Shin Splints – Overuse or Biomechanical?

Most runners at some point in their career experience pain either along the outer or inner lower part of the shin bone. If you are a new runner, experiencing this pain can be discouraging especially at the beginning of a training season. Shin splints are one of the top 5 running injuries. If you have developed shin splints, put the discouragement aside and instead use this as an opportunity to learn what caused the shin splints in the first place and how to treat them. The knowledge you gain will make you a better runner as well help you (and others you might help) to avoid getting them in the future.

Shin splints can be mild to severe, with stress fractures being a common result of severe shin splints not being treated effectively. Understanding the circumstances that lead to these injuries is the key to preventing them. Shin splints develop along the tibia bone. The usual location is along the lower half of the tibia, anywhere from a few inches above the ankle to about half-way up and can be on the outside or inside edges of it. For runners running too much too soon, who are over-striding, or have old worn-out shoes, the running cycle results in muscle fatigue along the tibia. The real source of the problem is weakness in the muscles that attach to the inside edge of the tibia (tibialis posterior) or the outside edge of the tibia (tibialis anterior). When these muscles are weak, they don’t handle to impact forces at foot-strike well and this stress is instead transferred to the associated muscle tendon’s attachment on the tibia. The severity of this injury increases as continuous forces are applied to the tendon, the attachment of tendon to bone, and finally the bone itself. This is a key reason we recommend that you seek the attention of your coach and doctor as soon as you have shin splints (or any injury for that matter).

By the time you have a diagnosis of shin splints, we recommend that you have stopped running and start immediately with determining the cause and solution. If you delay correct identification of the problem or proper treatment, your experience with shin splints could be a long, drawn-out ordeal. Many new runners drop out from running altogether because of this very treatable condition.

Once you have been diagnosed with shin splints, the best thing to do is identify the problem. Be sure to take a look as these three possible causes:

  1. Too much too soon: did you go too fast or too long? If so, work with your coach to make corrections.
  2. Shoes: do your shoes need replacing?
  3. Over-striding: a commonly overlooked cause of shin splints, especially with new runners. Shorten your stride- length by shortening the length of your arm swing.

All these can likely be entirely avoided by strengthening the shin muscles identified above. Exercises will be prescribed below.

Stop Running

You will need to stop running for as long as it takes for the pain to go away. You should be able to walk during this stage. While you have stopped running, identify the problem (what caused the painful symptoms?) and what you’re planning on doing to correct it.

Correct the Problem

First things first, strengthen the shin muscles by doing two simple activities in gradually increasing quantities. Heel-walking will strengthen the tibialis anterior and toe-walking will strengthen the tibialis posterior. Begin these exercises when they can be done pain-free. Start with perhaps 20 total steps of each activity every other day. Build up to as many as 50 total steps of each. That should be enough to tone those muscles and keep them strong.

If the problem is “too much too soon” then slow down, shorten your distances, and/or decrease your training frequency. Work with your coach to reassess your goals and get you on a suitable path. Cross-training and development of core-strength can go a long ways towards preventing a myriad of injuries including shin splints. Your coaches already know you can go the distance if you training sensibly.

Recover from the Injury

The time it takes for your body to heal itself has many influences, including the use of Non-steroidal anti-inflammatory drugs (NSAIDs such as aspirin and ibuprofen), icing protocols, proper nutrition, hydration, rest and reduction of stress on the injury. Discuss with your doctor and coach how to have a rapid recovery from shin splits, and use this time to identify the problem and suitable treatment.

Gradually return to Running

Once the problem has been identified, a treatment plan put into place, and you have recovered (pain-free), then you can gradually return to running. And the good news…you have learned a great deal about injuries that will make you a smarter runner!

More on Shoes

Distance-running shoes are specifically designed to provide padding, support, and motion-control for the biomechanics of running. They help dissipate shock and facilitate efficient energy (motion) transfer. Matching the type of running shoe to the athlete’s specific biomechanics and proper shoe fit are important. Similarly, worn out shoes should be replaced because of reduced shock-dissipating, support, and motion-control capabilities. Runners with high rigid arches tend to not handle greater impact forces as well, whereas those with flat feet tend to experience greater fatigue of the muscles that support the foot. Both can develop shin splints.

Early-Stage Shin Splints

In the early-stage of shin splints, a runner will describe a pain that is present when the training run first begins, but then disappears as running continues. The pain will often return after exercise or the following morning. As the injury progresses, the athlete will experience more time with the pain, and less time without it. There is frequently a tender zone along the edge of the tibia that one can map out by pressing with the fingertips as they “march up” along the bone. Eventually, if ignored and training continues, the pain may become quite sharp and may focus on a very small area of the bone. If this happens a stress fracture may have began developing.

More on Treatment

The treatment for shin splints is rest and icing. Depending upon severity it is typically necessary to completely stop running for a period of time. Generally this is done until day-to-day activities are pain-free. When running is resumed – and this is where many injured runners make a mistake – it should be significantly more gradual than the routine that lead to the injury initially. The concept of relative rest employs lengthening the interval between training as well as decreasing the volume and intensity of training. One can often substitute cross-training activities (e.g., bicycling) for running to help increase the interval between running days. There should be a graded and gradual increase in run training, keeping an eye-out for the return of any shin splint symptoms.

Stretching

Stretching and strengthening the lower-leg muscles can help prevent the injury from returning. However, the most important preventive strategy is not to repeat the mistakes that lead to the injury. Examine all the training variables – surface, shoes, training volume, intensity, workout type, hills, biomechanics, etc. Seek help from a qualified trainer or coach. This all takes time and effort, but it is well worth it.