open Sport & Exercise Medicine 2018;4(1) doi: 10.1136/bmjsem-2018-000421

  • Garnock C, Witchalls J, Newman P. Predicting individual risk for medial tibial stress syndrome in navy recruits. Journal of science and medicine in sport 2018;21(6):586-90.

  • Sharma J, Weston M, Batterham A, et al. Gait retraining and incidence of medial tibial stress syndrome in army recruits. Medicine and science in sports and exercise 2014;46(9):1684.

  • Verrelst R, Willems TM, Clercq DD, et al. The role of hip abductor and external rotator muscle strength in the development of exertional medial tibial pain: a prospective study. British Journal of Sports Medicine 2014;48(21):1564-69. doi: 10.1136/bjsports-2012-091710

  • Verrelst R, De Clercq D, Vanrenterghem J, et al. The role of proximal dynamic joint stability in the development of exertional medial tibial pain: a prospective study. Br J Sports Med 2013:bjsports-2012-092126.

  • Winters M, Bakker EWP, Moen MH, et al. Medial tibial stress syndrome can be diagnosed reliably using history and physical examination. British Journal of Sports Medicine 2018;52(19):1267-72. doi: 10.1136/bjsports-2016-097037

  • Zimmermann WO, Helmhout P, Beutler A. Prevention and treatment of exercise related leg pain in young soldiers; a review of the literature and current practice in the Dutch Armed Forces. Journal of the Royal Army Medical Corps 2017;163(2):94-103.

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