What To Do About Shin Splints
“I think I have Shin Splints — What Now?”
During my last post, I touched on my own struggles with shin splints as a high school runner in Arlington, Virginia. Now, let’s talk about what they actually are and what to do about them.
What ARE Shin Splints?
As I said in the last post- nobody really knows. However, there are two popular theories.
Traction periostitis: inflammation resulting from excessive traction on the periosteum - the outer layer of shin bone - from muscle tendons in the lower leg.
Early bone stress injury: repeated impact on the bone creates a stress reaction which if untreated can become a stress fracture. In MTSS, it is hypothesized that the highly active calf muscle may create a miniscule “bowing” of the tibia with each step that needs to be counteracted by stronger shin muscles to oppose that force.
No matter the mechanism, we know that certain things correlate with developing MTSS. Some of these include:
Rapid volume increase
Running gait faults including “crossover stepping”
Leg strength deficits
What to do?
First and foremost, most runners with MTSS will need some kind of active rest - research shows that more than 5 days running per week can increase injury risk, and many HS programs run more than 5 times per week. However, we have to stay away from total rest - that won’t give tissues the stimulus they need to heal (think goldilocks zone). Instead of running, we can work on heavy strengthening and conditioning that doesn’t cause pain. Targeting the lower limb muscles, especially at the front of the shin, can also be helpful.
For gait training, our goal is to remove as much impact force as possible. With shin splints, we often find that runners benefit from “quiet running” drills and increasing their cadence.
With specific strengthening, focusing on the foot and ankle muscles is key - often starting with the foot, then building up to the front of the shin to get the most direct possible stimulus to the area of pain. I love barefoot single leg stance activities and the “tibialis raise” shown below.
Reframing and Adapting
Sometimes, and definitively for runners and competitive athletes, the mental aspect of dealing with injuries can be an important piece of recovery. During PT we work on adapting to the injury so that it becomes a challenge instead of a barrier - something to learn from rather than stop you in your tracks. There may be some ego involved in the injury’s onset - why, exactly, do you feel the need to increase your mileage so quickly?
Need Help with Shin Pain?
If you or your child is struggling with shin pain, let’s talk. I’ve been there - and I can help.
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