Common Running Injuries: Shin Splints
by Tim Waanders, PT, DPT
What are they? Why do you get them? & how do you prevent them?
Shin Splints – what are they and why do they happen? Shin splints are an overuse injury that lead to pain on the inner shin bone. Some studies show that up to ⅓ of runners will experience shin splints at some point. Females are at a 2-4x greater risk of developing shin splints compared to males. This may be due to biomechanical factors that predispose females more than males, but also the female athlete triad may play a role if bone density is compromised.
What causes Shin Splints?
Shin Splints or medial tibial stress syndrome (SS) are caused most often by repetitive stress to the tibia, also known as the shin bone. Historically, researchers believed that the physiological mechanism behind SS was due to inflammation of the outer layer of bone due to excessive stress at the tibia during running. More recent evidence suggests that this is true, but could also be caused by tibial stress reactions, tendinopathies, or other dysfunctions of the musculature surrounding the tibia (e.g. flexor hallucis longus, tibialis posterior, soleus).
Often, SS will occur because the runner increased training volume and/or intensity too quickly, not allowing the areas surrounding the tibia to adequately heal in between bouts of exercise. Another risk factor includes overpronated and significantly flat-footed feet, which tends to place excessive stress up the chain into the inner tibia. Further, lack of dorsiflexion at the ankle and/or poor flexibility of the gastroc-soleus junction of the calf can cause SS because it forces runners to collapse into pronation more in order to get proper range of motion through the phases of running gait. As the foot and/or hip collapse inward multiple times over a run, it places too much compression through the tibia which can stress the area over time.
Core, pelvic, and gastroc-soleus muscle strength are another important factor in development of SS. If any of these muscle groups are overly weak, proper stability and prevention of fatigue while running are sacrificed and can again place excessive stress through the tibia.
How to treat Shin Splints?
The first priority when treating SS involves activity modification.
- Adequate rest periods during training cycles are important in preventing any overuse or repetitive stress injuries, including SS. Decrease running intensity and volume by about 50% and keep pain levels below a 3/10 on the pain scale as you gradually ramp activity back up.
- Also try running on more forgiving surfaces like a track or a bridle path to reduce the force that your tibia has to absorb when running.
Your PT may also work on specific gait retraining activities in order to improve your running form and prevent future injury to the shins.
- For example, if you tend to overstride (meaning your foot/heel lands too far out in front of your body when running), working on increasing your cadence may be helpful in preventing future bouts of SS or more severe tibial injuries.
- Restoring normal range of motion to the ankles and hips, as well as proper core, hip (think glutes!), and calf muscle strength will be a routine part of any rehabilitation program. Your PT will prescribe you exercises based on your specific needs in order to improve any impairments they may see upon physical examination. Manual adjunct therapies such as soft tissue mobilization or EPAT may be used in order to reduce pain levels.
- Another suggestion that may help treat and prevent recurrence of MTSS is ensuring you are running with sneakers that have good shock absorption. Remember the rule of thumb is to switch out running sneakers between 250-500 miles, depending on how quickly they wear out.
It is important to note that symptoms of SS can be similar to more serious injuries like tibial stress fractures or compartment syndrome, so it is important to be checked out by a properly trained professional like a physical therapist, podiatrist, or orthopedist. If you are currently being plagued by shin splints, reach out to one of our qualified PT’s at Finish Line Physical Therapy for an assessment and rehabilitation program that fits your needs!