Everything A Runner Should Know About Shin Splints
Shin splints is a common injury experienced by runners.
If you develop a shin splint, the most likely cause is that you did too much, too soon.
Since being enthusiastic about your running is a good thing, the disadvantage is when you put too much pressure on your body forcing it to do something that it is not trained for.
Considering the common nature of these injuries, it is important that as a runner, you fully understand
- What shin splints are?
- How are they caused?
- How are they diagnosed?
- And what can you do to prevent them?
In this article, we will go into detail about this injury.
What Is This Pain Called Shin Splints?
Simply put, shin splints can be defined as the pain occurring in athlete’s shins that is especially evident during exertion.(1)
The shin bone is also known as the tibia bone and is one of the most commonly fractured bones in the body. This long bone plays a vital role in supporting most of your weight and is also a part of your knee and ankle joint. (2)
Other Names Of Shin Splints
Although the term shin splints is now commonly accepted, you may also hear different names used to describe the same condition. These include:(1)
- Shin soreness
- Medial tibial syndrome
- Anterior compartment syndrome
- Posteromedial compartment syndrome
When it comes to the location of shin splints, there is no fixed location on your tibia where shin splints occur. They can happen anywhere along the bone.
Common Activities Causing Shin Splints
As mentioned at the outset, shin splints are basically an overuse problem.
- Generally speaking, you may develop a shin splint if you increase your training drastically or engage in too much activity.
Repetitive use of your lower legs and high impact movements are the two activities that may cause shin splints.
- Increased training days
- Running longer distances / intensifying your training
- Engaging in activities that constantly require you to stop and start
- Running on hilly terrain
- Running on hard surfaces
- Running downhill
Shin splints develop when you tire out your leg muscles or tendons.
If you have flat feet, suffer from muscle weakness and lack flexibility, you have an increased risk of developing shin splints.
Location Of Shin Splints
Although no specific location can be diagnosed as a shin splint, there are two major regions where you can suffer shin splints – the anterior and the posterior.
You may also develop a tibial stress fracture.
#1: Anterior Shin Splints
What Are They
The anterior compartment contains different muscle groups and is located in the front of the shin bone. An anterior shin splint involves the tibialis anterior muscle which is responsible for the lifting and lowering of your foot.
This muscle also lifts your foot during your stride and lowers it afterward. (5)
How They Work
When you over stride during running, the tibialis anterior tendon overstretches and separates from the tibia which results in inflammation.
The tibialis anterior muscle prevents your lower legs from experiencing stress when your feet hit the ground. In effect, this muscle group reduces the trauma to the leg. (6)
This is why running on hard surfaces or downhill puts extra stress on these muscles and can cause shin splints.
How To Know Problem
To determine if you have this kind of shin splint, lift your toes up while keeping your heels on the ground. If the pain increases, it is likely that you suffer from this kind of shin splint.
#2: Posterior Shin Splints
What Are They
This kind of shin splint is located on the inside rear part of the bone and involves the tibialis posterior muscle which is responsible for controlling your foot arch during weight-bearing movements.
How They Work
This particular kind of shin splint is often caused by imbalances in the leg and foot. (7)
For example, if you have flat arches (pronation) your foot flattens at each step which in turn causes the posterior tibialis muscle to stretch and put pressure on the tibia.
Over time, the connection between the posterior tibialis muscle and the tibia bone is damaged causing inflammation and pain.
#3: Tibial Stress Fracture
What Are They
Your lower leg is composed of two bones-the tibias and fibula. The tibia is the largest and carries most of the weight.
The most common location of a tibial stress fracture is about three inches above the ankle on the tibia bone.
How They Work
When you run, the tibia carries the load which is also shared with the muscles.
If your muscles become overfatigued because of overuse, the tibia bone takes most of the pressure.
This may result in a small fracture of the bone.(8)
Symptoms Of Shin Splints
During the early stages of shin splints, you may experience pain while you do physical activities but the pain disappears as you continue.
The next morning, the pain is likely to return and intensify as you continue your running routine.
In addition, you may find a soft zone inside the shinbone.
If left untreated, this pain may become very sharp in which case you probably have a stress fracture.(9)
Here are the common symptoms of shin splints:
- Swelling On The Inside Of The Leg
- Tenderness Either On The Inside Or Outside Of The Shin
- Pain When You Bend Your Toes Or Foot Downwards
- Swelling Of The Lower Legs
- In Extreme Cases, Pain While Walking
- Dull, Aching Pain That Is Localized
The most common cause of all these symptoms is overuse. If you increase your running routine and keep the recovery time the same, you are likely o suffer from an overuse injury.
4 Stages Of Overuse Injury
Stage 1: Discomfort in the leg that appears when you warm up
During this stage, it is safe to continue your physical activities as long as the discomfort doesn’t progress into pain.
On the other hand, continuing physical activities without seeking any medical advice will not remove the problem.
In order to make sure that your condition doesn’t become worse, it is best to seek medical advice as soon as you start experiencing discomfort.
Stage 2: Discomfort that disappears when you warm up but returns at the end of your training
This stage is a little more serious than stage one, but you will still be able to continue training as long as you reduce the intensity of your runs.
For example, if you start experiencing the discomfort or pain after 10 km, then stop when you reach that point.
During stage 2, you are likely already under treatment.
Stage 3. Discomfort that worsens into pain as you continue with the activity
If you reach this stage, you will need to take a break from running and any other physical activities that make the pain worse.
Although it may be possible for you to continue a training program that does not involve the muscles affected, you will need to seek professional advice on the matter.
Stage 4: Pain or discomfort felt almost all the time at different degrees
This is the most severe stage that will require you to stop all kind of training and even some of your daily activities.
It is urgent that you seek medical advice if you reach this stage.
Understanding The Causes Of Shin Splints
4 Main Causes Of Shin Splints
In order to properly diagnose the type of shin splint you have, you will first need to identify the cause of the condition. There are four main causes of shin splints.
#1: Overstress Of The Bone
When you run on hard surfaces, your tibial bone exerts a lot of effort due to the impact. Such forceful contraction may trigger a shin splint caused by overstressing of the bone.
This, in turn, can result in a stress fracture which manifests itself in the form of a shin splint.
#2: Compartment Syndrome
This occurs when the pressure in the muscle increases, thereby decreasing blood flow and preventing nourishment from reaching the muscle cells.
Chronic compartment syndrome is often caused by overexertion which triggers bleeding and swelling within a muscle group or compartment.
Activities with repetitive motions including running are at high risk of developing compartment syndrome. (12)
#3: Biomechanical Factors
The biometrics of running include three main positions:
- The initial foot contact
- Mid foot contact
- Push off
When the foot strikes the ground, it needs to absorb the shock before it pushes off for the other step.
The arch of the foot aids in providing this shock absorption.
Over pronation or flat feet syndrome puts extra strain on the muscles causing strain on the shin bone.
This is why runners with flat feet are more likely to develop shin splints.
#4: Muscle Fatigue
When overused, fatigued muscles can also cause shin splints. The muscles around the tibial bone act as shock absorbers, absorbing some of the stress that would otherwise go directly to the bone.
When these leg muscles are often overused because of engaging in too much physical exercise too soon, more of the shock reaches the bone.
This overload causes shin splints.
Common Mistakes In Training That Cause Shin Splints
When it comes to the causes of shin splints, the bottom line is that you are doing something wrong.
If you are moderate in your training habits, understand the importance of rest days and don’t push yourself too much, you are less likely to suffer from this condition.
The following are some of the most common training mistakes that trigger the condition (13)
#1: Not Having Enough Recovery Time
If you have the habit of pushing yourself too much and not giving your body enough time to rest, this can increase your chances of developing shin splints significantly.
The recovery time between workout sessions is necessary to promote tissue repair. Without adequate recovery, your muscles will become fatigued which means they will provide less support to your bones.
Overtraining leads to musculoskeletal problems which take time to heal.
#2: Running With Bad Form
The improper running form is another underlying reason for developing shin splints.
For example, if your heel strikes when you run, you are putting gait load into your anterior tibialis which will cause damage to these tissues.
Putting such pressure on these muscles can cause tissue to become inflamed, damaged or irritated which is a direct cause of shin splints. (14)
#3: Running Uphill Or Downhill
When you run downhill in particular, you are placing extra stress on your shin bone.Each step you take when running downhill puts more stress on your bones because you are hitting the ground hard. Such stress placed on your leg muscles can cause inflammation and in time, shin splints. (15)
Running downhill also increases the shock on foot up to 7 times body weight.
#4: Running On Unstable Terrain
Running on the unstable ground may lead to over-pronation in flat feet. This condition, in turn, can lead to ankle instability in high arched feet.
If you have flat feet, you are already putting more stress on your shin bone than necessary, and running on unstable terrain increases that pressure. (16)
#5: Running On Hard Surfaces
Running on surfaces such as concrete may cause more stress on your joints and muscles.
If you have a history of tibial stress fracture, you are likely to have stiffer legs and a greater force traveling up your shins.
#6: Increasing Workout Intensity Aggressively
Overusing your muscles is one of the fastest ways you can develop shin splints.
Your muscles desperately need to recover and upgrading your running continuously can cause them to tear.
When you develop a tear, the muscles over compensate and in turn put more pressure on the shin bone causing a shin splint.
#7: Lack Of Proper Stretching
Stretching your muscles before and after running provides many benefits including relief from cramps, improved range of motion and decreased injury risk.
Getting your muscles ready for a workout and giving them time to cool down can help relieve stress on the muscles thereby decreasing your chances of developing a shin splint.
Failure to stretch has the opposite effect. (17)
#8: Wearing Bad Fitting Footwear
The kind of footwear you use when running should depend on the type of foot you have.
For example, if your arches are high, your foot is rigid and thereby a poor shock absorber.
In this case, you will need a shoe that provides good shock absorption. Those with flat feet, excessive motion characterizes your foot.
You will need a shoe that provides a degree of firmness to help stabilize the foot. Failure to wear the right footwear leads to putting too much stress on the leg causing shin splints. (18)
How To Diagnose Shin Splints
The process of diagnosing whether you have a shin splint or some other kind of sports injury can be categorized into two parts.
The first diagnosis is a DIY test that does not require any professional help.
The second is medical imaging which involves one or more of the three scans conducted by a medical professional.
Do-It-Yourself Shin Splint Diagnosis
1. The Shin Palpitation Test
- Squeeze the lower two-thirds of the leg
- Include the shin bone and surrounding muscles in the squeeze
- Use the same amount of pressure you would squeeze out hot water of a sponge
- If you experience pain, you are positive
2. The Shin Edema Test
- Press your finger in along the two-thirds of the tibia
- Hold this for five seconds
- Remove your hold and look for an indention
- If there is a dent that remains, you are positive for the test
Medical Imaging Shin Split Diagnosis
These tests are performed by a medical professional and usually involve an interview, physical examination, and medical imaging.
During the interview, information such as regular training routine and technique will be asked for.
The physical examination will help determine the location of the pain and the activities that trigger it.
Medical imaging may also be performed with the purpose of differentiating a stress fracture from a shin splint. (23)
These are three most common methods used for medical imaging:
An x-ray of the leg will help determine whether there are any fractures along the bone. If your x-ray is clear (24) the probability of having a stress fracture can be ruled out.
This will help the physician come up with the right diagnosis.
During a bone scan, you will be injected with a small amount of radioactive material through your arm.
This travels to the area in question, and a gamma camera is used to detect the radiation emitted by the injected material. (25)
- A picture is generated by converting the different intensities of radioactivity emitted into different shades of gray. (26)
This scan can help determine areas of bone where there is the infection of damage.
MRI (Magnetic Resonance Imaging)
According to one study (27) using MRI in stress fractures and shin splints is a useful method to differentiate between stress fractures and shin splints.
During an MRI scan, strong magnetic field and radio waves create pictures in the area.
You are placed in an MRI scanner which is 1.5 meters long and needs to lie still for the duration of the scan which is painless. (28)
Treatment Of Shin Splints
Treating shin splints can be done by following three main steps: icing the area, resting, and exercise.
- Reducing the pain using an ice pack is the first step that will start you on your journey to recovery.
- While waiting for your inflammation to subside, you will need to rest.
- When you are able to achieve reasonable movement without pain, you can follow simple exercises to regain your strength.
We will discuss these three steps in more detail now.
Step 1: Reduce Pain And Swelling With Ice Packs
Ice is the first aid treatment for any kind of swelling or inflammation including shin splints.
- Fill a paper cup with water and freeze, peel off the paper and rub the ice on the area.
- In a Ziploc bag, add 1 ½ cups of water with ½ cups rubbing alcohol. Freeze and apply.
- Add two tablespoons of salt to 1 cup of water and place in a Ziploc bag. Freeze and apply.
- Pour some corn syrup into a bag and freeze it for hours. This makes a gel-like ice pack.
- Use dishwashing liquid in a Ziploc bag and freeze to make a gel ice pack.
How To Ice Your Shin
Whichever recipe for an ice pack you choose to use, once the pack is frozen, it is time to ice your shin.
Follow the steps below: (31)
- Sit on a chair and elevate your leg so that it is straight in front of you
- Place the ice pack on your shin to alleviate pain
- Remember to cover it with a thin towel, so it's not too cold
- Do this for 20-30 minutes every 3-4 hours until the pain is gone
- You may also elevate your leg to reduce swelling
Step 2: Rest For Recovery
Rest plays a significant role in recovery because it allows your muscles to heal and for the inflammation to settle down.
During this period, avoid any activities that may trigger pain, swelling or discomfort.
This does not mean that you should shun away from all kinds of physical activities.
You may still engage in low-impact exercises that do not cause discomfort (such as swimming).
You may refer to the list of alternative exercises provided at the bottom of this article.
Step 3: Exercise Your Way To Recovery
Once the swelling is gone, you can now engage in rehabilitation exercises that will help you return to running as fast as possible. Before progressing to a more intense training, you need to make sure that you are pain-free.
Here are six exercises to help you recover from shin splints. (32)
#1 - Toe Raises
- Stand against a wall keeping your back and legs straight
- Slowly pull your toes and foot up to exercise the shin muscles
- Continue until you feel no discomfort when performing the toe raises
#2 - Raising and Lowering Arches
- Step on one leg on a step so that your big toe and arch are resting on the edge
- Slowly lower your foot until it drops down
- This workout helps strengthen the arch and control pronation
#3 - Calf Stretch
- Facing a wall, stand with one leg in front of the other
- Press your hands onto the wall while pushing your back leg until it is straight
- Hold until you feel the stretch
- Repeat with the other leg
#4 - Bent Leg Calf Raises
- Stand at the edge of a step on one leg holding the wall for support
- Slightly bend the knee while rising until you are on the tips of your toes
- Hold the position for a few seconds and return to the original position
- Repeat with other foot
#5 - Straight Leg Calf Raises
- Stand on the edge with both feet holding the wall for support
- Rise up until both feet are on the tips of your toes
- Hold for a few seconds and lower down
#6 - Foam Roller Calf Massage
- Sit with a foam roller under your calf and hands behind you for support
- Stack one foot on top of the other and roll the length of the calf backward over the foam roller
- Target both the outside and the inside of your muscle
- Exchange feet and repeat
If you strictly follow the steps above to treatment, you will be able to return to your regular running routine in four weeks.
During the treatment period, always listen to your body and know when to stop. Since everybody is different, it is difficult to set a fixed period of total recovery.
A general rule to follow is if you have been walking without any pain or discomfort for two weeks, you can gradually return to running.
#7 - Back To Running
When returning to your running program, you may follow the following gradual process: (33)
Start each workout session with a 5-minute walk and a stretch
Things To Do
Walk for 4 minutes, then jog for 2 minutes and repeat this four times
Walk for 4 minutes, then jog for 3 minutes and repeat three times
Walk for 3 minutes, then jog for 4 minutes and repeat four times
Walk for 2 minutes, then jog for 6 minutes and repeat four times
Continue increasing the time you spend jogging and reducing the time you spend walking until you feel that you can start running again.
How To Prevent Shin Splints In 5 Steps
Although experiencing shin splints does not mean the end of your running career, you will save yourself a lot of pain if you prevent the condition in the first place. The secret to preventing shin splints is simply avoiding the causes mentioned earlier.
1. Practice Proper Running Form
In order to avoid putting unnecessary pressure on your shin bone, you need to practice running with good form. Here are six steps to help you do that: (34)
- Keep your stride short and quick. Lengthening your stride or overreaching in front of your foot will lead to injury.
- Make sure your foot strikes under your knee. Keeping your knee in line helps reduce stress on your legs especially when running downhill.
- Push up and off behind you.
- Keep your elbows at a 90-degree angle or less
- Keep your hands relaxed. If your hands cross in front of you or punch forward, you may lose your gait.
Things to remember:
- Keep your neck and shoulders relaxed
- Keep your head straight looking forward
- Try and land on your mid foot, not on your heel
2. Start Slow, Take Rest And Recovery Days
In order to prevent your muscles from becoming over-fatigued which in turn will increase the stress on your shin bone, you need to give them time to recover.
Whenever you start a new workout routine, increase intensity by up to 10% of mileage or time each week.
Gradual progression will prevent your muscles from becoming worn out and developing scar disuse in the wrong places which put pressure on the shin bone.
Getting enough rest between workouts allows your muscle tears to heal properly.
Whether you are training for a 5k, 10k, half marathon or marathon, following a training routine that allows for ample rest is an excellent way to prevent shin splints.
Here are some ideas to incorporate in your pre-training schedule: (36)
FOR A 5K RUN
FOR A 10K RUN
FOR A HALF MARATHON
FOR A MARATHON
Since these are only pre-training workout samples, you should be able to run this schedule for five weeks without any pain or discomfort before starting on the actual training program.
3. Cross Train And Stretch To Vary Your Workouts
Once you experience a shin splint, you are at higher risk of developing the condition again.
To prevent this from happening, you should practice stretches that specifically target the muscles around the shin.
In many cases, the calf muscles are tight and stretching them may greatly reduce your chances of developing shin splints. Here are some of the best stretches for shin splints. (36)
#1 - Soleus Muscle Stretch
- Stand to face the wall with the foot of the half extended at the back
- Lower yourself by bending the knee behind you
- Keep the knee of the back leg bent with the heel on the floor
- Repeat on the other side
#2 - Gastrocnemius Muscle Stretch
- Stand to face a wall
- Slowly put one leg behind until it is straight
- Move the heel back as far as you can until you feel the stretch
- Hold for 20 seconds and relax
- Repeat this three times on both legs
#3 - Seated Shin Stretches
- Sit down on your heels with your hands behind you flat on the floor
- Push down on the heels to stretch the front of the leg
- Hold for 30 seconds and repeat three times
- Repeat this three times on both legs
Aside from these stretches, you may also do the strengthening exercises mentioned in the recovery portion. These include toe raises and calf stretches.
4. Try Massage Therapy And Foam Rolling
Another great way to prevent shin splints is to use massage and foam rolling techniques. These strategies reduce the overuse stress.
Here is a step-by-step procedure to use a foam roller and tennis ball to self-massage your muscles along the shin and outside of the lower leg.
Using a foam roller:
- Lie on your side propping your body with your elbows
- Place the foam roller beneath the side of your leg piling the other leg on top of it
- Roll along the foam roller back and forth along the side of your leg using your hands to balance
- Reposition so that you can target the lower part by the ankle
- Reposition yourself again so that you are on your stomach and roll on the foam roller
- Do this for three to five minutes
Using a tennis ball:
- Start with the fibular head or the muscle on the top of your leg beside your knee
- Place the tennis ball on the floor and position your leg so that it sits above the target muscle group
- Use your hand to push down on your leg and make small perpendicular movements
- Reposition the tennis ball and work your way down to your ankles
- Next, move to the peroneal muscles which are further in
- You will need to rotate your leg to make sure the ball is positioned right
- Lean into your leg and make small perpendicular movements
- Lastly, target the strip of muscles where your ankle bone is and repeat movement
5. Wear Supportive Shoes
The truth is, no shoe is created equal. Some running shoes provide better support to your shin bone than others.
In addition, your foot type will play a significant role in determining what kind of footwear you should use.
One simple preventive measure to remember is always to wear shoes that are made for the particular sports you are engaging in. Also, it is advised that you replace your shoes every 350 to 500 miles.
If you have flat feet, you need to be extra careful when selecting running or walking shoes.
Remember these five qualities before deciding on a new pair of sneakers:
- Lightweight - to avoid muscle strain
- Flexible - to allow you to roll your foot naturally
- Good traction - to prevent slipping on uneven surfaces
- Arch support - to support your arch
- Rounded front - to provide ample space for your foot
Another strategy you can use is placing insoles inside your sneakers to provide more arch support.
The value of shock absorbing insoles in helping shin splints has been tested showing much potential. (40) Follow these 3 points when looking for the right insole for flat feet.
- It should be durable and rigid
- It should have good arch support
- It should have a stable heel
Aside from wearing proper footwear, you may also decide to use compression socks and wraps which may help in reducing the chances of inflammation.
Alternative Sports For Shin Splints
Since you will require a few weeks to recover from a shin splint during which running is not an option, you may have to find an alternative exercise routine to keep fit.
Staying without any form of physical activity for many weeks can greatly affect your running performance and cause you to lose the fitness level you worked hard to achieve.
Some alternative sports will help you stay fit while you recover.
Remember, it is still possible to engage in high-intensity workouts as long as they do not put any pressure on your shin.
In fact, many who have suffered from shin splints and have involved in these alternative training methods have become stronger than before. Here are some possibilities for you to choose from: (41)
This workout uses the whole body without putting any impact on your leg muscles.
In order to reduce the chance of injuring your shin, you can strap your feet, so they don’t move as you row.
You will also be able to change the degree of resistance depending on your personal fitness level. Like any other workout, always start with a warm up.
Deep Water Running Or Aqua Jogging
This is performed at the deep end of a swimming pool where your feet cannot reach the bottom.
You may use a floating device on your waist if you are a beginner. The goal is to mimic a running motion in the water slowly moving forward. You can even sprint underwater for as fast as you can for up to 30 seconds.
Remember to keep the right posture and make the proper running motion.
This is another great alternative for running and can be found in many gyms.
You do not put too much impact on your feet and will be able to change the angle of your running as well as resistance. The machine is easy on the joints and gives a total body workout.
Developing shin splints doesn’t have to lower your fitness level. With these three alternative training techniques, you can continue to stay in shape while you wait for your shin splint to recover.
You will be stronger than ever when you return to your running routine.
Shin splints are one of the most common overuse injuries experienced by runners but they are definitely preventable. If you have had shin splints in the past, you don't have to experience it again.
We have discussed how you can take simple steps to help you practice good running technique. This includes practicing proper running form, wearing the right footwear and being careful to rest before increasing your intensity.
In addition, in case you do get shin splints, you can diagnose yourself using the two self-diagnosis methods or consult a physician.
In order to have a speedy recovery, remember the three steps: reduce inflammation, rest and exercise.
While you recover, you can still engage in alternative sports to maintain your fitness.
Remember- knowledge is power. The more you understand shin splints, the better equipped to prevent this injury.