What are Shin Splints?
Shin splints, also known as Medial Tibial Stress Syndrome (MTSS) are one of the most common musculoskeletal injuries found in runners. Shin splints are an overuse injury of the muscles and tissues in the lower leg. The muscles of the lower leg run along the length of the shin bone. In shin splints, the area where the shin muscles attach to the tibia or shin bone becomes irritated and inflamed, causing pain. This irritation is caused by repetitive stresses such as walking, running, or jumping. People most commonly experience pain on the inside border of their lower shin.
What are the symptoms of shin splints?
The most common symptom is pain that runs alongside the lower part of the inner shin bone. This pain can be dull and achy or feel like a sharp pain. The pain is also made worse with activities such as walking, running, or jumping and eases with rest. Their area along the inner shin may also be tender and sore to touch. The pain associated with medial tibial stress syndrome is not usually localized to one small pinpoint area but usually spans along with a distance of at least five centimeters.
One interesting thing to point out about shin splints is that sometimes the pain can be felt at the start of a run or activity but then the pain may reduce once you are warmed up. The pain can then return towards the end of the workout and last for a few hours or even days after finishing the run or activity.
How are shin splints diagnosed?
If you think you have shin splints and are unsure what to do about it, you should see a physiotherapist or other health care professional. A physiotherapist will conduct a thorough history and ask you about some of the symptoms mentioned above. They will also perform a physical exam and palpate the area of pain along with a number of other physical tests. They will be able to diagnose you.
However, if a physiotherapist suspects a stress fracture they will most likely order an X-ray or MRI. An MRI is more effective than an X-ray to help diagnose stress fractures as it shows the bone at a higher resolution.
What is the cause of shin splints?
As mentioned, shin splints are an overuse injury. Runners and other athletes are often affected by this issue after there was a relatively sudden increase in their training loads. This increase in training load comes in various forms such as an increase in the volume, intensity, or duration of training. For example, you may have recently started to train for a marathon and decided to increase the duration of your long run on the weekends.
However, shin splints do not only affect runners and athletes. It can also affect walkers. For example, you may have gone on holiday or weekend breaks and drastically increased your daily step count.
What Should you do if you have shin splints?
1. Reduce your training volume
Shin splints are an overuse injury. This means that you will have to reduce your training volume for a period of time. This may not mean that you need to stop training entirely. Complete rest will not solve shin splints! Symptoms will reduce but the pain will come back once you start running again. How much you need to back away from the aggravating activity will be dependent on the severity of your symptoms.
Can you still run with shin splints? This depends. For example, if your pain is severe and sharp and you can even feel it when you are walking or hopping you should not run. However, if the pain is mild and improves once you warm up and remains only mild for an hour or so after your jog then you are probably fine to do some light jogging. You will require the advice and guidance of a physiotherapist.
It is clear that you should not ignore shin splints. Running through the pain or taking pain killers to get through training sessions will make the issue worse. You may develop a more serious injury such as a stress fracture and prolong your recovery time. You must reduce your training volume.
It is not all bad news. People with shin splints can often do other activities to maintain their fitness without aggravating their pain. For example, if you are a runner training for a marathon and reducing your running volume is stressing you out you will still be able to maintain your cardiovascular fitness with activities like swimming or cycling.
2. You need to get stronger
Shin splints are a really frustrating condition for people. Shin splints do not get better with rest, foam rolling, and stretching. Strength training is a really important part when it comes to getting over shin splints for good. You will need to build up the strength and capacity of the muscles local to the area. This means strengthening the muscles of your lower leg such as the shin, foot, and calf muscles. However, you will also benefit from strengthening the muscles further up the chain at your knee and hip such as the quadriceps, hamstring, and gluteal muscles.
If you would like to see Sean demonstrate some Shin Splint Rehab exercises you can check them out here. There we demonstrate some very effective exercises to strengthen the feet, calves, and shins such as the heel raise exercise or banded dorsiflexion exercise for shin splints. As mentioned you also need to strengthen your entire leg. Single leg exercises such as step-ups and lunging variations are great. So too are compound lifts such as the deadlift.
3. A gradual return to your normal training volume
One of the reasons people become very frustrated with shin splints and end up struggling with them for a very long time is because they do two things wrong. Firstly, they rest entirely and stop all activity. Their pain reduces however they have not actually solved the issue or prevented it from coming back once they return to their training. Secondly, once their symptoms subside, they pick up training back where they left off. They return to their normal training plan.
To prevent the pain from returning you must return to your normal training volume gradually. A general rule of thumb is to increase your total weekly mileage by no more than 10 percent week to week. For example, if you ran 5 miles total in your first week back from injury and had no recurrence of symptoms, then the next week you may aim to run 5.5 miles. If you are a runner you must not only take total weekly mileage into account. You must also consider the frequency of your runs per week, the time you allow for recovery, and the pace of the runs.
As a runner, it is a good idea to only ever focus on increasing one aspect of your training at a time. For example, if one week you decide to increase your weekend long run from 10 to 12 miles, it’s probably not a good idea to also increase the speed of your runs that week too.
If you would like to make an appointment with a Physio in our Lucan based Clinic you can do so here