A Runner's Guide to Shin Splints

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:

• Pain during or after activity along the distal 2/3 of the medial tibial border

• Pain reduced/relieved with rest

• Reproduction of pain when pressing into distal medial tibial border (the painful area being 5 or more centimeters long)

Signs that you probably don't have shin splints:

• You don't have any of the things in the first list (pain not improved with rest, less than 5 centimeters)

• Cramping or burning pain in the back of the lower leg

• Numbness and/or pins and needles in the foot during exercise

• Severe swelling or redness along the medial border of the shin

If you have any of the signs in this second list (probably not shin splints) like cramping, burning, numbness, swelling, etc., I would strongly urge you to seek medical attention.

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:

I'm going to make these numbers annoyingly specific so that you can do the math with me and make sure we're on the same page.

Week 1: You think you can complete a casual run of 0.5 miles without pain so you run 0.5 miles on Monday, Wednesday, and Friday for a total of 1.5 miles

Week 2:

You decided to progress by roughly 20% so your total distance is nearly 1.8 miles for the week, which is really 3 runs of 0.6 miles.

Week 3:

You're feeling good so you decide to progress by 30%. Total distance for the week is 2.34 miles or 3 runs of 0.78 miles

Week 4:

All things are going well so you progress to 3 miles through 3 runs of 1 mile (roughly a 29% increase).

These weekly increases may seem small but it depends on the starting point. If you can start at 1 mile pain free (3 miles for the week), you'll be up to nearly 2.2 miles a run (6.6 miles for the week) by the end of the month completely pain free.

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

Muscles are shock absorbers and muscle size and strength is directly related with risk of bone stress injury. The smaller and weaker the lower leg muscles are, especially the calves and other plantar flexors, the more risk there is as they will not be able to attenuate as much force.

Plyometrics

With shin splints, we want to stimulate bone growth (osteogenesis) which occurs with high magnitude load in a very short amount of time that is separated by rest. Running isn't osteogenic because it lacks the high magnitude, rapid rate, and rest. Plyometric exercise (jumping) is the best way to accomplish this. With that said, we need gradually progress exercise intensity the same way we are gradually progress running. Jumping might not be an option early on because of pain but, again, a guided and progressive strength training program that includes plyometrics is a great cross training option and it is my personal favorite.

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

Over-striding (taking large steps) increases ground reaction forces. We want to cut down that stride length and take shorter, quicker steps to reduce those ground reaction forces. The further out in front of you your foot is, the more braking forces you are creating. There are less braking forces when your foot is making contact with the ground directly under your body.

Strike Pattern

Ground reaction forces are created when we strike the ground and that's why it is important to see how we are striking the ground. My typical recommendation is to utilize a mid foot or forefoot strike as opposed to a heel strike. Landing on heels will not provide as much shock absorption from muscles and, as a result, increase load. A more forefoot strike will allow the calves to assist with shock absorption.

Cadence

Cadence, otherwise known as step rate, is measured as steps per minute (SPM). This can be tracked on your apple watch and other fitness wearables. I LOVE when people track their runs because I can look through them on the day of their evaluation and already get an idea of what we can improve before actually seeing them run. We want to aim for 170+ steps per minute. 180spm is a great goal generally speaking but height and other factors need to be considered. For every 1spm increase, there is about a 5% decrease in shin splint risk. These returns do diminish as cadence gets into the upper 170s and beyond but the general premise is that more steps decreases the stress on the bone. Need help increasing cadence? Search for playlists that are 170 or more bpm (beats per minute) and listen to them while you run. I've personally seen a few of these on Spotify where they actually list the bpm in the name of the playlist.

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 on concrete is going to be very different than running on turf or grass. Hard surfaces are going to increase ground reaction forces whereas soft surfaces reduce them.

Running Shoes

Shoes with big cushions on the bottom will help absorb some of those ground reaction forces and remove those forces from the shin. Running shoes will often have large cushions near the heels and the cushion will taper off towards the front of the shoe. I'm not at all being paid by any of these brands but when my wife and ran our first half marathon early last year, I ran in a pair of Sauconys and she wore Hokas. Shoutout to Footworks for helping us choose the right shoe! I highly recommend them if you're in the Miami area and looking for running shoes. We had a great experience. I've also heard more avid runners recommend using multiple running shoes when training. Some shoes can absorb force differently and make you run differently as a result so rotating the shoes you wear will hopefully keep things balanced and avoid stressing the same areas repeatedly.

Shoe Inserts

Surprise! More shock absorption. I'm sure you're starting to see the trend. I personally don't like having to rely on inserts though.

Diet

I'm sure it goes without saying that a healthy diet is recommended, but I wanted to point out calcium and vitamin D specifically. Runners should be getting 1000-1300mg calcium and 600 IU of vitamin D.

Recovery

Like I mentioned at the beginning, this is a load management issue and removing load/stress is going to be key early on. This allows the bone to heal. As you reintroduce load, rest is still vital so the bone can recover and adapt to those stresses you placed on it. This is why adequate sleep is important. People tend to ask me about other tools to "speed up" recovery. First of all, if there is a tool or treatment you like and makes you feel better (ice, heat, compression, etc.), do it. I tend to recommend ice massage early on to modulate pain but I have also had a patient with shin splints that really liked laying in a hot bath to relieve the pain so I told her to stick with the heat instead of icing. Now for my spiel . . . There really isn't a whole lot you can do when it comes to "speeding up" recovery. The best thing we can do is avoid delaying or slowing down the process by loading/stressing the bone too much. We want to make it as easy as possible for the body to do what it does through proper sleep and diet and without getting in the way through unnecessary load. The reintroduction of load (once the bone is ready) helps the bone adapt and increase its capacity / tolerance to stress.

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!