Shin splints treatment in runners.
Kim van Deventer

Kim van Deventer

A Runner’s Guide to shin splints: All you need to know to run pain-free

In this article we provide an overview of shin splints, explain the most common symptoms and causes, and discuss the best treatment options to get you back running without pain.

What are shin splints?

Shin splints are a stress reaction in the shinbone where the muscle and connective tissue attach to the inner part of the shinbone.

Bones of the lower leg - the shinbone (tibia) and fibula rests on the foot.

Anatomy

The lower leg is made up of 2 bones, the tibia and fibula. These bones rest on top of the foot and ankle and support the knees, hips and pelvis.

In shin splints, the most common muscles involved are:

  • Tibialis posterior
  • Flexor digitorum
  • Soleus
  • Tibialis anterior

All of these muscles work together to stabilize your foot and ankle (stop it rolling in too much). The first 3 also help to push off and move you forward while the tibialis anterior lifts the front of the foot off the ground as you walk and run.

Mechanism of injury

Did you know that bone “grows” in response to the muscles around it? So, when you exercise, not only do your muscles get bigger and stronger, your bones do too.

This is due to a process called bone remodelling. What’s that? Well, in normal, everyday life, bones shed old or damaged bone cells and replace them with new ones. When you exercise this process kicks in.

When you exercise, your bones, muscles, and tendons experience micro-injuries. These tiny injuries are natural and signal the rebuilding of your cells. This is how you grow stronger.

When you rest between workouts, your tissues recover from these micro-injuries. In this remodelling phase of healing, injured cells are rebuilt, and new cells are formed.

If there’s not enough time to rest and repair, then these micro-injuries accumulate and your bones shed cells quicker than your body replaces them and a stress reaction occurs.

How your muscles, tendons and bones grow stronger through exercise.

How can you tell if you have shin splints?

Shin splints symptomsWith shin splints, there is an area of tenderness or pain along the inner side of your shinbone that’s larger than 5cm in length. 

Pain ranges from mild to severe, and you may have some mild swelling in your lower leg too.

In the beginning, the pain might go away when you stop exercising, but over time it can become continuous, or more painful.

Downhill running tends to be more painful than uphill running in shin splints.

What else could your shin pain be?

Shin pain can be more than just shin splints in some cases.

Stress fractures and exertional compartment syndrome are rare, but they’re worth mentioning because they can become serious if not addressed early.

A specific area on the front of the shin bone (less than 5cm in length), pain at rest, or pain that keeps you awake at night, are typical signs of stress fractures.

The symptoms of compartment syndrome include aching, burning, numbness, and tingling in the calf. These symptoms are usually only present while you exercise and goes away within a few minutes of stopping an activity.

If you have any of these symptoms, its best to see a doctor to rule them out early.

What causes shin splints?

Shin splints often occur when there’s an increase in training intensity, or a sudden switch in training routines or surfaces (harder).

Although the exact cause of shin splints isn’t clear, common risk factors have been identified.  

Risk factors for developing shin splints include:

  • Having a higher body weight or carrying a heavy weight while running
  • ‘Flat feet’ or over-pronation of the feet
  • Poorly fitting shoes
  • No warm up or cool down with workouts
  • Muscle imbalances around the pelvis, hips and ankles

These risk factors all have something in common: They increase the load going through the shin and make the ankle muscles work harder while running.

Infographic listing all the risk factors that predispose a runner to developing shin splints

How do you treat shin splints?

The treatment of choice for shin splints is conservative.

Early rehab

During the early stages of rehab, the focus is on settling your shin pain by resting from all aggravating activities and reducing the load through the shinbone and muscles so that healing can take place.

In this phase, you can start strengthening the muscles that control your foot, ankle, hip and core with exercises that don’t place large loads through your legs.

Find an in depth explanation with examples of exercises here.

Late rehab

Once your injury has settled, you should start increasing the intensity of the exercises by adding in exercises that build explosive strength (plyometrics) in the calf muscles.

You can also ease back into a running program, gradually building up your running endurance and, finally, adding workouts that build the intensities and speeds you need to make a full return to your sport.

It can be tricky to know when you’re ready to move on to more intense exercises.

The best way to do this is through functional tests. This is also how we designed the shin splints program in the Exakt Health app. It sets specific targets for you to achieve with each exercise and gives you test movements to perform, which helps you know if your injury has gained enough strength to progress safely.

We’ve explained this whole process, including the targets we use for progression, in a lot more detail here.

What else helps improve shin splints?

  • Using ice (10 mins at a time) reduces pain and eases inflammation.
  • Orthotics and insoles provide arch support, improve body alignment and enhance leg and foot movement which reduces the load through the lower leg.
  • Improving nutrition and taking calcium and vitamin D supplements may help with bone healing.
  • Cross training, like swimming and cycling, can keep you fit while resting your shins.

How long does it take for shin splints to heal?

Recovery depends on how long you’ve had symptoms for:

  • Symptoms for less than 4 weeks: 12-16 Week recovery
  • Symptoms for 4 -12 weeks: 4 – 6 Month recovery
  • Symptoms for 3+ months: 6+ Month recovery

Shin splints is not a fast-healing injury but the quicker you get the right treatment advice, the faster your recovery will be.

The Exakt Health App contains a step-wise treatment plan for shin splints with tips on how to adjust all the activities you do in a day to speed up your recovery.

How do I stop getting shin splints?

  • Keep your legs and core strong with regular strength training.
  • Improve your running style to reduce load on your muscles and joints.
  • Use a training log to keep track of high-intensity workouts and rest days to make sure you aren’t overloading your body.
  • Invest in a supportive pair of running shoes if you have ‘flat feet’ or over-pronate to improve your foot arch support and reduce the load on the muscles that control your arch.
  • Eat nutrient rich meals and take vitamins and supplements (calcium and vitamin D) that support bone and tissue healing.
  • Get enough sleep to help your recovery.

 

Fortunately shin splints don’t have to be permanent, and most people recover with a conservative treatment plan consisting of rest and strength training exercises.

Now that you have a good understanding of why you get shin splints and how to treat it, have a look at this article where we explain the rehab process and what exercises to do in a lot more detail.

We understand. We’ve been there. Finding convenient and reliable help for injuries online can be a tedious and demoralising process. Here’s our story and why we started Exakt Health.

The Exakt Health App provides a convenient, intuitive and science-based injury rehab experience for runners. 

All treatment advice is based on trusted medical evidence and reviewed by licenced sports physiotherapists, with each rehabilitation plan tailored to your unique grade of injury and phase of healing.  Download the Exakt Health App and start your recovery now.

References

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