Shin splints are one of the most common running injuries, but also one of the most poorly understood. The term 'shin splints' is more of an umbrella term for shin pain, rather than an actual diagnosis, and it is this lack of understanding that often gets runners in trouble.
Shin pain that is related to the bone is more commonly referred to as medial tibial stress syndrome, and this is the most common type of shin pain. It typically presents as pain along the inner shin bone (tibia) during exercise and afterwards, and when you touch it.
Muscular shin pain is much less common and is experienced as a more vague tightening pain in the muscular part of the shin, most commonly down the front.
What's causing shin splint pain?
It is important to make sure you have a proper diagnosis from a physiotherapist or sports doctor to determine if the pain is bone-related or muscular.
Bone-related
Bone-related medial tibial stress syndrome is caused by stress on the inside part of your tibia bone, which causes the bone to swell inside. If irritated for long enough, it can lead to a tibial stress fracture. This is when the bone starts to crack, and swell.
Pain can also occur along the front part of the tibia (the tibial spine), which is a more serious type of shin pain. It's where the tibia bone flexes, or bows, upon landing, which causes it to widen, and this can quickly turn into a stress fracture. It is harder to treat than medial tibial stress syndrome. You should consult your doctor/physio if you suspect you have this.
Under the medial tibial stress syndrome umbrella you also have periostitis - inflammation and irritation of the outer lining of the bone. The periosteum is the connective tissue that forms a layer around bones and acts as a point of attachment for muscles, among other things. Irritation and inflammation of this often occurs in the early stages of medial tibial stress syndrome and can cause soreness along the inner border of the shin bone. It often presents as a bone stress injury, however, with periostitis, symptoms often occur over a slightly larger area than with, say, a true stress reaction or stress fracture.
Muscular
Muscular shin pain, which is far less common, is characterised by a tightening in the shin that worsens during exercise - some patients report that their legs feel so tight they might explode. As the muscles expand during exercise, the fascia (which the muscles sit inside) gets squeezed and this causes a tightening sensation.
This condition is called chronic exertional compartment syndrome (CECS), and in 80% of cases, is in the front part of the shin. The leg is normally pain-free except during activity. Neurological type symptoms can sometimes occur in these cases - tingling, numbness or weakness in the foot may sometimes present. If you suspect you have any of these symptoms seek expert medical advise.
Stress fractures will continue to even get more painful during a run. And if you press your fingertips along your shin and can identify a definite spot of sharp pain, this is a common symptom of a stress fracture.
Stress fractures often feel better in the morning too because the bone has rested all night, where shin splints often feel worse in the morning because the soft tissue tightens overnight.
Pain from medial stress syndrome is usually most severe at the start of the run, but often lessens and can even go away completely during a run, once the muscles are loosened up.
This is an easy way to distinguish between shin splints and a stress fracture of the shin bone.
If you suspect you have a stress fracture, you should see a doctor/physio and get an X-ray.
Treatment for stress fractures is usually four to six weeks off from running completely, depending on the severity of the fracture.
The most common causes of medial tibial stress syndrome are:
In most cases, shin splints are an overuse injury. Beginners are more susceptible as their leg muscles haven't been used or stressed in the same way before, but equally, runners returning from injury can be at risk if they increase their mileage too quickly.
Medial tibial stress syndrome presents as pain in the bony part of the shin, while exertional compartment syndrome (ECS) is experienced as a tightening pain in the soft, outside, muscular part of the shin.
As a rule, shin splints feel like a nagging pain, concentrated in the inner border of your tibia, typically. As mentioned, with bone-related shin pain (medial tibial stress syndrome), you will feel pain in the bony part of the shin, during and after exercise, and when you press on the area, while with muscular-related shin pain, pain is experienced as a tightening pain in the soft, outside, muscular part of the shin.
Imaging can be useful to help diagnose stress reactions, stress fractures or periosteal issues. But the findings on MRI must be correlated by the presenting symptoms alone.
Medial tibial stress syndrome (or shin splints) tends to not respond well to running. Whereas with tendon injuries we tend to allow running with some soreness and awareness in the area (3/10 level of pain) typically running with this level of discomfort for medial tibial stress syndrome prolongs the issue. Rest is the first course of action unfortunately. And this does not mean going out for a 'test run' every few days. Rest means rest. Give it an initial two weeks to let things settle.
If your shin pain is acute, you shouldn't run through it - you need to give the bone or muscle time to heal.
While recovering from shin splints, you can try non-impact exercises such as swimming, or using an elliptical or cross-trainer. You can also try walking and cycling in a low gear, without standing up on the pedals.
If you have persistent shin splints try the following:
If the injury doesn't respond to self-treatment and rest, see your GP or physio to rule out other causes. A physio can also help you work on any weaknesses that have caused the problem so that it doesn't reoccur.
Your kinetic chain is your whole body from your neck to your toes - one big interconnected chain of muscles, ligaments, tendons, bones and so on. Each part of the body is a link, and each link depends on the others around it for performance - so whole-body conditioning is key to reducing your injury risk.
However, one area to focus on is your hips and core, as weakness in these areas is linked with shin splints, as well as many other common injuries. If your core (which includes your hips) is weak, your pelvis is unstable, and other muscles have to compensate to keep your hips level and this can put excess strain on the shins and knees.
Strength train twice a week and include exercises like clamshells, glute bridges, side planks, reverse crunches and single-leg squats in your routine.
Change your shoes
It's also important to check your shoes, as incorrect footwear can itself be an underlying cause. If you can, it's worth having your gait analysed at a good running store, where a specialist can check if your shoes are right for you. As mentioned, you might need a shoe that helps control your pronation or to try orthotics that offer similar support.
Never up your weekly mileage by more than 10%, whether you are building up or returning from injury. Give your body time to adjust to the workload.
Up your calcium and vitamin D intake
This will help increase your bone density. Try taking 1,300 milligrams of calcium and 400 micrograms of vitamin D per day. Easy ways to get this without taking a supplement are consuming more milk and yoghurt. Taking a vitamin D tablet daily is recommended by the NHS.
If you tend to overstride, it can place unnecessary forces through your body. So shortening it slightly while increasing your footstrike cadence may help you generate better stride mechanics, because you'll be putting a lot less load on your feet, shins and knees. Count your footstrikes on one side for a minute - a good number to aim for is 85 to 90 strikes of one foot per minute.
Matt Bergin, chartered physiotherapist at Performance Team and Witty, Pask and Buckingham Physiotherapists, suggests the following strength exercise to do at home:
Ankle inversion with resistance band
Calf raises
Straight leg
Do 3 x 25 reps
Bent knee
Do 3 x 25 reps
Hop, hop, hold on spot