What is Shin Splints?
If you are a runner, there is a high chance you have suffered from shin splints. Shin splints is a frustratingly vague term used to describe a host of different lower leg non-traumatic, overuse injuries that are typically associated with running or impact activities like jumping. The focus of this article is on shin splints on the lower part of the shin, called medial tibial stress syndrome, or MTSS. Reported in research to be the second most diagnosed running related injury, with up to 13.6-20% of runners develop MTSS 2,4.
What causes it?
Several theories have come and gone over the years about which anatomical structures are the source of MTSS, but it is now thought that bone stress is the likely cause of symptoms5. Bone, like other tissues in our body, is constantly changing, and adapts in response to load placed through it. Running and jumping place bending loads through the shin bone, the tibia, and whilst repeated bending can cause healthy adaptations within bone tissue and causes bone to gain strength, injury can occur if this threshold is exceeded. The lower leg also has several layers of muscle, several of which attach to the tibia. Accompanying bony stress of the tibia, the muscle attachments of the deep calf muscles to the tibia may also be involved in MTSS. MTSS is now considered to part of a spectrum of bone-related injury, with MTSS on the mild end and stress fractures of the tibia to be at the severe extreme1 ,3.
Causes of stress on the tibia and the surrounding muscle and soft tissues can be multifactorial, poor biomechanics and muscle imbalances of the lower limb are associated with MTSS, such as over-pronation of the ankle3. Several risk factors for MTSS have been identified by research, although their meaning and relevance are not yet fully understood. As you will see below, some risk factors can be changed or influenced. The role of some of the identified risk factors in MTSS also remain unknown, or, whether they are the cause or simply an effect of the symptoms.
Risk factors for MTSS5:
- Increased pronation
- Previous history of MTSS
- Being female
- Increased body mass index (BMI)
- A higher BMI indicates that there is increased body mass relative to an individual’s height. Whilst this is not an indication of body fat levels, higher overall body mass will increase the mechanical load on the tibia during physical activity
- Orthotic use
- Less than 5 years of running experience
- Increased hip external rotation
How do I fix it?
This is not an easy one to answer, nor a quick one unfortunately. If you’ve ever tried to get over shin pain, then you will probably know that it can take ages. One scientific trial in which runners were randomly allocated into different groups found that it took between 102-118 days on average for participants to be able to run 18 minutes. Furthermore, 90% of participants took 250-300 days to be able to run 18 minutes5, so, patience is key.
At this stage, research can only tell us that trials investigating interventions haven’t established better management than prolonged reduction or management of load5. What this means in plain English is that MTSS is best treated by reducing the amount or intensity of running, and, carefully progressing your running once symptoms have improved.
So yes it may take a while, but the good news is that with careful progressions of volume and intensity of running in combination with appropriate footwear and correcting imbalances in your strength or flexibility, you can return to pain-free running.
How do you prevent shin splints?
- Identify and address risk factors that are modifiable, such as footwear, biomechanics and your training programme.
One of the best preventative strategies is appropriate training design.
- Be patient if you wish to increase how much you are running
- Be realistic with the amount of time that is needed, if you want to train for a specific fun run or event. Is the stock standard online 16 week beginner marathon running programme appropriate for you?
- Spend a few months establishing a decent foundation of kilometres per week you can run without symptoms
- Increase your weekly distance gradually. A well known tradition is the 10% rule – increase the total weekly distance by a maximum of 10% per week. Schedule in recovery weeks every 4-6 weeks, so that you aren’t increasing your total weekly distance for weeks on end.
- If you are a beginner to running, run no more than 3 days a week, giving a day’s rest from running in between. This allows your bones and muscles to recover and adapt to the training, which will ultimately allow you to run more in the future.
- Cross training and strength training is an under-appreciated must! Running alone is not going to strengthen up your running muscles. Improving your posture, stability and strength of the pelvic, hip, torso, leg and foot muscles will increase your overall physical resilience so that you will be able to fun further and faster as well as reducing the risk of other injuries.
Whether you are recovering from shin splints, or wanting to prevent them from occurring in the first place, a tailored program and run plan is vital for everyone. Come in to see us at Absolute where industry experts can help you.
Written By Performance Coach Liz Hewett
- Carr K, & Sevetson E (2008). How can you help athletes prevent and treat shin splints? The Journal of Family Practice 57 (6): 406-407.
- Hamstra-Wright KL, Huxel Bliven KC, Bay C. (2015). Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis, British Journal of Sports Medicine. 49:362–369. doi:10.1136/bjsports-2014-093462.
- Galbraith RM & Lavallee ME. (2009) Medial tibial stress syndrome: conservative treatment options, Current Reviews in Musculoskeletal Medicine 2:127–133 DOI 10.1007/s12178-009-9055-6.
- Lopes AD, Hespanhol LC, Yeung SS, Costa LOP (2012). What are the main running-related musculoskeletal injuries? A Systematic Review, Sports Medicine, 42(10), 891-905.
- Newman P, Witchalls, Waddington G, Adams R. (2013). Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis. Open Access Journal of Sports Medicine 4: 229–241. http://dx.doi.org/10.2147/OAJSM.S39331