If you're an avid runner, you've probably dealt with your fair share of aches and pains. I would guess that you've tried to run through some, if not most, of these pains hoping they will get better with time. Sometimes they get better, sometimes they come and go, and sometimes they just keep getting worse. Medial Tibial Stress Syndrome, commonly known as "shin splints," are one of those that you probably shouldn't just run through and they can definitely get worse.
If you're reading this, I'd love to explain what shin splints are in the next section! As for the rest of you, I'm sure you skipped down to the bottom already . . .
What are shin splints anyway?
Anyone else imagine their shin bone starting to look like splintered wood? That's exactly what I thought was happening to my shin bones when I started playing football in high school and heard the name for the first time. Thankfully, this isn't the case.
Shin splints are an inflammation of the outer layer (periosteum) of the tibia bone (your shin bone). As the name "medial tibial stress syndrome" suggests, it is typically on the lower half and inner side of the shin and it will likely be painful over an area of 5 or more centimeters when you touch it.
I think it's important to point out that ignoring shin splints and running through them for an extended period of time can lead to stress fractures. Maybe they got the name "shin splints" from the visual of the bone splintering first and then cracking...? Anyway, moving along!
Are you sure you have shin splints?
Unless you're a nerd like we are at Bridge PTP, this blog is probably a waste of your time if you don't actually have shin splints or know someone who does. Now, how can you tell if this pain is shin splints or something else? Let me start by saying that I would recommend scheduling an evaluation with us or your physician to get a definitive diagnosis. With that said, there are a few signs you can look for to help you determine if you have shin splints . . .
Signs that you might have shin splints:
Signs that you probably don't have shin splints:
If you don't have any of the symptoms on either of the lists, I want to take a moment to say I appreciate your support and your willingness to learn as this blog obviously does not apply to you directly. I also want to thank you in advance for sharing this blog with your friends, family, coworkers, on your social media platforms, etc. :)
What causes shin splints?
Like most injuries, shin splints are a product of doing too much too soon too quick. When the amount of load, or "stress" as the name suggests, placed on the bone exceeds the capacity of said bone we can expect that bone to become painful. Exceeding the capacity is done by making drastic increases in intensity, distance, time, and/or frequency of your runs that are far beyond what you have done recently.
The road to pain free running!
Load management is going to be key for getting rid of this pain and keeping it away. Where we start depends on how severe your case of shin splints are currently.
Essentially, we want to decrease load as much as we need to for as long as we need to so that the area can rest. All your normal activities (walking, stairs, etc.) should be pain free for at least a few days before progressing.
Running Progression:
Once, your day to day activities have been pain free for a few days, we want to slowly reintroduce load while keeping everything pain free. Find a running distance that doesn't reproduce pain and stick to that distance for one week, completing the distance 2-3x in that week.
The next week you're going to increase the distance by 10%-30%, again, making sure the the distances are pain free.
If that was confusing, open this to see an example with real numbers:
Cross Training:
Cross training is essentially including another physical activity in your regimen that isn't running. It can be yoga, swimming, cycling, etc. but it should absolutely positively be strength training. Granted, any form of cross training is better than no cross training at all but strength training is going to give the most benefit, especially as it relates to shin splints. I'll explain a little about strength training and plyometrics in the drop downs below if interested. I know I'm biased because I wrote it but I would recommend reading both.
Strength Training
Plyometrics
Quick note: Cross training should not be done on the days you are running. It should be on your off days. Not on all of your off days as you should still have scheduled rest days but 2-3x a week is going to be ideal. Early on, scheduling 2 rest days would be great.
Running Form:
Whenever I'm evaluating a runner, I want to see their normal running form. There's a lot that goes into running and there isn't necessarily a right or wrong way to run, but there are strategies that will reduce ground reaction forces and create less stress on the bone. I look mainly at stride length, strike pattern, cadence, and I'll even look at the bottom of their running shoes to see what areas they are loading most based on how quickly certain parts of their shoes are wearing out. Overall, the best thing is to be able to vary the way you run rather than running the exact same way all the time but I personally lean towards utilizing mid and forefoot striking, fast cadence, and shorter stride lengths where the foot make contacts with the ground directly beneath your body. More on this in the drop downs below.
Stride length
Strike Pattern
Cadence
Other Considerations:
I'm sure there are going to be questions that I failed to answer in this blog but I genuinely want to try my best and cover as many aspects of this as possible. Below are some of the more common aspects I was able to think of and the ones that people may have questions about.
Running surface
Running Shoes
Shoe Inserts
Diet
Recovery
Conclusion
Shin splints are very common and, when ignored, can progress to stress fractures. They are typically a product of dramatic increases in activity (often running) beyond the capacity of the bone. Load management is key for resolving shin splints. This is accomplished by eliminating load temporarily (running much less and maybe not at all) so that the bone can heal and then slowly reintroducing and gradually progressing the amount of load we place on it making sure to avoid any pain. Cross training, such as strength training a few days a week, should be part of your training regimen not only to return to running but to be able to continue running. If you're a runner and have any questions, please feel free to reach out! If you're interested in working with us to resolve an injury, guide your strength and conditioning for cross training, create a running program, or just need some recovery or dry needling we would be happy to help!
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