Suspect you may have shin splints? Here are the different causes of shin pain explained, treatment options for you to consider and most important how to prevent shin splints from re-occurring in the future
Shin splints are one of the most common running injuries, but also one of the most poorly understood. The term ‘shin splints’ is more of an umbrella term for shin pain, rather than an actual diagnosis, and it is this lack of understanding and clarity that often gets runners in to trouble.
Shin pain that is related to the bone is more commonly referred to as medial tibial stress syndrome, and this is the most common type of shin pain. It typically presents as pain along the inner shin bone (tibia) during exercise and afterwards, and when you touch it.
Muscular shin pain is much less common and is experienced as a more vague tightening pain in the muscular part of the shin, most commonly down the front.
Causes of shin splint pain
It is important to make sure you have a proper diagnosis from a physiotherapist, sports doctor or other medical professional to determine if the pain is bone-related or muscular. This blog is for general non-specific information ONLY and should not be used in lieu of specific medical advice from a qualified professional.
Bone-related medial tibial stress syndrome is caused by stress on the inside part of your tibia bone, which causes the bone to swell inside. If irritated for long enough, it can lead to a tibial stress fracture. This is when the bone starts to crack, and swell.
Pain can also occur along the front part of the tibia (the tibial spine), which is a more serious type of shin pain. It’s where the tibia bone flexes, or bows, upon landing, which causes it to widen, and this can quickly turn into a stress fracture. It is harder to treat than medial tibial stress syndrome.
Under the medial tibial stress syndrome umbrella you also have periostitis – inflammation and irritation of the outer lining of the bone. The periosteum is the connective tissue that forms a layer around bones and acts as a point of attachment for muscles, among other things. Irritation and inflammation of this often occurs in the early stages of medial tibial stress syndrome and can cause soreness along the inner border of the shin bone. It often presents as a bone stress injury, however, with periostitis, symptoms often occur over a slightly larger area than with, say, a true stress reaction or stress fracture.
Muscular shin pain, which is far less common, is characterised by a tightening in the shin that worsens during exercise – some runners report that their legs feel so tight they might explode. As the muscles expand during exercise, the fascia (which the muscles sit inside) gets squeezed and this causes a tightening sensation.
This condition is called chronic exertional compartment syndrome (CECS), and in 80% of cases, is in the front part of the shin. The leg is normally pain-free except during activity. Neurological type symptoms can sometimes occur in these cases – tingling, numbness or weakness in the foot may sometimes present.
If you suspect you have any of the above symptoms seek expert medical advise.
How do you know if you have a stress fracture?
Stress fractures will continue to even get more painful during a run. And if you press your fingertips along your shin and can identify a definite spot of sharp pain, this is a common symptom of a stress fracture.
Stress fractures often feel better in the morning too because the bone has rested all night, where shin splints often feel worse in the morning because the soft tissue tightens overnight.
Pain from medial stress syndrome is usually most severe at the start of the run, but often lessens and can even go away completely during a run, once the muscles are loosened up.
This is an easy way to distinguish between shin splints and a stress fracture of the shin bone.
If you suspect you have a stress fracture, you should see a doctor/physio and get an X-ray.
Treatment for stress fractures is usually four to six weeks off from running completely, depending on the severity of the fracture.
How are shin splints caused?
The most common causes of medial tibial stress syndrome are:
- Poor biomechanics, including poor hip rotation, overpronation of the foot, flat feet or dropped arches, though high arches can also cause shin splints.
- Increasing volume of, or intensity of, running too quickly.
- A low bone density, which is more common in women. Softer bones bend more easily, which causes strain and microdamage to the bone.
- Poorly cushioned or worn-out running shoes, which don’t provide the necessary cushioning and support to absorb impact from the pavement.
In most cases, shin splints are an overuse injury. Beginners are more susceptible as their leg muscles haven’t been used or stressed in the same way before, but equally, runners returning from injury can be at risk if they increase their mileage too quickly.
What do shin splints feel like?
Medial tibial stress syndrome presents as pain in the bony part of the shin, while exertional compartment syndrome (ECS) is experienced as a tightening pain in the soft, outside, muscular part of the shin.
As a rule, shin splints feel like a nagging pain, concentrated in the inner border of your tibia, typically. As mentioned, with bone-related shin pain (medial tibial stress syndrome), you will feel pain in the bony part of the shin, during and after exercise, and when you press on the area, while with muscular-related shin pain, pain is experienced as a tightening pain in the soft, outside, muscular part of the shin.
Imaging can be useful to help diagnose stress reactions, stress fractures or periosteal issues. But the findings on MRI must be correlated by the presenting symptoms alone.
What’s the best treatment for shin splints?
Medial tibial stress syndrome (or shin splints) tends to not respond well to running. Whereas with tendon injuries running might be permissible with some soreness and awareness in the area (3/10 level of pain) typically running with this level of discomfort for medial tibial stress syndrome prolongs the issue. Rest is the first course of action. Just because you could run does not mean you should. And this does not mean going out for a ‘test run’ every few days. Rest means rest. Give it an initial two weeks to let things settle. Overall it will be your quickest route back to fitness and proper training.
If your shin pain is acute, you shouldn’t run through it – you need to give the bone or muscle time to heal.
While recovering from shin splints, you can try non-impact exercises such as swimming, or using an elliptical or cross-trainer. You can also try walking and cycling in a low gear, without standing up on the pedals.
If you have persistent shin splints try the following:
- Ice the inflamed area for 15 minutes, three times a day, and ice the shin area immediately after running.
- Take anti-inflammatories like ibuprofen (though always consult a doctor or pharmacist first if you have existing health conditions) but do not take in order to run pain free, as this will make the problem worse.
- Try running in a pair of stability/overpronation running shoes, or a pair of orthotic insoles to unload the inside part of your foot’s arch.
- If you have been diagnosed with exertional compartment syndrome (ECS), loosening up the muscles in your leg will help. As mentioned, part of the problem is due to a tight fascia, the tough material that wraps our muscles. Run your shins and calves over a foam roller to help loosen it. Massage can help too.
If the injury doesn’t respond to self-treatment and rest, see your GP or physio to rule out other causes. A physio can also help you work on any weaknesses that have caused the problem so that it doesn’t reoccur.
How to prevent shin splints from re-occurring
Strength train your kinetic chain
Your kinetic chain is your whole body from your neck to your toes – one big interconnected chain of muscles, ligaments, tendons, bones and so on. Each part of the body is a link, and each link depends on the others around it for performance – so whole-body conditioning is key to reducing your injury risk.
However, one area to focus on is your hips and core, as weakness in these areas is linked with shin splints, as well as many other common injuries. If your core (which includes your hips) is weak, your pelvis is unstable, and other muscles have to compensate to keep your hips level and this can put excess strain on the shins and knees.
Strength train twice a week and include exercises like clamshells, glute bridges, side planks, reverse crunches and single-leg squats in your routine.
Change your shoes
It’s also important to check your shoes, as incorrect footwear can itself be an underlying cause. If you can, it’s worth having your gait analysed at a good running store, where a specialist can check if your shoes are right for you. As mentioned, you might need a shoe that helps control your pronation or to try orthotics that offer similar support.
Follow the 10% rule
Never up your weekly mileage by more than 10%, whether you are building up or returning from injury. Give your body time to adjust to the workload.
Up your calcium and vitamin D intake
This will help increase your bone density. Try taking 1,300 milligrams of calcium and 400 micrograms of vitamin D per day. Easy ways to get this without taking a supplement are consuming more milk and yoghurt. Taking a vitamin D tablet daily is recommended by the NHS.
Shorten your running stride
If you tend to overstride, it can place unnecessary forces through your body. So shortening it slightly while increasing your foot-strike cadence may help you generate better stride mechanics, because you’ll be putting a lot less load on your feet, shins and knees. Count your footstrikes on one side for a minute – a good number to aim for is 85 to 90 strikes of one foot per minute.
Strengthen your lower limbs
You can find many runner appropriate workouts at BitFitter as well as being able to plan your holistic running programme that includes strength as well as running training sessions.