Shin Splints in Runners: The Complete Guide
If you are searching the internet for “lower leg pain, running” then there’s a good chance you are suffering from shin splints. Read on – in this guide we will cover symptoms, causes, treatments and exercises to prevent and heal shin splints.
What Are Shin Splints – and How Are They Different from Stress Fractures of the Shin
The term “Shin splints”describes pain in the front of your lower leg, where the large shin bone (tibia) is located. Shin splints are therefore also known as “ medial tibial stress syndrome” (MTSS). 14% and 20% of runners suffering from shin splints at any time making it the most prevalent injury among runners.(1)
Type of Pain from Shin Splints vs. Stress Fractures
Shin splints are an overuse injury resulting in inflammation and micro-tears in the connective tissue around the shin. At times the pain is accompanied by minor swelling.
Often – in the initial phases of the injury – pain from shin splints is only present during faster running and disappears when walking or at rest. This differentiates shin splints from stress fractures, which are physical changes, such as cracks and breaks to the bone, which cause similar symptoms but eventually are likely to hurt during walking and eventually even rest.
With shin splints the pain is often covering a small area, typically along the inner side of the shin bone and in the initial phases of the injury tends to get better or even disappear during an activity. In contrast the pain from stress fractures is often specific to a small spot and tends to get worse during exercise. (2)
Visiting a Doctor vs. Home Treatment for Shin Splints
When visiting a medical professional for this type of pain they will check your symptoms and running regime to diagnose shin splints. To rule out other potential injuries (most notably stress fractures) with similar symptoms they may also conduct an X-Ray if the diagnosis is not clear. In some cases it can be difficult to distinguish a shin splint from a stress fracture on an X-Ray in which case an MRI scan might be conducted.(3)
It is important to see a doctor if the pain persists after at home treatments such as rest, ice and compression (4) to avoid that you self-diagnose a stress fracture as shin splints . Proper treatment can also avoid that you develop stress fractures from shin splints without proper treatment.
Recovery Time for Shin Splints
Typical recovery time for shin splints ranges from 70 days to 6 months, however individual cases can last as little as two weeks and more than 9 months. (5) This large range is likely a result of the large range of the severity of the cases, treatment options chosen and other individual factors.
Causes of Shin Splints in Runners
Training Volume and Intensity as a Cause of Shin Splints
When runners ramp up their training volume or their training intensity too quickly they become susceptible to shin splints. This is a result of the fact that initially cardiovascular fitness improves faster than the connective tissue and muscles around the shin can get stronger.
While shin splints are more common among recreational than elite runners even experienced runners can suffer from it when increasing training volume or intensity too fast. (6)
Running Form as a Risk Factor in Shin Splints
A number of biomechanical running form characteristics are increasing the likelihood to suffer from shin splints.Running form analysis and gait retraining is an important, proven component of a successful program to heal shin splints (7)
- Overstriding, which is when the foot lands relatively far before the runner’s hips. This correlates with lower knee flexion and a higher shank angle.
- Low cadence
- A higher pelvic drop
- Excessive pronation (Some pronation is normal)
If you would like to see if your running form puts you at risk check Movaia’s online running form analysis.
Is it Time to Change Work Out Shoes?
Runners typically absorb about 2.5 times their bodyweight when running. While most of these forces are best absorbed by the body (which is why proper running form matters so much), shoes also play a role. Shoes lose their shock absorbing properties with time and usage.
A study on this topic found that after 150 miles / 240 kilometers shoes had lost one third off their shock absorption capabilities.This study was done in 1985, one would hope that more recent shoes would fare better, however especially carbon super shoes with their super-springy foam also have shown to break down quickly.
Apart from tracking your running mileage you can also give your shoes a quick health check. Is the sole worn out? Does the shoe feel too soft or bendier than it used to be?
Ultimately the loss in shock absorption over time can contribute to shin splints, especially when running on hard surfaces. (10). If the sole of your shoes like this it may be time to invest in new runners.
Higher Body Mass Index as a Risk Factor
In several studies a higher body mass index increased the risk of developing shin splints significantly. (8)
Women are more susceptible to Shin Splints
Female runners are at significantly higher risk of developing shin splints then male runners at a ratio of 1.71 to 1. This may be related to running form differences in women compared to men (for example less knee flexion) another potential factor could be hormonal differences.(8)
Treating and Preventing Shin Splints
Treatment of Shin Splints
Many runners can still run with shin splints. To stop aggravating the shin and start the healing process, significantly reducing running volume (by 50% or more) may already be sufficient to lead to improvements. (11, 12)
Applying ice and compression
During acute pain applying ice to the affected area can reduce swelling and pain. If still working out with shin splints then ice can be applied after workouts. Ice could be applied using a reusable icing pad, frozen ice bags, or even frozen blocks of ice that can be used to massage the area.
Compression socks anecdotally also help with recovery by increasing blood flow to the area and reducing swelling and pain.
Over-the-counter pain medication such as ibuprofen (Advil or similar generic medicines) or acetaminophen (Tylenol or generic equivalents) is often prescribed to manage acute pain in the initial phase of recovery. (4)
Soft tissue massage and other treatment options (Ultrasound, Taping, etc.) by a physiotherapist can improve pain but also start the healing process.
Shin splints: Long term recovery and prevention
After the acute, short term treatments for shin splints it is crucial to modify the conditions that lead to the injury in the first place. This sets you up for long term recovery and prevention
Do a Running Form Analysis
Perform a running form analysis and improve your running form to avoid repeating movement patterns that led to shin splints. Movaia running form analysis is a convenient and effective option to check your running technique.
Review Your Training Regimen
Cut your training volume and slowly build up your volume. While an increase of 10% is a common guideline a better approach is to listen to your body and err on the side of caution. Low impact cross training such as swimming or cycling can help to maintain general fitness during this recovery period.
Initially hills, uneven and hard surfaces might be best avoided. The track, as a softer, flat surface is a good idea for runners returning from a shin splint injury.
Prescribed by a physio custom made or over the counter orthotics are effective in correcting biomechanical issues such as flat feet or high and stiff arches.
Invest in New Shoes and Shock-Absorbing Insoles
Shock absorbing insoles have been shown effective in studies. New shoes, with their better shock absorption are also helpful.
Do Strength Exercises and Stretches
Build up strength and improve flexibility to reduce the risk of getting re-injured (or to prevent it). See below a collection of exercises to prevent or overcome shin splints or check out the Movaia Youtube channel for more exercises.
Best Exercises to Avoid or Fix Shin Splints
These exercises help you strengthen muscles that help you stabilize the tibia, thus reducing the root cause of shin splints. This includes not just the shin muscles (tibialis anterior muscle), but also the much larger hip and calf muscles. These exercises are best reserved for the non-acute phase, i.e. when swelling and sharp pain has disappeared, to not further exacerbate the injury.
Heel – Calf Raises
- Stand on the edge of a step with your heels hanging off the edge.
- Slowly lower your heels down (about 3 sec), hold (about 2 sec), then raise them (about 3 sec) up as high as you can.
- Repeat 12 times, and repeat the set.
- Focus on slow, controlled movements and hold on to a wall or other object for balance if needed.
- Start with raising both feet at the same time and progress to single leg calf raises. Slowly increase the number of reps until you can perform 12.
- To increase plantar fascial loading you can place a rolled up towel under your toes.
Tibialis Wall Raises
This exercise will strengthen your tibialis anterior muscle on the front of your shin, which is responsible for ankle flexion.
- Lean against a wall with slightly bent knees and your feet a few inches / centimeters away from the wall. Raise your foot upwards by pulling your toes up while keeping the heels in place. Hold for 3 seconds and slowly lower your feet back to the ground.
- Aim for 3 sets of 12-20 reps.
- You can increase the difficulty and range of motion of this exercise by moving your feet further away from the wall.
Heel walks are another exercise that strengthens your tibialis anterior which increases your resistance to shin splints.
- Raise your toes up then walk forward on your heels..
- Keep the toes off the ground and stay tall and upright.
- You can do this with or without shoes.
- Aim for 3 sets of 30 seconds each
Towel Curl (Toe Curl)
Toe curls are a very effective exercise that simultaneously strengthens and stretches the foot. By doing this it improves your balance and strength of your arches and overall foot muscles.
- Sit on a chair with your feet flat on the floor.
- Unfold a towel in front of your feet and place one feet on the side of the towel closest to you.
- Lift your toes and reach out straight ahead with your toes.
- Grab the towel with all five of your toes and pull back.
- Keep your heel firmly planted on the towel and create a dome-shape with your arch while doing this.
- Repeat 10 times for one set and repeat the set 3 times. (You might have to start over if your towel is fully pulled back before completing ten reps). Repeat this exercise 3 times a day.
- Face a wall at arm’s length and place your hands on the wall.
- Step back with your leg suffering from plantar fasciitis and keep it straight and extended. Make sure to keep the foot flat on the ground without raising your heel.
- Bend your front leg and lean into the wall until you feel a stretch in the calf of your back leg.
- Keep both heels on the ground as you do this.
- Hold for 30 seconds and repeat 3 times.
- Repeat on your other leg to avoid imbalances
Glute Bridge and Single Leg Glute Bridge
- Glute bridges build strength in the glutes and core, stabilizing your legs including your lower legs, which can take load off your lower legs. This is why glute bridges are also an effective exercise for shin splints. For extra motivation: this is also a great toning exercise!
- Lie on your back with your knees bent.
- Firmly place your heels on the ground
- Slowly raise your hips off the ground.
- Make sure that you maintain a straight line from your shoulders to your hips and knees.
- Hold for 3 seconds
- Lower slowly and repeat.
For a more advanced move progress to single leg glute bridges once double leg glute bridges feel easy and are executed with good form.
- Raise one leg off the ground and keep it straight.
- Lift off the ground with the other leg and raise your hips.
Let’s recap this guide to shin splint recovery and prevention with the saying “An ounce of prevention is better than a pound of cure” . Following this logic build strengthening and flexibility exercises into your running routine and check if you need to improve your running form. If so – here are a few running form drills to improve your form to get you started.
If you are unlucky enough to get shin splints see a doctor soon if pain does not go away within a few days. Then rebuild your strength and flexibility after the acute pain has receded using the exercises above.
Sources and further reading
- Lopes AD, Hespanhol Júnior LC, Yeung SS, Costa LO. What are the main running-related musculoskeletal injuries? A Systematic Review. Sports Med. 2012 Oct 1;42(10):891-905. doi: 10.1007/BF03262301. PMID: 22827721; PMCID: PMC4269925., https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4269925/
- DEEPAK S. PATEL, MD, MATT ROTH, MD, NEHA KAPIL, Stress Fractures: Diagnosis, Treatment, and Prevention, American Family Physician, 2011, Volume 83, Number 1 ◆ January 1, 2011, https://www.aafp.org/pubs/afp/issues/2011/0101/p39.html
- Brendon, Ross, MD, Stress Fracture or Shin Splints? How to tell the difference, 2020, UChicagoMedicine, https://www.uchicagomedicine.org/forefront/orthopaedics-articles/stress-fracture-or-shin-splints
- Johns Hopkins All Childrens Hospital, https://www.hopkinsallchildrens.org/Patients-Families/Health-Library/HealthDocNew/Shin-Splints
- Menéndez, C.; Batalla, L.; Prieto, A.; Rodríguez, M.Á.; Crespo, I.; Olmedillas, H. Medial Tibial Stress Syndrome in Novice and Recreational Runners: A Systematic Review. Int. J. Environ. Res. Public Health 2020, 17, 7457. https://doi.org/10.3390/ijerph17207457,
- Phil Newman, Jeremy Witchalls, Gordon Waddington & Roger Adams (2013) Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis, Open Access Journal of Sports Medicine, 4:, 229-241, DOI: 10.2147/OAJSM.S39331
- Zimmermann, Wes & Linschoten, Christian & Beutler, A. (2017). Gait retraining as part of the treatment programme for soldiers with exercise-related leg pain: preliminary clinical experiences and retention. South African Journal of Sports Medicine. 29. 1-6. 10.17159/2078-516x/2017/v29i0a1923., https://dx.doi.org/10.17159/2078-516x/2017/v29i0a1923
- (11) Newman P, Witchalls J, Waddington G, Adams R. Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis. Open Access J Sports Med. 2013 Nov 13;4:229-41. doi: 10.2147/OAJSM.S39331. PMID: 24379729; PMCID: PMC3873798., https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3873798/
- Becker J, Nakajima M, Wu WFW. Factors Contributing to Medial Tibial Stress Syndrome in Runners: A Prospective Study. Med Sci Sports Exerc. 2018 Oct;50(10):2092-2100. doi: 10.1249/MSS.0000000000001674. PMID: 29787473., https://pubmed.ncbi.nlm.nih.gov/29787473/
- Cook SD, Kester MA, Brunet ME. Shock absorption characteristics of running shoes. The American Journal of Sports Medicine. 1985;13(4):248-253. doi:10.1177/036354658501300406, https://journals.sagepub.com/doi/10.1177/036354658501300406
- Galbraith, R.M., Lavallee, M.E. Medial tibial stress syndrome: conservative treatment options. Curr Rev Musculoskelet Med 2, 127–133 (2009). https://doi.org/10.1007/s12178-009-9055-6
- Miller Mark, D. DeLee, Drez, & Miller’s orthopaedic sports medicine: principles and practice. Elsevier, 2003.