Shin Splints: Causes, Symptoms, and Treatment

You have just finished a long run. You get home, take off your shoes, and settle down to relax. Then, you feel a slight pain on the front to the inside of your shin (tibia) bone. You analyze your run by trying to remember whether you fell or twisted your leg. However, you are unable to recall any such moment. 

Over the next few runs, this pain worsens, and walking downstairs becomes quite painful. After seeing a sports physiotherapist, you are diagnosed with medial tibial stress syndrome, which is popularly known as shin splints. 

What are shin splints?

According to a study published by Thacker and others in 2002, shin splints account for 6% to 16% of all running-related injuries. The American Medical Association had stated in 1966 that shin splints are the pain and discomfort in the leg from repetitive activity on hard surfaces or due to forceful, excessive use of foot flexures. The diagnosis should be limited to musculoskeletal inflammations, excluding stress fractures or ischemic disorders. Usually, when there is a pain in the lower leg, shin splints are the most probable diagnosis once the doctor has ruled out fractures, specific compartment syndromes, and muscle hernia. Explained further are the shin splints – causes, symptoms, and treatment. 

Causes and risk factors

Generally, shin splints develop due to overworking of the muscle and bone tissue in the leg from repetitive activities. So, runners have a high risk of developing shin splints. There may be various shin splints causes. Although shin splints are a common running injury, beginner runners tend to be more susceptible to it. This is because the muscles in their legs have not been stressed in the same way before. Anyone can get shin splints; however, you may be at a higher risk of developing this condition if:

1. You suddenly increase the number of days of training, intensity, duration, or running distance

2. You have flat feet, high arches, or abnormally rigid arches. The arch of the foot acts as a shock absorber that absorbs the impact of force every time you take a step. People with flat feet or high arches may be unable to absorb the shock and distribute the force from impact evenly.

3. You run on uneven surfaces, such as hills or hard concrete surfaces

4. You are running with improper or worn-out shoes

Also Read: Can You Run If You Have Arthritis?

Shin splints symptoms 

A few symptoms of shin splints are quite prominent. There is a sharp or dull pain during running and walking downstairs or downhill. Also, you may notice tenderness of the anterior tibia (front shin bone) when pressing on it. When you are having pain, it is not advisable to run or do any form of movement, which can worsen it. 

Given the higher risk, runners need to know the signs and common treatment methods for shin splints. However, if the condition aggravates, consult a physician to detect the problem and rule out other possible injuries like stress fractures. 

Shin splints treatment 

1. The treatment for shin splints begins with rest along with ice and inflammatory medication during the acute period, which lasts for the first three days. Do rest during this duration until the pain starts improving. After this tenure, do not rest completely. According to a study by Galbraith and Lavallee in 2009, taking complete rest after the acute duration may delay recovery. 

2. Once the acute period is over, decrease your weekly distance, frequency, and intensity by 50%. Avoid running on hills or uneven surfaces. Instead, run on tracks or completely uniform surfaces of moderate stiffness to reduce the impact on the lower body. 

3. You can start running after the first three days if you are relieved from the pain. However, as soon as you feel pain, stop running and walk. While you are recovering, include specific strengthening exercises of the tibialis anterior, muscles of the foot, and calves. Exercises, such as standing and seated calf raises, arch lifts, towel curls, and toe raises can be useful. 

4. Also, work on strengthening your core and glutes by doing exercises such as the glute bridge. Do these exercises at least thrice a week. Make it a point to do three sets of 15-20 repetitions on each leg. 

5. Wear shoes that have more shock absorption and a stable heel counter. Ensure to replace them after every 250miles-500miles (400km–800km). 

6. Foam-roll your calves and the underside of your foot before each run and slowly increase your weekly mileage by 10%-25%. After four-six weeks, you will begin to notice that the pain is less, and you can run longer comfortably. Eventually, after eight-10 weeks, you will notice pain-free running.

7. If the above therapies have not worked, then opt for other techniques after consulting your fitness therapist. These may include the use of orthotics, manual therapy, splinting, or shock therapy. 

Prevention

Shin splints can be debilitating and demotivating for your running. It is because there are very few proven conclusive ways to prevent shin splints. However, as per a study by Timothy Tolbert and Helen Binkley in 2009, you can minimize your risk of developing this condition by adopting strategies, such as: 

1. Proper warm-up

The warm-up enhances blood flow to the working muscles. Additionally, it raises the nerve impulse to improve correct running biomechanics. Always warm up for five-10 minutes by doing exercises that involve large muscle groups of the lower body. Some exercises that you may consider are squats, lunges, light skipping, and bodyweight calf raises. Usually, one set of 15-20 repetitions per exercise is sufficient just before running.

2. Static stretching

This exercise involves stretching for runners.. Due to the relationship of the muscles in the closed kinetic chain of the hamstrings and calves, it is suggested to focus on stretching these regions. Muscle tightness in the hamstrings can affect biomechanics in this chain, resulting in injury. 

Tight hamstrings cause more stress on the lower leg during running, leading to compensatory dorsiflexion of the ankle. You can stretch the hamstring by lying on your back. Grab a towel at both ends in one hand and wrap it around the bottom of one foot. Slowly, lift the leg up off the floor. Keep the lifted leg straight and ensure that the other leg is on the floor. 

In addition, stretch your calves, which include gastrocnemius and soleus. Do this by standing in an upright position on the leg that has to be stretched, with the bodyweight on the forefoot, and the ankle in plantar flexion. To stretch the soleus, be positioned close to a wall with the legs staggered, the back straight, and the palm of the hands against the wall. To start, be in a position that allows the legs to be bent and the buttocks dropped. Then, lean into the wall until you feel a comfortable stretch in the lower calf. 

Ensure that you hold all these above stretches for 30 seconds and release them for 15 seconds. Repeat this exercise thrice on each leg, and do these stretches four-five times a week. 

3. Strength training and insoles

One of the key risk factors is a high navicular drop, which is a high degree of pronation. You can prevent this by wearing anti-pronation insoles and by strengthening the muscles of the lower leg, hip and pelvis region, and core. Both these methods achieve similar outcomes. 

According to experts, using insoles is unnecessary unless you are already suffering from shin splints, and strength training is a much better idea. A few exercises that you can consider doing include single-leg glute bridge, single leg controlled step-ups, single-leg standing calf raises, elbow bridge, and controlled walking lunges. Do each exercise at least once a week. Do three sets of 10-15 repetitions on each leg. 

4. Gradual increase of running mileage and type of running surface

You can prevent shin splints by gradually increasing your mileage and giving yourself enough time for rest and recovery. Some risk factors that may result in shin splints are hill training and a change in running surface to a harder or tilted type. If you can, limit hill-specific training sessions to once a week, and restrict running on cambered or slanted roads. Run on softer surfaces, such as grass or trail once or twice a week. Doing exercises to increase running speed and stamina can be useful.

Shin splints can be extremely painful, but they need not be debilitating. You can have a long and shin splint-free running career by following preventive measures and dealing with problems promptly when any discomfort arises.  

References
1. American Medical Association, Committee On The Medical Aspects Of Sports, Subcommittee On Classification Of Sports Injuries. Standard Nomenclature Of Athletic Injuries. Chicago: Ama, 1966, P. 126
2. Galbraith, R. M. and Lavallee, M. E. (2009) ‘Medial tibial stress syndrome: Conservative treatment options’, Current Reviews in Musculoskeletal Medicine, 2(3), pp. 127–133. doi: 10.1007/s12178-009-9055-6.
3. Thacker, S. B. et al. (2002) ‘The prevention of shin splints in sports: A systematic review of literature’, Medicine and Science in Sports and Exercise, 34(1), pp. 32–40. doi: 10.1097/00005768-200201000-00006.
4. Tolbert, TA. (2009) Treatment and prevention of shin splints. Strength and Conditioning Journal. 31(5), pp. 69-72.