Shin Splints – A Runner’s Handbook to Causes, Treatment & Prevention

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Medial Tibial Stress Syndrome (MTSS) – or –  Shin Splints + The differences.

It happens to every runner sooner or later. After prolonged jogging or running, unfamiliar amounts of stress on your legs can result in a phenomenon commonly referred to as shin splints. These are shooting pains experienced on the lower leg, focused around your bone or tibia. Untreated, these can develop into very painful injuries such as stress fractures. There is a great deal of misinformation being spread about this condition, so it is important to be informed.

Having this condition can be very painful and make life difficult, but they are easily treated and even more easily avoided. The pain can be soothed, and you can change the conditions in order to prevent this pain from happening in the future. Even better, this can be done while still exercising, meaning you won’t lose too much progress. Take a look at this full breakdown to understand what they are, how you get them, how to treat them, and how to prevent them. This way, you can work around them if necessary, and continue training towards your goals.

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What are shin splints?

They are micro-sized tears in lower leg bones. These can cause a mild to severe level of lingering pain, and can be confused with regular soreness at first. If these muscles experience an unfamiliar amount of stress or a higher than usual amount of activity, they tend to become swollen and irritated. The bone fracturing occurs mainly in the tibia and the primary muscles affected are the ones surrounding it. It’s for this reason that medical professionals refer to this injury as medial tibial stress syndrome. They do not cause permanent damage. However, they may lead to permanent damage if treated poorly or not given adequate recovery time.

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Symptoms

Swelling of the lower leg, or pain & tenderness along the tibia are usually tell-tale signs. The pain will usually be present when exercising at it’s first stage of development, but if progresses can become a constant pain. You must always diagnose the complication at first signs, and start treatment immediately so as not to let it worsen.

To break it down, this is what you want to watch out for, especially during exercise.:

Some more serious symptoms may include:

  • Severe pains when moving, or exercising
  • Hot area
  • Inflammation
  • Worsening swelling
  • Even when not doing any physical exercise, you still feel pain

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Causes

This is one of the most common injuries runners experience, affecting up to a third of runners on average.

They have many possible causes, but the most common ones are extended stress put on the shin and lower leg. Many athletes engaging in extensive physical training for the first time, such as for track and field related sports, find themselves suffering from pain  a few weeks in to their workout regimen. If this is the case for you, you’ll need to adequately manage this injury so that it doesn’t negatively affect your routine.

Pain and soreness are instrumental to any physical training process. When you exert force on your body to perform physical activities, muscles will often tear and swell up as a result. This can be seen most often with weightlifters, who train their bodies to lift heavy weights in order to ‘pump’ up their muscles and sculpt their bodies into an aesthetic form.

However, the pain that results from this activity is dull, and fades after 48 hours of rest and proper nutrition. If you experience sharper pain that lingers for a longer period of time than this, something’s wrong.

Women are more likely to develop this condition than men, mainly due to their increased hip rotation when walking.

Because of this, men who tend to walk more with their hips are also more likely to develop this injury. Other causes are flat feet, wearing foot protection with inadequate shock absorption, muscle imbalances and low bone density. In general, working the legs too hard when they aren’t accustomed to a high level of physical activity is the main cause of this injury. The result of this is a lingering pain that can impede progress in training.

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Risk Factors

Anyone who is involved in intense physical activity and constantly puts high amount of pressure on their legs are susceptible to development. There are many ways for it to occur and certain things can can raise the chance of them occurring. These include:

  • Being unfit, smoking and having a lack of cardio – This leads to higher impact on exercises, and the area takes more or a beating.
  • Spike in level of exercising done – You may still be adjusting to the jump of routing.
  • Activities that require quick stops, and change of direction, especially on hard surfaces.
  • Running, exercising or taking part in any physically demanding activity on uneven surfaces
  • Lack of solid muscle structure – weak, flimsy, undeveloped muscles
  • Bad choice of footwear – especially old shoes, or shoes with poor cushioning
  • Ankles are weak, or weakening
  • Lack of stretching – causing tight muscles or tight Achilles tendon
  • Pronation complications, flat feet complications, and high arches can also be a problem.

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Diagnosis

Examinations by a Doctor will usually lead to a proper diagnosis. You will need to go forth with a physical, and may even need to get an X-ray done in order to see bone structure, and overall condition.

There are some conditions that can fool you into thinking you have Shin Splints. It’s not always easy to tell the difference, so you need to go through the proper processes, and really pay attention. Some of these conditions include: Lack of blood circulation in the lower leg, Muscle Hernia, Compartment Syndrome, Radiculopathy, Stress Fractures, Tendonitis, exertion caused blood clots, and Popliteal Artery Entrapment Syndrome.

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Treatment

The most important thing to know is that the pain will go away eventually. For many scenarios, simply resting your feet for a long enough period will result in the problem being solved. Additionally, your feet and legs will grow stronger as a result. However, athletes in the middle of a long training period can’t afford the lost time and physical setbacks caused by this. In that case, these treatments should be considered alternatives to resting. For the majority of people reading this, rest is the best cure, but if the pain persists after a few weeks of downtime, consult a medical professional. If you can’t rest and need to mitigate the damage, try some of these methods:

shin-splint-prevention-tools

  1.  MudGear OCR Compression Socks
  2.  Tread-Labs Stride Insole
  3. SpiderTech Kinesiology Tape
  • Method 1: Compression

Compression sleeves, socks or shoes can serve as a great method to prevent shin splints and soothe the pain induced by them. The purpose of a compression sleeve is to provide structure and support for your legs, ensuring blood circulates evenly throughout the area of compression. Additionally, the extra support provided by the sleeve will offset some of the pressure when running. This will decrease the likelihood of developing it in the future. Whether it’s dealing with soreness or trying to prevent pain down the line, compression is a good method to try, although not the most effective one.

  • Method 2: Insoles

Sometimes, the problem that causes the condition is your foot. The shape of its arch or the quality of support on your training shoes can be the cause. In situations like these, a gel insert can give you extra cushion in key areas of your feet. This is useful for runners that have flat feet, and those who have pronated or supinated feet when running. Insoles fix the uneven weight distribution caused by these foot conditions, and are molded to match the shape of your foot. In these conditions, insoles offer pain relief, allowing you to continue exercising while recovering.

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  • Method 3: Kinesiology Tape

Using KT or kinesiology tape, joints can be positioned and held in their proper place. This can aid in the healing process of shin splints, as it helps set the tibia and muscles while restoring these body parts. This is important in the event of damage being caused due to displacement. In fact, because of its highly effective application in treating shin splints, KT can reduce the pain caused by them due to its load-distributing capabilities. Consider using KT to treat an injury like this if you need to continue exercising through the recovery. It may also be helpful if you’re concerned about long-term damage developing as a result of your injury.

KT Step-by-Step

  1. Clean and shave affected leg
  2. Place an underwrap if skin is sensitive
  3. Cut a 12-18 inch length of tape
  4. Flex foot to 45 degree angle and place tape on top of foot
  5. Wrap tape under foot and across arch
  6. Wrap diagonally up to shin
  • Method 4: Surgery

In very rare and extreme cases, the only cure for shin splints is a surgical procedure. These will cost you an exorbitant amount of time and money, so it’s more of a last resort. However, if you tried all other options and are still experiencing pain, this may be the only thing that stops it. A fasciotomy, or series of small cuts in the fascia that connects to the shin, is often implemented. In other cases, periosteal stripping, or removing some of the tibia’s connecting tissue, is a procedure done to ease the pain of shin splints. After an extended period of rest, these procedures should take care of any aches and pains in the tibia.

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Prevention

Treating shin splints is one thing, but what about preventing them from happening in the future? Once you’ve recovered from an injury like this, it’s important to take measures to avoid it happening later on. Frequent shin splints can cause serious damage down the line. It’s inevitable for athletes to experience this at least once in their career, but future cases are often indicative of bad habits or improper technique. In order to spare yourself the pain and loss of progress, here are some techniques to try:

  • Method 1: Incremental training

When starting a strenuous physical routine for the first time, it’s important to ease in to the exercise. Shin splints are often caused by adopting a routine that is too intense for someone of their health level. It can be due to a lack of frequent exercise, poor diet, or no sleep. A terrific method to prevent injuries like shin splints and much worse is to train at a lower pace first. Then, work your way up to a more intense level of exertion. Simple changes, like running for shorter periods and cross-training with swimming, are often all that are needed to prevent this injury from happening. Additionally, this can provide relief in the event of an injury, while still allowing you to make progress in your workout plan.

  • Method 2: Ice

Sometimes, your muscles just need to cool down. Inflamed muscles can lead to micro fractures in the tibia if left unchecked, so in some cases it can be beneficial to put ice packs on your lower legs if they become swollen from excessive activity. This helps reduce the swelling, eases the pain, and prevents shin splints from every happening with a bit of foresight. While commonly used in the treatment of this injury after it’s already occurred, the cooling and deflation of sore muscles can be used as a very effective preventative measure. Don’t wait until you feel the pain to add the ice!

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Ice Step-by-Step

  1. Get an ice pack or plastic bag full of ice
  2. Wrap in a towel
  3. Place the towel-wrapped ice on affected area for 15 to 20 minutes
  4. Repeat every hour as needed
  • Method 3: Barefoot running

Barefoot running is an unconventional modern exercise. However, it has been quickly gaining popularity in recent years among fitness enthusiasts and professionals. The knowledge that hard striking of the heel provides support for dull aches has been harnessed by native tribes in Mexico. It is commonly recommended by fitness gurus as a more natural way to run as a result. The justification for this statement is that your ancestors walked in harsh environments without foot protection, and so had to rely on their hardened feet. Based on prevailing scientific thought, this may seem like a logical explanation, but adequate proof from extensive testing has yet to develop. Still, it’s hard to deny the satisfying feeling of striking your heel hard against the ground!

  • Method 4: Foot drills

Your legs perform better if they are stretched first. This is true of any other part of the body. Medical professionals have designed special warm-up routines that target the areas susceptible to shin splints. Performing these exercises before your workout session will prime the muscles you are working and help prevent injuries. Toe curls, heel drops and leg bridges are all effective as warming up exercises. Try implementing these exercises in your warm-ups, and you will cut down on shin splints and other painful conditions.

khourychiropractic.com.au

Foot Drills Step-by-Step

Toe Curls:

  1. Stand with feet hip-width apart
  2. Place foot on the edge of a towel
  3. Curl toes, gathering towel toward you
  4. Repeat with other foot

Monster Walks:

  1. Stand with feet shoulder-width apart
  2. Place resistance band around thighs
  3. Extend right leg and step out toward the right
  4. Repeat with left leg
  5. Take two steps backwards in similar fashion
  6. Repeat a few more times

Heel Drops:

  1. Stand on your toes at the edge of a step
  2. Shift weight to one leg
  3. Lift other leg
  4. Lower heel of leg with weight placed on it
  5. Raise heel and return to starting position
  6. Repeat with other leg

One-Legged Bridges:

  1. Lie on back with arms on the side
  2. Bend knees
  3. Use glutes to lift hips off the floor
  4. Extend one leg in the air for 30 seconds
  5. Lower leg and repeat with other leg
  6. Repeat incrementally, working your way up to 60 second extensions
  • Method 5: Vitamins

Since shin splints are a result of tears in your tibia, an effective preventative measure is to strengthen your bones. Some effective vitamins for promoting bone strength and density are calcium and Vitamin D. These nutritional supplements are connected to increased bone density in medical studies. Consider altering your diet to include foods with higher concentrations of these nutrients. Orange juice, milk, tuna, mackerel, and egg yolks are great sources for these vitamins. Taking this step will not only prevent shin splints, but can even stop the development of osteoporosis!

Foods with High Vitamin D:

  • Mackerel
  • Salmon
  • Tuna
  • Beef Liver
  • Egg yolks
  • Cheese
  • Vitamin D enriched milk

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Muscle balance and bone density

Muscle imbalances occur when one muscle group on the body is neglected for another. This is possible by exercising one leg more than the other, or by focusing more on biceps than triceps when lifting weights. These imbalances can cause tightening and swelling, which affects the underlying bones and may even cause fractures. In addition, weaker tibia can bend slightly when running, due to the high strain put on them from impact with the ground and weight of the entire body focused on them.

These factors working in tandem are often the cause of shin splints in less experienced runners. Over time, these pains will occur less, due to improved muscle definition and bone density.

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Arches, Feet, and Gait

When assessing the cause of shin splints, there are times when the cause is how you walk, rather than how much. If you’re flat-footed, pronated or supinated when walking or running, this can be the cause of your injury.

If your feet walk in an abnormal position and don’t evenly distribute your body weight, more pressure is exerted on your tibia, increasing the likelihood of shin splints. Examine the way your feet move when walking, and consider investing in orthotics if you have a chronic condition. Sometimes, these irregular walking habits can only be treated with extensive physical therapy, but the pain relief that comes with proper walking habits is worth the effort.

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Stress fractures

Shin splints are a common injury among runners, but it’s still very important to treat them when they sprout up. In the event that you don’t adequately manage this injury (either through rest or through other methods), you increase the likelihood of a more painful condition, such as a stress fracture. With a stress fracture, the pain in your foot increases dramatically. It can even cause permanent physical damage if not treated properly and in a timely manner.

Don’t leave this injury untreated and continue to exercise in the manner that resulted in the condition in the first place. Further stress on the tibia can result in a stress fracture. These happen most commonly to runners who work too hard without proper diet, form, or health necessary to run so much for so long.

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Recovery takes several weeks of inactivity, meaning any progress gained through training will most likely be lost afterward. It’s for this reason that athletes make sure to take steps to prevent this injury, or in the unfortunate case of getting shin splints, make an effort to mitigate the damage caused.

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False positives

When a shooting pain occurs in your lower feet, near the shin, a common culprit for runners is shin splints. Even though this is a safe bet, there are a few other possibilities you may want to eliminate before coming to the conclusion that you’re actually experiencing this injury. Ruling these out can prevent a waste of your effort trying to treat the symptoms and not the cause. In that case, you may want to have an MRI taken or consult a doctor to rule these other conditions out:

  • False positive 1: Tendonitis

Tendinitis is a condition where the muscles take on more of the pressure than the bone, resulting in tendon pain. This is often a cause of what is classically referred to as shin splints. However, it’s different from these because the damage is located on the muscle, not the bone. Instead of micro-fractures, the tendon experiences unnatural stretching and tearing. Because of this, a more accurate term for this specific condition is acute tibial tendinitis. When dealing with pain in your feet, consider if you are experiencing bone pain or tendon pain, and seek according treatment.

  • False positive 2: Periostitis

Another type of pain that commonly afflicts the lower legs of runners is periostitis. This is similar to tendonitis in that it is caused by tissue rather than bone. However, the affected tissue is the periosteum, a tissue that surrounds both the tibia and fibula. When this is torn, many athletes will improperly refer to it as shin splints. However, it is important to rule out this possibility before coming to that conclusion, because it can impede in your recovery process otherwise.

  • False positive 3: Compartment syndrome

Chronic exertional compartment syndrome, referred to as compartment syndrome for short, is a much rarer condition that afflicts the muscles. It comes as a result of excessive pressure on them, and can cause a loss of blood flow. In some extreme cases, debilitating muscle injury can result from this condition, so it is advised to check with a medical professional if this is a possible reason for recent shin pain. The methods required for treating this condition is different from shin splint treatment. Because of that, you should rule this out if you wish to relieve leg pain.

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To sum it up

After reading this article, you should now be adequately informed on the causes of and solutions for shin splints. Refer back to this article in the future if you need a refresher on this condition; the information here is comprehensive and can offer aid in the event that you find yourself suffering from it. If you’re worried about shin splints, or if you have the condition and want to treat it, this article will provide adequate working knowledge of it.

With a bit of forethought and some common sense, most cases of shin splints can be avoided. The implementation of knowledge from experienced professionals will also aid in the treatment process. If you’re serious about your training, you’ll want to leave nothing in the way of you and your fitness goals. Now get back out there and start running!

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Here are some of the sources used while conducting our research

The sources listed below back up several health claims made in this article. They are pulled from scientific studies and online posts written by medical professionals. Regardless of the amount and quality of the research put in, this article is only meant to inform. Do not treat the contents of this article as professional medical advice. You should always talk to a doctor if you are experiencing unfamiliar pain in order to get an accurate diagnosis.

Sources

  1. Open Access Journal of Sports Medicine, Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis, Online sports medicine journal,
  2. Journal of Orthopaedic & Sports Physical Therapy, Medial tibial stress syndrome in high school cross-country runners: incidence and risk factors., Online Library of Health Topics & Information,
  3. Clinics In Sports Medicine, Medial tibial stress syndrome., Online Library of Health Topics & Information,
  4. Dr. David Ryan, Shin Splints: Learn To Run Pain Free!, Fitness Information Website,
  5. Brian Fullem, A Stress Fracture Primer, Runners General Information Source,
  6. Dr. Marybeth Crane, Shin Splints Can be Anterior Tibial Tendonitis, Injury & Complications Information Database,
  7. Ortho Info, Compartment Syndrome, Orthopaedics Information Database,
  8. Physical Therapy In Sports, Lower-leg Kinesio tape reduces rate of loading in participants with medial tibial stress syndrome., Online Library of Health Topics & Information,
  9. Robert P. Wilder, MD, Surgery for Shin Splints, Sports Injuries and Health information Database,
  10. Caitlin Carlson, 4 Exercises to Prevent Shin Splints, Runners General Information Source,
  11. Drugs.com, Shin Splints, Online Database of Complications & Treatments,
  12. Daniel E. Lieberman, Strike type variation among Tarahumara Indians in minimal sandals versus conventional running shoes, Online Database and Journals of Scientific Research,
  13. The Journal Of Nutrition, Vitamin D and bone health., Online Library of Health Topics & Information,