Shin splints, or medial tibial stress syndrome (MTSS), are one of the most common overuse injuries in the active population, especially in runners. For new runners, it can be frustrating when you start to become limited by this pain as you begin to ramp up your miles. For runner’s who’ve dealt with shin splints previously, it can just be outright devastating for it to come back again. […]
So What Exactly Are Shin Splints?
Shin splints most commonly begin as a tightness sensation in a runners calf region; as pain progresses, they typically experience sharp or burning pain while running as well as a dull ache and soreness the persists after running. Pain is diffuse, usually along the inner shinbone and calf region, and in more severe cases inflammation can be seen in similar region.
The exact pathology of shin splints isn’t fully understood, but there is a general consensus that there is a bone stress reaction caused by chronic repetitive loads that induce tibial bending. Our bodies can typically handle the stress placed on the bones during running by adapting and remodeling the bone to get stronger after each run. In new runner’s whose bones haven’t fully adapted to the stress of running yet, or runner’s who quickly increase the volume or intensity of their runs, the process of bone remodeling process doesn’t a chance to fully adapt to the new stresses. With future runs, there is more bone stress, leading to a constant process of bone remodeling, which can actually lead to some pain and inflammation. In shin splints, the cause of the pain is diffuse inflammation of the lining of the bone itself, or even the muscles or ligaments that attach to the bone.
Shin splints are a slightly different process than what occurs in tibial stress fractures. With a tibial stress fracture, the stress on the bone is more localized to a specific area, is considered a true bone injury, and has the ability to progress to a full fracture. Tibial stress fractures are more serious of a condition, so it is generally recommended to stop running altogether and to see your orthopedist. Stress fractures are commonly diagnosed with an MRI or bone scan.
What To Do About Shin Splints
The most important thing about treating shin splints is getting an accurate diagnosis as soon as possible. This may require you to see your podiatrist, orthopedist or physical therapist, as well as get an x-ray, MRI or bone scan. The treatment of shin splints will be different than tendinopathy or stress fractures, so it’s crucial to know what’s going on.
Once properly diagnosed, usually a period of either significantly cutting back your running or a period of rest is recommended; it can be as short as 3-4 weeks or up to 4+ months in more severe cases. It is important to allow the bone to heal fully and then gradually stress it for increased strength, rather than over-stress it, which will just lead to injury. Finding the cause of the problem becomes the next step in managing shin splints, as just rest will only temporarily subside symptoms until you return running again. A few possible contributors to shin splints including training errors, muscle imbalances, ankle stiffness, poor joint and running mechanics, leg length discrepancy or even the footwear selection. Figuring out what is causing this increased stress to the tibia will allow you possibly make adjustments and allow you to recover and prevent recurrence of symptoms.
Conservative treatment is typically the best option for managing shin splints. In the acute phase of this injury, ice, rest and analgesics are generally recommended to help with the pain and inflammation. Once pain begins to subside, the goals of rehab then consist of reducing impact and tibial loading, strengthening the muscles around the bone, and eventually strengthening the bone itself.
In runners, increasing your stride rate ~10% (bringing it closer to 180 steps per minute), has been shown to decrease the impact the tibia absorbs with each stride. This will bring a runners foot closer to their body with each stride as well as decrease the overall time spent on the ground, both factors that has been shown to ultimately decrease stress on the tibia.
Strengthening the shin and calf muscles may help absorb some shock during running, reducing the strain on the tibia. It has been shown that female runners with a smaller calf circumference were at a much higher risk for developing a stress fracture. Runners with shin splints have also been shown to have poor calf strength, so developing good lower leg strength can possibly aid in the recovery and prevention of shin splints.
Reloading the bone in a progressive manor can help increase bone strength in general. This can be done with weight bearing strengthening exercises, plyometric exercises, or slowly returning to running – all which has been shown to increase bone mineral density and therefore bone strength. It is recommended to progress slowly both in intensity and volume when returning to running after a period of rest. Mileage should not increase more than 10% each week, minimizing or avoiding hills is recommended for the first few weeks to month or more, and alternate between soft and harder surfaces when returning to running.
If ever in doubt, or if pain persists for more than 1-2 weeks, it is best to see someone who specializes in running injuries to help determine the appropriate diagnosis. A physical therapist can help identify risk factors contributing to shin splints, identify running and biomechanical errors as well as muscle imbalances, and provide instruction’s to help you get back to running pain-free again!