In this article and podcast episode, we dig into the topic of shin splints. Shin splints are fairly common among new runners, or experienced runners who suddenly increase their distance or training intensity. In this article, we discuss what shin splints are, what are the symptoms of shin splints, what causes them and how to get rid of them and keep them from coming back.
Shin splints is an overuse injury that can be quite painful and equally frustrating. Pain typically occurs when there is inflammation in the muscles, tendons and bone tissue surrounding your tibia. More specifically, where the tendons attach to the bone. The tibia is one of two main bones just below your knee and above your foot. Most of us frequently refer to it as our shin bone.
Along the tibia is two primary muscles, the tibialis anterior muscle and the tibialis posterior muscle. The tibialis anterior muscle is the primary muscle that lifts or lowers your foot. The tibialis posterior muscle helps with supporting the foot during the weight bearing phase of your foot strike as your foot naturally pronates to absorb impact. A weak tibialis posterior muscle can lead to arch collapse during the weight bearing part of your foot strike and places additional stress on your lower leg. Since running is a high impact activity, these two muscles, their tendons and the bone tissue that they connect to, gets inflammed and painful when we try to do too much before our body has adapted to running or the new onset of increased activity.
When experiencing shin splint pain, the pain is most often felt on the front or inner edge of your shin. If it is more towards the front or inside-front, it is most likely Anterior Tibial Stress Syndrome or Anterior Shin Splints. If more to the inside and back, it is most likely Medial Tibial Stress Syndrome or Posterior Shin Splints.
Shin splint pain often feels like tiny razors or sharp-razor like pain digging into your bone. Other early signs of shin splints are often a dull or throbbing sensation in the area. You can often press and feel a sore spot by pressing around the area.
Shin splints usually start during a run and can last throughout the run and afterwards. Often the pain during a run becomes severe enough, it forces you to stop running.
It is important to note, that other things can contribute to shin pain. If your pain does not resolve fully or does not show signs of improvement after a few days to a week of self treatment, or if your pain is extreme, the area shows signs of swelling, or pain does not resolve with rest, then you should see your doctor and have your lower leg examined. Overuse injuries like stress fractures, tendonitis and a few other issues can feel very similar to shin splint pain. When chronic inflammation occurs, shin splints can progress into tendonitis, larger tears, or even stress fractures as the bone starts to break down.
Remember, I am a running coach, not a medical doctor so if you are not sure what you have, get it checked out. Usually it is better to know for sure so you can properly address the right injury, rather than risk making it worse.
Shin splints are first and foremost an overuse injury. Shin splints can be aggravated by other things, like poor footwear, having flat feet or poor foot anatomy such as rigid arches, but shin splints primarily come on due to a sudden changes in activity level that increases stress on your bone and tendons. As your muscles get used repetitively over and over again as you run, the muscles pull on the tendons and can start to microscopically tear and inflame where the tendons are attaching to the bone.
New runners are often the first to get shin splints. If you are a new runner, you are often motivated to get started and often find yourself doing too much early on because of this motivation to get in shape.
However, running day after day with no rest days or running further that you are ready for, often leads to injury. Running too much or overdoing it early on will systematically tear your tissues down and lead to overuse injuries. If your body is not prepared to handle the impact and that impact is around the shin area, then shin splints or stress fractures can occur.
Shin splints can occur in experienced runners as well. If you are used to running 3 miles per day, 3 times per week and suddenly increase running to 6 days per week or drastically increase your distance, then you might experience pain in your shins due to the sudden onset of volume.
A sudden increase in intensity, hills, or speed workout can also be problematic for experienced runners. Even changes of surface (packed trails to pavement and vice versa) can contribute to shin splints.
If you have been searching around for tips on getting rid of shin splints, you have probably seen a dozen different suggestions. This is especially true if you have been searching on forums or through social media. I often cringe when I see some of the advice. Everything from changing shoes to foam rolling. Getting rid of Shin Splints is a fairly straightforward process. First and foremost, we need to apply the RICE principle. Then, and only then do we work on flexibility and strength training once the injury has had a chance to heal.
"Running through shin splints, or going straight to flexibility and strength training before you have had a chance to start the healing process is a common mistake."
(R)est: Since shin splints are an overuse injury, we need to first dramatically reduce the level of activity. This usually means taking a few days off from running or incorporating other forms of low impact cross training like swimming or cycling. In more experienced runners, simply taking a day or two off and then walking a day or two, followed by a slow, gradual ramp up is usually enough to get over shin splints. For beginners, it may require additional time off, followed by a gradual comeback through run/walk along with flexibility and strength training to help build up your muscle strength and flexibility. A strong muscle is an injury resistance muscle and will help your body absorb the impacts from running. A flexible muscle will help reduce the tension applied to the tendons and bones.
(I)ce: Inflammation, especially right after exercise or injury can be reduced by frequent icing. Use cold packs or baggies filled with ice and apply to the area off and on throughout the day. Never apply ice directly to the skin. Use a hand towel as a barrier between ice and your skin.
(C)ompression: Compression socks after exercise can help, but often is not needed. Compression often helps reduce inflammation or additional swelling but often just makes you feel better due to increased circulation and pushing lymphatic fluids out of the area.
(E)levation: With shin splints I don't feel this is as useful. Shin splints rarely have swelling.
Light stretching and simple strength training exercises can help you increase flexibility and build strength that will help strengthen the area and help your body better absorb the impact from running. I have whole strength and flexibility routines designed specifically for runners and injury prevention inside my PaceBuilders membership area for those using our training plans and coaching, but some of my favorite exercises to get rid of shin splints involves various single leg balance and stability drills, calf stretches, gastroc calf stretches, heel drops and raises, hamstring stretches, hops and jumps, BOSU ball exercises to name just a few.
But before you introduce stretching and strength into the treatment mix, please give your legs a few days to start that healing process and certainly cut your training volume back. No amount of foam rolling, stretching, or strength training alone will help you heal. You need to temporarily cut back training volume.
If you need help with a training program that will help balance the right level of training with your experience level so that you can meet your running goals while minimizing the chance of injury please check out our PaceBuilders training program. We work with runners all the time who are trying to overcome injuries so that they can get back to training. Shin splints is very common and we have experience helping runners get over them.
The correct answer is maybe. While most advice on the topic is well meaning and can sometimes be helpful, the reality is that shoes and orthotics rarely by themselves solve any running injury. They are nothing more than tools.
Orthotics can help if someone has really high arches or flat feet, but the vast majority of runners outside of this group do not need them. Using them temporarily however has been helpful in some of the clients I coach as it helps 'temporarily' remove the stress in the spot of injury so the overall load is lowered thus allowing your injury to heal. Using orthotics with high arches helps prevent against arch collapse (or more commonly known as over pronation) or the added tendion on the bottom of the foot that can sometimes cause plantar fasciitis in runners with high arches. Still Plantar Fasciitis is an overuse injury, and almost always a training deficiency unless it was caused by a sudden tear due to weakness or failure in the muscle.
For the same reason, shoes may or may not work. Certainly change your running shoes often as the cushioning breaks down fairly fast in running shoes. Most running shoes should be changed every 300-500 miles. However, switching to a new brand or style of shoe can work but again most likely because it has simply shifted the stress slightly to another area thus giving your shin splints time to heal.
Changing your shoes or adding an orthotic is worth a try but only after you have fixed your training issues and cut back your volume first.
When returning to running after experiencing shin splints, the process must be methodical and slow. Before you resume running you should be pain free for at least a few days to a week. Do not rush back. If your shin splints were severe, you may want to wait two weeks before your return.
When you return, start by doing a 10-15 dynamic warmup. I also have routines inside PaceBuilders for this, but you want to to find exercises that slowly increase your heart rate and involve movement. This is not stretching where you stretch and hold. Lunges, High knees, squats, hip flexor stretches, jumping jacks, are just a few examples.
After your dynamic warmup, do some easy walk/run intervals. If the pain returns, stop and repeat the process for everything up to this point. You may have to repeat this a few times. Once you can run/walk pain free, then you can slowly resume back to your training volume starting from about 50% of your pre-injury volume and slowly increasing over the next two weeks until you are back to pre-injury volume. Sometimes you can come back a little faster, but always pay attention as you run and stop if pain returns. If you made it through most a run, before pain returned, cut the run short, and try again in two days and run the distance just short of where the pain came on a couple days before.If you can maintain that distance without pain, slowly add in additonal distance for subsequent runs. Running through pain will only make your shin splints worse, or lead to more severe, chronic injury.
In the following video, Bob and Brad, two physical therapists with an awesome YouTube channel share their pro tips for getting rid of shin splints.
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