Shin Splints? Before you amputate, read this.

We’ve all heard someone complain of their “shin splints,” or naively used the term ourselves, but it is not a direct diagnosis. “Shin splints” is a descriptor of the type pain being experienced. There are several causes of pain in the lower legs, and the best route to prevention or recovery is to determine the true root of the issue and take early action.

Exercise-induced leg pain is most likely the result of bone stress, compartment syndrome of muscles with resulting nerve compression, compromised blood flow, or compression of a nerve close to the spine that transmits pain to the leg [1,2].

The most common cause is overuse or improper joint mechanics/technique, so we will focus on those common causes and what you can do to assess and alleviate pain from those origins.

A term often used interchangeably with “shin splints” is medial tibial stress syndrome (MTSS): stress placed on the tibia by the surrounding muscles which causes pain and inflammation.

Just because these terms are used interchangeably does NOT mean MTSS is the cause, however, MTSS is the MOST COMMON cause.

Too much, too soon

In individuals who are not trained long-distance runners, the first issue they confront is “too much, too soon.” You do NOT have to be a beginner to experience this effect. In fact, the majority of you reading this likely fall within this category. Jumping into a weight-bearing cardiovascular (or resistance) exercise regimen at a more advanced stage than you should is a sure way to light up that inflammatory response. Repetitive landing and take-off on hard surfaces (box jumps, jump rope) is nothing to turn your nose up at when it comes to careful exercise practices.

When going from little-to-no physical activity, taking on a new form of exercise, or increasing mileage, it’s important to start slow and small with gradual increases in distance and time. Although everyone needs gradual progression, pre-program level of activity DOES play a significant role. Those who are starting from scratch (previous couch potato) certainly need a longer on-ramp stage [1].

Be careful not to compare yourself to the advanced athletes taking on the same program if this is how you would consider your prior level of activity.

On the other hand, gradually increasing shin pain can develop without change to exercise programming. Running is a common trigger of shin splints, and while doing so, we repeatedly "plantar-flex" which strengthens those calf muscles that allow you to point your toes. Over time, this can create stress on the attaching tendons and bones because these muscles get stronger without strengthening any of the OPPOSING muscles that “dorsiflex,” or pull your toes towards your body.

Take the time and care to stretch the muscles along the back of your calf, and strengthen those in the front by using full ROM calf-raises, coupled with resisted dorsiflexion to prevent stress-induced pain of these tissues.

Improper running technique

If you are a heel-striker, the culprit of your pain may be direct bone stress from repeatedly jarring your heel on the running surface. It should be noted that some heel-strikers never experience pain when running, but for many it leads to issues in the bones and joints of the entire body affected by each strike.

Some other bio-mechanical causes may be “gait issues” of rolling the foot in or out with each stride, or by taking too long of a stride.

This can be corrected through specific attention and practice, and/or through finding proper footwear for your anatomy.

It is a concept that has been pounded to death, but it is important to find adequate running footwear if you have excessive arches or flat feet.

Check out some videos on proper running form like this one by Sports Rehab Specialist James Dunne, and this great series of running preparation by Kelly Starrett with further explanation of other issues that might come about from poor form or tension.

Still in Pain?

If correcting biomechanical issues is overly difficult or resulting in pain, there is likely a muscular imbalance that needs further assessing, possibly by a PT or physiologist. For example, over-pronation is a more common cause in females since our natural anatomy predisposes some of us to knee-caving (valgus) which causes the foot to roll inwards. This can be corrected by strengthening the external rotators of the hip which will, in turn, enable your knees and ankles to align properly with each stride [3]. (Let me know if you get to the point of needing THESE strengthening exercises, and I'll show you some specifics)

If you have exhausted all of these options of relief and you’re still feeling pain, then assessment and diagnosis by a physician is the best route. The condition could be result of vascular issues, especially if you have strong family history of vascular disease or diabetes, or may be advanced to the point of musculoskeletal damage from improper treatment of the initial inflammation.

When you notice a minor pain around the shin bone (tibia), anywhere from the ankle to the knee, back off on the weight-bearing activity and allow those muscles time to recuperate before engaging in more activity that will further irritate the already inflamed tissues.

Shin splints are most commonly caused by inflammation, therefore the treatment protocol includes anti-inflammatory practices (rest, ice, compression, elevation) to reduce the pain and swelling. Once the inflammation goes away, you should ease your way back into the exercise program, along with soft-tissue therapy, strengthening, and stretching to build your way back to success.

We all want the quickest possible results from our programming, but we must be careful not to sabotage our results with improper application.

The best way to prevent onset of acute or chronic shin splints is to ease your way into any new or longer-duration activity, ensure proper technique in exercises of repeated force production, and focus on increasing strength and flexibility of the muscles involved.

Final Thought

One final point often left out of the discussion is the importance of weight-management. When carrying around higher weight, excess stress is placed on bodily tissues. Therefore, working to decrease body mass may alleviate some pain and inflammation due to any physical stress related issue.

1. Bates, P. (1985). Shin splints--a literature review. British Journal of Sports Medicine, 19(3), 132.

2. Padhiar, N., Malliaropoulos, N., & Lohrer, H. (2015). Exercise-induced leg pain in sport.British Journal of Sports Medicine, 49(24), 1546.

3. Verrelst, R., Willems, T. M., Clercq, D. D., Roosen, P., Goossens, L., & Witvrouw, E. (2014). The role of hip abductor and external rotator muscle strength in the development of exertional medial tibial pain: A prospective study. British Journal of Sports Medicine, 48(21), 1564.

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