***This information is also available in the form of Mojo for Running Podcast #68.
Shin splints! Yikes! Those two words strike a chord of fear in the heart of any runner. They’re right up there with PF, meaning plantar fasciitis, ITB, iliotibial band syndrome, stress fractures and runner’s knee. Those are the running injuries I hear about most often, and shin splints and plantar fasciitis, in my experience, are the most common.
My task, today is to share as much information about shin splints as I can in the space I have here. It won’t be a book, which would definitely be an option because there’s plenty of information out there, but it will be quite a bit. The reason it could be expanded to a book is because there are multiple causes, multiple preventions, and multiple modes of treatment, as you’ll see in the next few paragraphs.
It’s important to note here, that like most – and by that I mean just about all running injuries – shin splints, while terribly painful, to my knowledge are in no way life-threatening. They will always, eventually, go away on their own, at least if you stop running, and the benefits of running to overall health are so great that even if you are troubled by shin splints from time to time, it’s worth the aggravation to wait them out and get back to the sport you love.
The good news, though, I hope, is that after reading this post, you should be able to avoid ever experiencing shin splints in the future, and that is a big deal.
I’ll describe the symptoms, what causes them, how to avoid them, what to do if you’re already suffering from shin splints, and what will likely happen if you have shin splints and keep running.
I am not a physician nor a medical professional. I have done considerable research, I have experienced shin splints several times, myself, and I have worked with many runners who were coping with shin splints. I will present information here from many reputable sources, and I will link to the primary sources to make it easy for you to go to the primary source, which is a medical professional.
Even non-runners know about shin splints. You most likely know exactly what I’m talking about. Generally speaking, it’s pain on the fronts of the leg between the knee and the foot.
Key here is that when I refer to shin splints, I mean pain in the front of the leg or just to the side of the front.
Over the years, besides my own experience with shin splints, I’ve worked with – or talked to – many, many runners suffering through this common running injury.
Technically, or maybe I should say, anatomically, a shin splint occurs when the muscles on the front of the shin become torn away from the bone, the tibia. This causes varying degrees of discomfort but can be excruciatingly painful.
The cause and level of discomfort can be different depending on severity, individuality, and perhaps, cause.
The technical term for shin splints is medial tibial stress syndrome. The tibia is the larger lower leg bone on the inside, and that’s what is meant by medial; medial means on the inside, not inside your leg; all the bones are on the inside, but inside as in on the inner side of the leg.
It surprised me when I started to research this topic that I found there were so many differing views within the professional medical community. If you listen to ten different medical professionals tell you what causes shin splints, how to treat them, and how to prevent them, you’ll get at least five different answers to those questions. Some might be close, but everyone seems to have at least a slightly different perspective., and each one seems to be sure she or he has exactly the correct answers rather than recognizing that shin splints can be triggered by various behaviors and may need either a variety of treatments or may respond better to one treatment than another.
It’s not an exact science, either, because as with many running injuries, it’s likely that sometimes we attribute improvement or cure to some activity or treatment, due to timing of improvement, when it could be that that specific treatment happened to coincide with the body’s own recovery. After all, most injuries will resolve on their own if you just rest them long enough.
Similarly, there are plenty of people recommending different things to prevent shin splints, but it actually could be the case that some runners are predisposed by their body type or gait or physiology, and others would never get shin splints, no matter what they did. However, honestly, I doubt that.
You could spend hours watching YouTube videos of ‘experts’ telling you how to prevent or treat shin splints. I’ll link to some of the better videos I’ve found.
If you have shin splints, perhaps I’ll mention the one treatment you haven’t tried or the one method of prevention that will help you avoid a recurrence; I sure hope so.
First some definitions of shin splints:
From the Mayo Clinic website: “Shin splints are caused by repetitive stress on the shinbone and the connective tissues that attach your muscles to the bone.”
Irritated and swollen muscles, often from overuse
Stress fractures are tiny breaks in the lower leg bones.
From Runner’s World:
Stress fractures – incomplete crack in the bone
Running downhill, either when not properly trained on hills, or running downhill with reckless abandon, meaning without proper control due to lack of strength, or suddenly increasing mileage or doing too much mileage too soon, or from beginning to do speedwork and not being adjusted to it yet, or from running strenuous off road trails when unaccustomed to it, or from running a longer distance than usual, or from tight muscles, or from a muscle imbalance between the muscles of the calf and the muscles of the front of the leg, or from running with toes lifted or tensed, or from wearing the wrong shoes, or from running with barefoot shoes or minimalist shoes when not properly conditioned, or from poor running form, or from running many miles on a slanted road surface, or from running on a hard surface when not conditioned to it, or simply from wearing running shoes that have too many miles on them.
My Own Experience with Shin Splints
I remember, early in my running career – and that means in the late 70’s – I always wore the same model of New Balance shoes, and I knew when to replace them when I started to get shin splints. I’d buy new shoes, and voila, no more discomfort. That was an easy fix. That stopped happening many years ago. I think due to the fact that with improved strength and running form, I don’t require that same level of shoe-provided cushioning or support. I do wear highly cushioned shoes, but I stopped having that issue many years before my current affection for highly cushioned shoes. I’ve worn minimalist shoes without shin splints; so, I suspect it’s the improved form and strength.
Another time when I experienced severe, excrutiating shin pain was when I did a half marathon trail race. I had had no discomfort, whatsoever prior to the race, but the pain in my shins was so bad the next day that I could barely walk. Obviously, the pain was not caused by pounding, since I was on a soft surface; in that case it was the hills that I had not properly trained for combined with muscles that were just too tight. That was just two weeks before a marathon. I saw my podiatrist, who determined that it was definitely not a stress fracture. He said, “Just take it easy for a few weeks. As long as you don’t have any big races coming up, you’ll be fine.”
This was on a Tuesday. Yikes, I thought. Sheepishly, I said, “I’ve got the Marine Corps Marathon a week from this coming Sunday.”
“Oh,” he said, “then I am going to send you to a great physical therapist, for some daily therapy.”
That was when I met Jeremy Maddox, a doctor of physical therapy, here in Tampa. Jeremy determined that my lower leg was extremely tight and prescribed two exercises, each to be held for two minutes and to be done, daily. He also worked on my ankle joints, which were unnaturally tight.
I did the marathon, and I had absolutely no pain in my shins on race day. That was a good outcome, and, by the way, I’ve never had that same pain again. Now, I just do the stretches he taught me three times a week and only hold them about 30 seconds each; that’s for maintenance. He had me hold it for a long time, originally, because the muscles need to be stretched.
A side note here: Another lesson I learned back then was not to do a half marathon two weeks before a marathon, particularly if the race is off road and the marathon will be on road. That was definitely a rookie mistake. It seemed reasonable because my schedule called for 12, but I had not been running trails much, due to marathon training, and the trails were too strenuous, tiring out my legs, which is the last thing you want to do when you’re tapering. I had an okay race, but I will never know how much better it could have been. That was many years before I became a coach.
So those are some – hopefully – most of the causes of shin splints, and the causes in some cases point to the possible solutions, which we’ll get to.
What to do if you have shin splints:
Well, the single most important thing is to determine whether the pain is caused by a stress fracture or not. If you already have a stress fracture, your only intelligent option is to stop running.
If you don’t have any important races on the horizon, you can just take some time off running. If you can’t get to a doctor, for whatever reason, just stop running. Seriously, if it is a stress fracture, you’ll just make it worse, and if it’s a stress ‘reaction,’ which means the bone is stressed and it could easily become a stress fracture, then running on it will guarantee a fracture while will cause you to miss much more running.
Your physician can probably tell you whether it is a stress fracture or not, but x-rays do not show stress fractures until they’re already healing, but your dr will probably do one, anyway, maybe because they’re convenient to do – usually in the dr’s office – and maybe insurance companies require that first before moving on to more expensive tests, such as an MRI and/or bone scan.
Anyway, if it is a stress fracture – or a stress reaction – you need to stop running, immediately. I know, you ‘ll hate to do this if you don’t know that it’s a stress fracture, but that is a chance you do not want to take because it means even more time off from running. A stress fracture will mean 6 to 8 weeks off and maybe more. Taking off a couple of weeks early on can save you having to take off months later.
- Foam rolling and The Stick. Two of my favorite pieces of equipment. I’ll link to several videos showing how to use both. The foam roller is 1 to 3’ long and about 6” in diameter. It’s great for self massage. The Stick is a brand name. It is a device that is about a foot or a little more – long – and it is slightly flexible and has 1” wide rings that spin on the shaft as you roll it on your legs. When you use either of these devices, make sure you don’t roll on the bone. You want to the side of the front of the leg to work the muscle.
2. Ice. Freeze a small paper cup with ice in it. Then you can tear off the edge of the cup and massage the area with ice.
3. Stretch: Wall lean, bent knee wall lean, stretching out the ankle by kneeling on floor with foot out flat on floor. Don’t do anything that hurts, though. Stretching should be quite gentle.
4. Strengthen: You’ll do well to strengthen all your muscles. You might be surprised that strengthening your core will help, even, because a stronger core means less stress on the legs and makes improved form possible. Do, work diligently at strengthening the leg muscles, though, and foot muscles.
5. Form: Eliminate any overstriding in your gait. When you overstride, meaning to plant your foot in front of your center of gravity, you’re using the part of your leg between your knee and foot as a fulcrum to pull your body up and over, putting much more stress on your lower leg. If you plant your foot right under your body, you’ll likely land on a very stable whole foot platform, and you’ll be on the downward part of your stride, already, immediately unloading the stress on your lower leg.
6. Concentrate on making sure the muscles of your leg are in balance. Many people have powerful calves but weak front leg muscles. Work on that.
7. Massage. You’ll find many examples in the show notes of physical therapists demonstrating how to massage the muscles involved. Plus, I always recommend periodic full body therapeutic sports massage. This will help tremendously with improved form and relieving tightness. A good MT will help you identify tight areas that you can then work on yourself.
8. Evaluate your shoes, whether they are worn and whether they are the best shoes for you.
9. Compression calf sleeves. These are not a gimmick. Especially for newer runners or for anyone who is having any problems with your shins, I would wear them for all your runs until the problem completely subsides, at least.
10. Kinesio taping. When I had a stress fracture to my tibia, the location where they most frequently occur, after three months, an x-ray showed the bone was completely healed, but the pain lasted for months. A different doctor of physical therapy, Eric Schweitzer, showed me how to tape it. I did, and that definitely, helped with the nagging pain. He also showed me that I was overstriding. Not much, but enough to make it hurt more. I knew better, of course, but self awareness, as I’ve said before, is far from accurate, and I am not immune. He shot video of me on a treadmill, and video does not lie. I worked on that, and it helped as well.
Now, let’s talk about prevention:
You can probably guess how to prevent shin splints based on the treatments, but I’ll provide a short list:
1. Avoid muscle imbalance
2. Run with good form
3. Stretch, enough, but not too much. Being too flexible is as much of a problem as being too tight, but if you have shin splints, there is a good chance that you will benefit from the stretches described above, but be careful to do dynamic stretches before exercising and only do static stretches when you are warmed up.
4. Get regular deep tissue massages and use The Stick and foam roller, daily.
5. Avoid sudden increases in mileage or intensity.
6. Learn hill-running technique and apply it.
7. Avoid suddenly doing more miles on harder surface. Ease into it.
8. If you switch to shoes with less cushioning, give yourself weeks to get adjusted to them by wearing your old shoes for at least half of your runs for a while, and depending on how little cushioning they have, you may need to only wear the new, less cushioned shoes, for a couple of tenths of miles at a time, gradually building up.
9. Do not run with your toes lifted. This alone causes stress to the muscles of your shin.
10. Wear compression socks for long runs or intense training, i.e., speed work.
11. Consider shoes with less drop. I have become a personal fan of Altra shoes, but other brands are offering shoes with zero drop or low drop. A lower drop will encourage good form, but shoes are quite individual. Be careful with any shoe change, and get your gait analyzed by an expert, a real expert.
12. Study running form videos, and get a friend to shoot video of you, running, and strive for high cadence, short steps and light steps. Loud steps mean pounding. A stronger core will help keep you light on your feet. Planks are my very favorite core exercise. Make this part of your daily routine.
I hope that helps. If you are dealing with shin splints, just remember, you will get through this, and it will make you a stronger runner, both mentally, and physically. Injries are a part of running – to an extent. We do everything we can to avoid them. We try to make wise decisions, but sometimes we just can’t see what’s coming. We do something we think is reasonable only to find out our lower leg disagrees. Shin splints a huge pain, literally, and, mentally, because they keep us from doing what we love, at least for a time, but they always go away. Hang in there.
“Shin Splints” Runner’s World
How to Treat and Beat Shin Splints by Kelly O’Mara, Competitor.com