No More Shin Splints

Six Pack Abs   by Maren Sederquist, MES, CSCS, CPT

If you’ve had Shin Splints before, you know you don’t ever want to get them again. If you’re a runner or other high-impact activity participant and you haven't gotten them, you don’t ever want to! Shin splints are the common name for Medial Tibia Pain Syndrome (MTPS) or Medial Tibia Stress Syndrome (MTSS). To you, that means tenderness, burning or even sharp pain in your shin – usually toward the inside lower third of your shin. Pain can be severe at the start of a run, better or non-existent when warmed up, and then severe again after your run or the next day. Or sometimes it just gets gradually worse while you’re running.

Preventing Shin Splints in the first place is best, but if you start to get a hint of them, takes steps immediately to alleviate them so it doesn’t lead to a worse condition. This overuse injury is the inflammation of a tendon, where it attaches your shin muscle to the bone. If untreated, it can pull at the bone and lead to a possible stress fracture.

Beginning runners, or those returning to running or another high-impact sport and increasing their mileage too quickly are most susceptible to Shin Splints. Sometimes just backing off and reducing your mileage can help, but it’s important to look at all the possible causes and eliminate them all before the Shin Splints come back again! 

Possible Causes of Shin Splints

Your Body:

  • Weak shin muscles (anterior tibialis).
  • Tight calf muscles or Achilles tendons.
  • High arches cause anterior shin splints.
  • Flat feet cause medial (also called posterior) shin splints.
  • Pronation (arches collapse and toes turn out).

Your Shoes:

  • Shoes with insufficient shock absorption.
  • Shoes that don’t have enough stability or motion control.
  • Shoes that aren't supportive of your arch.
  • Shoes that are wrong for the activity you’re doing.
  • Shoes that are worn out or don't fit well.

Your Environment:

  • A surface that’s too hard.
  • An uneven surface.
  • Hills (incline, decline).
  • A banked or cambered surface.
  • Cold weather.

Your Training:

  • Increasing your mileage too fast.
  • Increasing intensity/speed too fast.
  • Poor running technique.
  • Addition of plyometrics or other jumping exercises.
  • Over-striding.
  • Toe running.

For Immediate Relief of Shin Splints

The second you start feeling Shin Splints, STOP what you are doing immediately! It’s much easier to treat Shin Splints early on before the pain becomes chronic.

Treatment: PRICE+

  • PREVENTION – Prevent the pain from occurring by looking at all the possible causes and fixes for them.
  • REST – Rest the aggravated area by doing another activity that doesn’t cause the pain for a week.
  • ICE – Ice your shins for 20 minutes. My favorite way to get the shins is to massage the painful area with an ice cube or peeled down ice in a paper cup.
  • COMPRESSION – Putting pressure on the inflamed area also helps decease inflammation. Wrapping the ice pack in place with an ACE bandage is a good way to apply compression.
  • ELEVATION – Elevate your shin above heart level while you’re icing it.
  • If you tolerate it well, take aspirin or a non-steroidal anti-inflammatory (NSAID) like Advil, Motrin or Aleve for pain and inflammation.

 

Long Term Fix of Shin Splint Causes

Your Body:

  • Balance the musculature of your lower leg by strengthening your anterior tibialis (shin muscle). Do toes raises (not heel raises) with an ankle weight or weight boot on top of your foot, pull your toes toward your knee against a band or someone’s hand, walk backwards or on your heels or practice alphabet writing with your toes.
  • Stretch your calf muscles regularly when they’re warm.
  • Have your your tight calves massaged, or do it yourself with a foam roll.
  • Look into arch supports or orthotics. Custom shoes inserts are the best, but some people can get away with inserts off the shelf. Board certified Pedorthist Adam Kemist, C.Ped. of The Runner’s High does a great job.

Your Shoes:

  • Get shoes that have better shock absorption.
  • Get shoes that have stability or motion control.
  • Get shoes, or inserts for your shoes, that are supportive of your arch.
  • Get shoes that are designed specifically for the activity you’re doing. (Don’t run in walking or aerobic shoes!)
  • Get shoes that fit well. Don’t compromise. Your shoes should feel comfortable immediately. You shouldn’t have to break them in.
  • Change your shoes at least every 500-750 miles or 6 months.

Your Environment:

  • Run on soft surfaces like dirt, grass, or synthetic tracks. Stay away from concrete sidewalks.
  • If you have to run on a street with a camber, make sure to spend equal time on both sides.
  • Introduce hills into your workout very gradually, and be sure to strength-train your shins to compensate for the extra strength your calves will gain.
  • Be sure to do an adequate warm up in cold weather, and stretch your calves after you’re warm.

Your Training:

  • Never increase your mileage or time by more than 10% per week.
  • Don’t increase the intensity or speed of your training too rapidly.
  • Have your running technique looked at by someone who understands how to analyze gait.
  • Make sure to add plyometrics or other jumping exercises very gradually.
  • Don’t over-stride or run on your toes. Your stride should be comfortable and your full foot should strike the ground.

 A Worse Problem?

If your shin pain doesn’t resolve in 6 weeks, consult a physiatrist or sports medicine physician so they look for other possible causes, and to refer you to physical therapy for further treatment, possibly including ultrasound or eletrostimuli.

Valerie Barlett, MPT is the best physical therapist I’ve found in the area (Menlo Park, 650-323-3001).

 Other signs you should consult your physician immediately:

  • A lump or bump on the bone.
  • Pain that remains severe throughout run.
  • A foot that goes to sleep or that you can’t push off with.
  • Severe pain even when walking.

 

Simply doing too much too soon can cause Shin Splints, but since there are many other possible causes, you should look at all of them for prevention of recurrence. It’s important that you change what you did before, or Shin Splints can come right back!

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