Medial (inner) shin splints treatment plan

Inner (medial) shin splints is also known as medial tibial stress syndrome. It is when the inner part of your tibia (shin bone) becomes painful and sore in the area where your calf muscles attach to it.

Researchers are still unsure whether the pain from shin splints comes from the bone or the fascia (connective tissue) attaching the muscles to the bone.

It is an overuse or overload injury that develops because that part of your leg was placed under more strain than it could handle. The overload can happen suddenly, during one intense training session (acute overload), or slowly over several training sessions (gradual overload).

• Pain along the inner border of your shin bone, spanning an area of about 2 to 4 inches (5 to 10cm) or more when you press on it
• It may initially hurt only during exercise, but as it progresses, it may also be painful after exercise, while walking around, and with normal daily activities
• Often, downhill running hurts more than running on flat surfaces or uphill
• It usually doesn't hurt when you're at rest (e.g., sitting or lying still), and the pain will not wake you up at night

A shin bone stress fracture can often be misdiagnosed as shin splints. But, the pain from a stress fracture is different from shin splints. Usually, it is very localized, with a particularly painful spot that you can press on in your shin bone. It will also often hurt when you're at rest. The app's rehab plan is unsuitable for you if you have a stress fracture.

You should consult your doctor or physiotherapist before using the app to ensure your diagnosis is correct and your injury is ready to start rehab exercises.

If you have any concerns about your injury after you've started your rehab, schedule a review with your doctor, particularly if:

• Your leg hurts when you're lying down, or you have pain at night that keeps you awake or interrupts your sleep - this may mean that you have a stress fracture
• You feel a sudden sharp pain in your lower leg during an activity - this may mean you've strained something, and the app’s program may no longer be appropriate
• You notice bruising - shin splints do not cause bruising
• Any part of your leg (thigh, calf, or foot) is swollen, red, hot to touch, or throbs with pain - these signs can indicate a blood clot, and you should have it investigated as soon as possible
• You feel pins and needles or tingling in your leg - this can indicate an injured nerve, and the rehab plan may not suit you
• Your symptoms are getting worse
• Your injury is not recovering as expected (see expected recovery times below)

If you have a chronic condition, e.g., osteoporosis, heart disease, or an inflammatory condition, the rehab plans in the app are likely not appropriate for you. Please check with your doctor before using the app.

The factors contributing to overloading your inner shin bone and muscles can be divided into intrinsic (inside your body) and extrinsic (outside the body) factors:Intrinsic factors:

• Weakness or lack of control around your hips, pelvis, foot, and ankle, causing your leg to turn in (over-pronate) more when you run
• Having flatter foot arches

Extrinsic factors:

• Sudden changes in training load, e.g., increasing your running volumes too quickly or doing a lot of downhill running
• Not allowing enough recovery time between training sessions
• Shoes that are too flexible and increase over-pronation
• Training on hard surfaces, e.g., Astroturf

The right combination of rest and exercise tailored to the individual is usually the most effective intervention. Research suggests that the most helpful treatment plans for medial tibial stress syndrome include the following:

• Relative rest: Cut out aggravating activities and reduce your training program to allow your injury to settle
• A slow, progressive strength training plan: Gradually restore your foot and ankle strength while postponing exercises targeting the muscles in the injured area until your injury has calmed down
• General strength and control exercises: Condition your core and other supporting muscles (glutes, hamstrings, and calf muscles) to help share the load when you run and jump
• Mobility and range of movement exercises: Gain and maintain good mobility in all your lower body joints and muscles (calf stretches can be helpful, but only once your injury has settled, as stretching sensitive tissues will make them more sensitive)
• Movement retraining: Learn how to use your whole kinetic chain (all the interconnected parts of your body) optimally while running, specifically during the landing phase

The rehab plan in the app includes all of these components. It starts with low-load exercises that help settle your pain, then slowly increases the exercise intensity as your injury heals.

Other treatments you may encounter:

• Supportive insoles that reduce pronation: May be helpful if you overpronate
• Complete rest: May calm your pain initially, but resting for prolonged periods is not advised as it can cause you to lose more strength
• Massage: May help reduce pain, but it does not strengthen your leg, and vigorous massage can also irritate your injury and increase your pain
• Electrotherapy (like ultrasound): Not recommended by the current research
• Shockwave therapy: May help in some cases, but research shows contradictory results

The length of time your recovery takes usually depends on how long you waited before starting the correct rehab plan:

• If your symptoms started less than 4 weeks ago: 12 to 16 weeks
• If your symptoms have been present for 4 to 12 weeks: 4 to 6 months
• If your symptoms have been present for longer than 3 months: 6 months, or more

You may reduce your risk of shin splints if you keep your body strong and avoid common training errors. We recommend that you:

• Invest in supportive running shoes and insoles if necessary
• Allow enough recovery time between hard training sessions
• Avoid sudden increases in training volume or intensity
• Do strength training twice a week — the stronger your core and leg muscles, the less strain your lower legs take
• Add balance exercises to your training plan — they help develop your control and improve your movement patterns
• Get plenty of sleep and adapt your training intensity when you feel tired - you are more likely to injure yourself when physically or mentally tired

Once you’ve completed your rehab, switch to the injury prevention plan in the app — we designed it with all of these elements in mind.

1. Alfayez, S. M., et al. (2017). "A review article of medial tibial stress syndrome." Journal of Musculoskeletal Surgery and Research 1(1): 2.
2. Capt Christopher J. Couture & Kristine A. Karlson (2002) Tibial Stress Injuries, The Physician and Sportsmedicine, 30:6, 29-36, DOI: 10.3810/psm.2002.06.337
3. Galbraith, R. Michael; Lavallee, Mark E. (7 October 2009). “Medial tibial stress syndrome: conservative treatment options”. Current Reviews in Musculoskeletal Medicine. 2 (3): 127–133. doi:10.1007/s12178-009-9055-6. ISSN 1935-973X. PMC 2848339. PMID 19809896.
4. Hamstra-Wright KL, Bliven KCH, Bay C. 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 2015;49:362-369.
5. Kuwabara, A., Dyrek, P., Olson, E.M. et al. Evidence-Based Management of Medial Tibial Stress Syndrome in Runners. Curr Phys Med Rehabil Rep9, 177–185 (2021). https://doi.org/10.1007/s40141-021-00326-3
6. Lohrer H, Malliaropoulos N, Korakakis V, Padhiar N. Exercise-induced leg pain in athletes: diagnostic, assessment, and management strategies. Phys Sportsmed. 2019 Feb;47(1):47-59. doi: 10.1080/00913847.2018.1537861. Epub 2018 Nov 5. PMID: 30345867
7. Lopes, A.D., Hespanhol, L.C., Yeung, S.S. et al. What are the Main Running-Related Musculoskeletal Injuries?. Sports Med 42, 891–905 (2012).
8. Menéndez, C., et al. (2020). "Medial Tibial Stress Syndrome in Novice and Recreational Runners: A Systematic Review." International journal of environmental research and public health 17(20): 7457.
9. Mendez-Rebolledo, G., Figueroa-Ureta, R., Moya-Mura, F., Guzmán-Muñoz, E., Ramirez-Campillo, R., & Lloyd, R. S. (2021). The protective effect of neuromuscular training on the medial tibial stress syndrome in youth female track-and-field athletes: A clinical trial and cohort study. Journal of sport rehabilitation, 30(7), 1019-1027.
10. Naderi, A., Bagheri, S., Ramazanian Ahoor, F., Moen, M. H., & Degens, H. (2022). Foot orthoses enhance the effectiveness of exercise, shockwave, and ice therapy in the management of medial tibial stress syndrome. Clinical Journal of Sport Medicine, 32(3), e251-e260.
11. Patel, Deepak S.; Roth, Matt; Kapil, Neha (2011). “Stress fractures: diagnosis, treatment, and prevention” (PDF). American Family Physician. 83 (1): 39–46. PMID 21888126. S2CID 1736230. Archived from the original (PDF) on 12 February 2019.
12. Reinking, M. F., et al. (2017). "Medial Tibial Stress Syndrome in Active Individuals: A Systematic Review and Meta-analysis of Risk Factors." Sports health 9(3): 252-261.
13. Willwacher, S., Kurz, M., Robbin, J., Thelen, M., Hamill, J., Kelly, L., & Mai, P. (2022). Running-Related Biomechanical Risk Factors for Overuse Injuries in Distance Runners: A Systematic Review Considering Injury Specificity and the Potentials for Future Research. Sports Medicine, 1-15.
14. Winters, K. K., et al. (2014). "Treatment of medial tibial stress syndrome: A critical review." International Journal of Athletic Therapy and Training 19(4): 27-31.