Explained: Shin Splints

Nov 30

Shin splints, otherwise known as “medial tibial stress syndrome” are a common crux for those who love to run, hike, or who just enjoy living an active lifestyle. In this article, we’ll be going over not only what shin splints are, but preventative measures to keep them from happening in the first place as well as ways we can manage our activity while going through them.

This article will be diving deep into anatomy and science, so if you’re not into that, no probs - I’ll lay out a simplified summary at the end.

Also, this article should NOT be taken as medical advice. If you have a more chronic injury, please seek the help of either your doctor or a sports physician.

What are Shin Splints?

“Shin Splints” otherwise known as medial-tibial-stress-syndrome (MTSS) is when the muscles of the frontside of the tibia (lower leg bone) become inflamed and overworked and are common in runners, dancers, military personnel, and those with poor biomechanics, which we’ll go over later.

Shin splints are pretty easy to self diagnose as it’ll feel like someone’s jabbing a thumbtack into your shin every step you take. Though I can give you a general definition, I personally believe that if we understand what’s going on, we can better self assess, so now we’ll take a look at the various causes of shin splints.

Causes

The tibia along with the fibula are the two bones that make up the lower half of your leg with the femur making up the upper half.

Shin splints are when the muscles, tendons, and connective tissue that surround the tibia become inflamed, meaning they’re under micro damage caused by excessive stress and are going through the repair process. This repair process can cause redness and some level of swelling, leading to the affected area becoming sore to the touch.

More specifically, the tibialis anterior often is the main culprit and is the muscle that sits on the front side of your shin. It functions in bending your foot both up & down, rotation, bending it laterally, and helps in maintaining your foot’s arch. Usually, it’s when this muscle becomes inflamed that we experience the pain associated with shin splints.

Now the causes for this muscle’s irritation vary, but I can simplify it into a few key reasons.

1. You’re doing too much or are doing too much too quickly.

Often, when someone starts running, it’s really easy for them to try and push themselves as much as possible - if you’ve ever experienced “runners high”, you’ll know what I mean.

Cardio, like weight training, should be treated with a gradual approach, rather than doing as much as possible right from the get go. If you’re currently running zero times per week, but wish to get started, try starting off with just one or two sessions per week with each one being only between 10-15 minutes in length - this should be enough to avoid any pain or discomfort. I personally wouldn’t have someone who’s new to lifting weights workout 6 days per week as due to the micro damage placed on the muscles, there’s a good chance a new trainee can overdo it and experience a great deal of post workout soreness. And not only will they feel stiff and sore, but throwing in more volume than what the body can currently handle can lead to a quick overuse injury, hence why you see a high margin of small injuries within the first few months following new years.

The muscles you have can only handle so much volume, but the cool thing is you can actually increase that threshold via progressive overload. By starting off small and getting really effing good at what you’re doing, you can gradually increase the volume (reps/sets/running distance/time) overtime as your body adapts. You may start off week one running for 10 minutes two times, but by week two or three, you bump it up to running still twice per week, but for 15 minutes instead of 10.

Running, unlike strength training, has a much lower barrier of entry because you don't need any equipment or gym membership. As long as you have two legs and can walk, you can run. And because running is so easy to get into, that can make it even harder for someone to practice self discipline. “Discipline” being your ability to self regulate. If you’re experiencing knee pain that’s lasting for minutes on end and ranks more than a 3/10 on the pain scale, stop running. If you’re sprinting and can no longer maintain optimal running form, unless you’re at an event where you’re competing, either back off into a slower pace or take a break altogether.

Often, the most common sports injuries you’ll see are overuse injuries, so as long as you’re aware of where you’re at, practice progressive overload, and are not running yourself into the ground like a dummy, you should be good.

2. You're a dancer or are military personnel.

I’m not a dancer by any means, but I know that especially with competitive dancers, overuse injuries in the ankles and shins are prevalent as you’re constantly jumping and landing, sometimes on one foot, laterally rotating your ankle while balancing, standing and doing tricks on your toes, and more. And while the ability to perform these movements is certainly admirable, there’s still a lot of stress placed on all of those smaller muscles and connective tissue which can result in soreness, swelling, or even minor stress fractures. Ideally, you’ll be working with a professional instructor who's knowledgeable in program design, but in case you’re not, what I'd recommend (as someone who isn't a dancer) would be to space out your training sessions just like you would with strength training. I can’t for sure say what a good frequency would be as I’m not educated on dance programming, how long sessions are, or what exact movements are performed, but I believe that could be a good approach.

With military service, especially the first few months of bootcamp, stress-related injuries including shin splints are more likely to occur due to the repetitive nature of your training. A lot of new recruits are thrusted into a routine they’re not physically prepared for with constant trekking throughout the day with heavy loads, physical drills, conditioning, standing for extended periods of time, and walking/running on uneven terrain. These conditions can create a perfect environment for minor injuries.

The best course of action would be to prepare for boot camp by practicing a routine that includes strength training (weights and bodyweight), cardio, rucking, and mobility. You should start your training long before you head off to bootcamp with the focus of improving not only your strength to be able to lift heavy objects, but strength endurance so you can lift heavy for longer periods, because in boot camp you’ll be doing plenty of that. You’ll also need a good bit of overall endurance for all of the running you’ll be doing, so setting time to run outside will be a good move. Mobility is something so many people overlook. Movements such as combat stretch, tibia raises, calf stretches, and short foot can improve the mobility and strength of those small muscles that support your joints & bones, leading to hopefully less chance of injury.

If you need help visualizing what a program could look like, here’s a hypothetical weekly routine to help give you an idea.

Monday - Full Body ST / Mobility

Tuesday - Outdoor Running

Wednesday - Full Body ST / Mobility

Thursday - Outdoor Running

Friday - Full Body ST / Mobility

Saturday - Outdoor Running

Sunday - Low Impact Cardio

Again, this is a purely hypothetical workout as your schedule may differ, but I wanted to show you that the plan itself doesn’t have to be super complicated. Personally, I would center the workouts around movements that’d best reflect what I’d be doing in boot camp, so things like squats, lunges, pushups, pullups (assisted/unassisted), overhead presses, and planks are all movements I’d center my workouts around. I’d also put a focus on unilateral / multiplanar movements to avoid developing weakness in major supporting muscles.

Multiplanar meaning your training outside the sagittal plane, meaning you’re including movements that feature side to side movements (adduction/abduction) and rotation. Cossack Squats, Curtsy Lunges, Lateral Step Ups, Windmills, Cable Woodchops, and Pallof Presses are wonderful movements you can implement. And when I say “supporting muscles”, I’m talking about the smaller muscles that aren’t visible on the surface that support various movement patterns. Things like the Gluteus Medius which supports external rotation and abduction of the hip/femur as well as stability within the pelvis. Or the Quadratus Lumborum which helps in keeping your pelvis stable and aids in lateral flexion (bending your body sideways). Modified Donkey Kickbacks, Band Monster Walks, Lateral Step ups are great for targeting the glute med while unstable movements like single-arm suitcase carries are great for strengthening the QL.

If you’re able to commit to a full, well thought out workout routine that’ll mobilize, strengthen, and improve your endurance, you’ll be in a great position where the risk of developing an overuse injury is far less likely than someone who didn’t put in the time to prepare.

3. Improper footwear

Not saying you need to walk outside barefoot like a caveman, but chronically wearing shoes with extra thicc padding may weaken the tissues in your lower foot such as your plantar fascia. Imagine constantly wearing a thick winter glove all year round, overtime, you’d lose dexterity in your fingers as well as a loss in grip strength. If you prefer shoes with thicker padding, just make sure you’re including movements that strengthen the tissue of your foot to prevent injuries such as shin splints or plantar fasciitis such as short foot, toe scrunches, heel raises, calf raises, ankle mobilization drills, and toe stretches.

Shoes that are worn out, have little or no support, or are the wrong size may also raise the risk of you developing minor injuries as well. When looking for a shoe, look for something that gives you enough support, fits comfortably, and is durable enough to be used in a variety of settings.

4. Poor biomechanics

When I say “poor biomechanics”, what I'm referring to is either having less than ideal posture, suboptimal running technique, weakness in certain muscles, or tightness in various areas.

When it comes to posture, there is NO perfect shape as every person will have some difference in the way their body’s structured. For example, I personally have wicked long femurs which will impact my form running or weightlifting compared to someone with shorter femurs. I’ll have much longer strides and during movements such as the squat, I may lean forward more to get depth whereas the person with shorter femurs will be able to sit more upright in said deep squat.

“Poor posture” just means you may have tightness and/or weakness in various muscle groups that are responsible for movement. Examples could be excessive stiffness in the lats which could impact your ability to raise your arm overhead, weakness in the 4 rotator cuff muscles, limiting your ability to articulate your shoulder, weakness in the hip abductor muscles such as the TFL, glute med, glute min, or piriformis which can limit hip mobility and/or cause pain/discomfort in the hip or the low back. A well rounded workout plan that includes mobility drills for the whole body can improve mobility and increase range of motion for various joints, thus, reducing the likelihood of future pain or injuries.

Proper running technique should include the following. 1) you’re light on your feet and are not stomping on the ground 2) you’re avoiding smashing your heels onto the ground but rather, are landing on the soles of your feet instead 3) you maintain a mostly upright posture with your ears aligned with your shoulders as to avoid slouching forward 4) you’re taking appropriate breaks as needed and are not pushing yourself past form failure.

Just as with weightlifting, your form is imperative in not only making the exercise effective, but safe. If I’m pulling a weight that’s too heavy for me during a deadlift, my core may either fatigue or not be strong enough to support my pelvis, resulting in my lower back excessively rounding, creating a risk for injury. If I’m far fatigued while running, my form might give in and I may end up doing something that’ll put excessive stress on my joints such as heel-smashing. If you’re tired, take a break. Unless you’re in boot camp, there’s no one forcing you to keep moving past failure.

Prevention

We actually covered quite a bit of the things you’ll need to do to prevent the onset of shin splints, but I’ll go over those points again in greater detail.

1. Use a progressive overload mindset and pace yourself.

Be objective with assessing where you’re currently at fitness-wise. If you’re just starting out or are coming from a long hiatus of not running, understand clearly that right now, at this moment, you’re not going to be in the same place as some of your friends. Be okay with that and remember that endurance is the quickest adaptation the body can experience and you can see improvements within just a couple training sessions. Avoid letting your ego take over just like with weight training; if your form is breaking down, take a break. Start small and build yourself up overtime. You’re not in a race, so pace yourself!

2. Train with various forms of cardio

Repetitiveness can not only lead to monotony, but a higher risk of a stress injury as we discussed earlier. Even if your main goal involves running, try to include some movements that are different, such as cycling, rucking, or swimming. If you're someone who loves to do cardio everyday, then it’s definitely a good call to include movements that aren’t as impactful on the joints such as swimming, cycling, or using the elliptical. You can challenge yourself pretty similarly on a machine than you can outside running, so utilize them if you have the opportunity.

I love longer runs outside, but also enjoy sprints on an upright bike. Here in New England, it’s getting pretty cold as it’s currently 30 degrees outside as of writing this article and it’s only going to get colder, so being able to run outside may not always be feasible. I personally enjoy setting my phone on a mount while cycling and listening to something informative such as a podcast or long form video content. Find a form of cardio that’s enjoyable for you, yet challenging enough and cycle through that with other means of cardio activities.

3. Include proper warm ups and mobility drills

A proper warm up does the following. 1) it gets your mind ready for the activity in question 2) it promotes blood flow to the muscles that’ll be worked during the activity, allowing for better movement 3) it primes your CNS, allowing for better muscle activation/force production 4) it promotes mobility within the joints for better active range of motion.

A warm up, whether for strength training or cardio could include the following:

Mobility drills, both static and dynamic
Stability drills, if you’re focusing on improving the strength in smaller supporting muscles
Practice (warm up) sets, to practice the movement pattern of the exercise in question

If I’m going into a heavy bench press, I want to make sure my chest, shoulders, and back are all opened up, so mobilizing those will be a top priority. Sometimes my shoulder clicks when lowering my arm with heavy loads, so I like to do some movements to prime my rotator cuff. I’m a huge fan of elevated arm external rotations with cable or light resistance bands. In the warm up sets, the amount I do varies on how I’m feeling and the weight I’ll be using during the work sets. First set is pretty light as I’m just practicing the movement. Once that feels good, I may increase the load to anywhere between 60-70% of my workset and execute several reps, pretending that the weight is heavy - this is to get my head in the right place. Another set with 75-80% with less reps to prevent fatigue and perhaps maybe, a final set with 85-90% with a couple reps, just to let me get a good feel for the heavier load.

Now for running, after I’ve done my mobility drills, I may do a couple warm up rounds of running. I’ll pick a short distance, and run that. I want to make sure that the distance I practice with isn’t so long that I burn myself out, but I also want to ensure that it’s a good enough distance to where I can self assess. Do my joints still feel iffy? Do I need to stretch my calves more or perhaps my back? Once my heart rate is elevated slightly, I’ll take a quick break, then begin my actual run.

And while running, I’m constantly reassessing myself based on how I feel. If I’m developing pain in certain areas and that pain persists for minutes on end, I’ll pause the run and try my best to work on the affected area. If my shins are hurting at a pain level of 5/10, then I may try something like an anterior tibialis stretch or calf stretch. I also may give myself a few minutes to chill out before attempting to run again. But if the pain does persist and ends up becoming more like a 7 or 8 out of 10, I’ll stop the run altogether as that probably means I’m overdoing it. I’ll stick to non-impactful movements I enjoy while letting my affected areas heal.

4. Wear proper footwear

A good running shoe should be well-fitting, meaning you don’t feel like your feet are being squished inwards, have enough room for your toes so that they can function to maintain your foot's natural arch, and have enough support if you’re running on hard and flat surfaces.

5. Strength train supporting muscles

Your plantar fascia, metatarsals, calves muscles, ankles, and front shinbone muscles all work together to support your foot’s natural arch, creating stability, as well as other movements seen in running. Perhaps you don’t need to dedicate an entire strength training workout solely for the foot as you can work all these muscles and joints with just a couple movements. Short Foot, Combat Stretch, Toe Scrunches, Single-leg Toe Touches, and Calf Raises are movements that can have a profound impact on the health of your lower limbs.

Try mixing these movements into your workout and you should see some noticeable results after a few weeks.

Rehabilitation

Depending on the severity of your shin splint, it can take anywhere between a couple weeks to as much as a few months to fully heal. Now I'm not saying this to demoralize you, I just wanna make sure your expectations are realistic. It’s a good idea to be in the mindset that the healing process will take longer than expected, rather than assume it’ll heal quickly to avoid frustration.

If you catch it early, focus on strengthening the foot as we discussed earlier. Your workouts should include movements that target the larger and smaller muscles of the lower body. Spread your running apart with a few days between, but feel free to include movements that are less impactful like cycling or swimming. Though if the pain persists even after the run and occurs with every session, my first piece of advice would be to talk with your doctor and schedule a time to meet with a sports physician if available. Follow their routine to a T. Rehab takes a lot of time which can suck mentally, but it’s worth it.

Conclusion

Like I said in the beginning, here’s a TL;DR version of this article layed out in a few key points.

Shin splints are when the muscles located on the frontside of the lower leg bone, the tibia, become overworked and inflamed.
Repetitive movements that are high impact can create microscopic damage to both the muscles, ligaments, tendons, and even bone, creating the risk for stress-related injuries if not recovering properly.
Runners, athletes, military personnel, and dancers are all at risk for overuse injuries.
Improper footwear, worn out footwear, muscle weakness, or poor posture can all result in the raised risk of overuse injuries.
When running, stay objective where you’re at fitness-wise and avoid letting your ego take over, just as with weight training.
Focus on mobilizing and strengthening the small muscles that support the foot, hip, pelvis, and low back.
Swap between different forms of cardio to avoid monotony as well as repetitive stress on the joints.
Seek the help of a specialist if the pain becomes chronic. Don’t try to be a badass and “fight through the pain”.

The purpose of this article is meant to inform you on the subject of shin splints and strategies you can take to hopefully put you on the road to recovery. But seriously, if you do have chronic pain, I implore you to seek the help of a qualified specialist. Though I am a trainer and have experience with anatomy, I am NOT qualified to give out medical advice for chronic conditions. Speak with your doctor if you’re experiencing any long term pain.

But with that, I hope this article was able to help you out!

Talk soon

-R