I Think I Might Have Shin Splints. Now What?
It’s the age old story of runners everywhere: you start back up a training cycle and you get an annoying nagging pain in the front of your shin. For some, it will pass in just a couple of days without any intervention. For others, the discomfort lingers and develops into full blown shin splints. While shin splints won’t necessarily force you to hang up your racing shoes, the pain can make training runs pretty miserable for a number of weeks if it’s ignored. Even worse, you can find yourself dealing with a more serious injury if it’s not properly treated.
What are shin splints?
Medial tibial stress syndrome (MTSS), the medical terms for shin splints, describes an overuse injury where the tibia bone actually becomes inflamed from the repetitive stress to the muscles that attach to it. Recurrent impact sports that involve running or jumping tend to put athletes at a greater risk for developing shin splints. Because the injury is a bony injury, it is no surprise that an untreated diagnosis of shin splints can lead to the development of a bone stress fracture.
Shin splints account for nearly 20% of all running related injuries. Runners will typically describe a widespread pain along the distal portion of the shin bone. The pain worsens with the impact of their foot hitting the ground or with activities such as prolonged walking or standing.
Shin splints can be confused with other diagnoses affecting the lower leg and should be carefully assessed to ensure the proper plan for treatment. Other injuries that should be ruled out include:
Stress Fracture
Compartment Syndrome
Posterior Tibialis Tendinitis
Shin splints commonly occur as a result of some kind of training or biomechanical error.
In nearly all of the patients with shin splints, we can always point back to some rapid increase in training volume or intensity as the main cause. That would constitute a training error. Making sure that you are gradually progressing in your training plan is key in preventing an injury like shin splints. Other intrinsic risk factors include:
Previous history of shin splints
Uncontrolled pronation
Reduced mobility in your ankle joint
Excessive hip internal rotation and adduction in stance
Running in old or worn out shoes can also predispose someone to getting shin splints. Check out your local running shoe store to get properly fitted and rotate your shoes every 300-500 miles.
Working with a professional is important because you don’t want to miss the signs of a more serious injury, such as a bone stress fracture.
Remember that shin splints are technically a bone injury-small little micro-tears in the cortical bone of the tibia. So if a runner is not careful, they may find themselves with a full on stress fracture if they continue to train on shin splints without proper modification or intervention. Some runners will wait too late before trying to take care of their injury and have to play the guessing game as to whether or not they have shin splints or stress fracture.
Some questions to ask yourself to help decipher between the two injuries might look like:
Is my pain localized to a very specific spot on my shin?
Do I have pain when I am walking, or even at rest?
If I hop on one leg, do I need to stop before I get to 10 hops?
(For females) Have I missed more than one menstrual cycle in the last 3 months?
If you answered yes to these questions, you may want to talk with your doctor to see if you might have a stress fracture. If that is the case, you will need to completely shut down running for 6-8 weeks to allow for full healing.
Contrary to popular belief, the R.I.C.E. method is not the best treatment for shin splints.
If you suspect that you might have shin splints, throwing some ice on your shins after every run is not going to get you where you’re wanting. Neither will taking off a few days and then jumping right back into training. First thing you’ll want to do is work with a running physical therapist so that you can get a full examination on different factors that might be contributing to your shin splints. From there, your physical therapist will be able to provide you with an individualized treatment plan emphasizing strength training to address whichever impairments they found.
Studies have shown that there are certain muscle attachments that are more likely to create the bony microtrauma that occurs with shin splints so working to strengthen those muscles specifically are key. Strengthening exercises should not only focus on muscles in the lower leg (posterior tibialis, flexor digitorum longus and soleus) but also should include the gluteus muscle group. And you can’t ignore mobility. Improving range of motion in the ankle joint can help treat or prevent shin splints.
Shin splints don’t have to mean your training cycle is over.
If properly managed, a runner can fortunately continue to train as they recover from shin splints. That is great news for every runner! Some modifications may be needed to reduce overall impact to the injury which might look like:
Replacing easy miles with pool running or biking
Running on softer surfaces instead of asphalt/concrete
Changing shoes based on running gait
Check out my previous blog on training while injured to learn more about ways to continue working towards your race day goals when dealing with an injury.
