Shin Splints Exercises Guide
Kim van Deventer

Kim van Deventer

Shin Splints: A step-by-step exercise treatment plan for runners

In this article, we dig deeper into the treatment of shin splints and provide you with a detailed rehab program, including what exercises to do and how to know when to progress.

Quick recap: Definition, causes and risk factors for shin splints

Shin splints is an overload injury of the shins, caused by too much force going through the shinbone, or when there’s repetitive tugging and pulling on the bone where the muscles attach.

Studies show most people who suffer from shin splints have the following traits in common (intrinsic factors):

  • Increased body mass (or carrying extra weight while running like in military fitness training)
  • Flatter foot arches or pronated feet
  • Muscle imbalances affecting range of movement around the hips and ankles

Interestingly, being a woman, having lower bone density, having smaller shin bones, or being vitamin D deficient also increase your likelihood of getting shin splints.

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

Circumstances that can increase your risk of getting shin splints (extrinsic factors) include:

  • Recently increasing running mileage or training intensity
  • Running on uneven terrain or hard surfaces
  • Inadequate warm-up or cool down routine
  • Poor fitting or unsupportive shoes

Now let’s talk about treatment.

What’s the best treatment for shin splints?

Currently, effective treatment for shin splints includes rest from pain-causing activities, improvement of biomechanics (body alignment, range of movement and movement efficiency) and following a graded return-to-running program.

This combination of strategies helps to control the initial pain and inflammation associated with shin splints, promotes healing and builds up your shinbone’s strength to a level where it can tolerate a load that matches your normal running routine. This is called load management.

We discuss what a typical load management program looks like below.

Do shin splints get better with exercise?

Yes, there’s evidence that muscle strengthening, particularly your calves and hip abductors, and improving your core stability makes you more resistant to shin splints injury.

When treating shin splints, you should work on the muscles that support the foot arch (instinctive foot muscles, calf muscles) and those that align the hips and knees while running (hip abductor and core muscles).

What are the best exercises for treating shin splints?

It depends on your stage of healing. There isn’t a definite set of exercises you should be doing. Instead, your exercise program should adapt as you recover – it should include easy, low load exercises to start with and progress to more complex, high load exercises. 

We provide examples below.

The Exakt Health app divides shin splints treatment into 7 stages

The app supports you through the stages of bone healing and guides you with evidence-based advice and progressive exercises to a full recovery. Here’s how it works.

Rehab aims

  • Settle your shin pain and get the healing process started by avoiding activities that cause/increase pain.
  • Build the baseline strength in your ankles, hips and core in positions that don’t place strain on your lower legs.
  • Maintain your cardiovascular fitness with low load activities like swimming or cycling.

When you have shin splints balancing exercises are important because they strengthen your foot and ankle.Examples of shin splints exercises in Stage 1

Any core and glute exercises that don’t load the legs (e.g. clams, side leg lifts, bridges, planks) work well during this stage.

Arch correction exercises in sitting (gathering a towel or picking up marbles with your toes) are a good choice if your shin is still very sensitive.

Balance exercises are also important because they strengthen your arch and develop control, but you may have to start with short holds (10 seconds) if your shin is very sensitive.

The app introduces these exercises slowly and uses your feedback about pain and difficulty to adjust their intensity.

What to avoid

  • Strong calf stretches make the muscles pull on the injured part of the shin and can make it hurt more. Leave them for later.
  • The research shows that people who stop running and jumping activities during their rehab recover more quickly than those who don’t.
  • Long periods of walking or standing can also cause trouble, so limit the time on your feet during the day. If you find your shins hurting towards the end of the day, it’s usually a sign that you’ve done too much.

When to progress

  • When you can complete low load exercises (e.g. balancing on one leg) without pain; and 
  • You can go up and down on your toes (on two feet) for 15 repetitions without experiencing pain.

Rehab aims

  • Build strength in your calves in positions that don’t stretch/strain the injured area.
  • Continue to improve the strength and control in your legs and core.
  • Maintain cardiovascular fitness with low impact activities.

Shin splints exercises - Heel raises to floor level are a good choice during the early rehab stage.Examples of shin splints exercises in Stage 2

 

Heel raises (double leg and later progressed to single leg) that you do to floor level are usually a good option as they strengthen the calf muscle without stretching the sensitive tissue.

What to avoid

  • Strong calf stretches
  • Running and jumping activities

When to progress

  • When you can do 3 full sets of 15 repetitions of the single leg heel raise exercise without pain.

Rehab aims:

  • Progress your calf strength exercises to build strength through the full range of motion.
  • Continue to develop the control in your legs and core.
  • Maintain cardiovascular fitness with low impact activities.

Shin splints exercise for stage 3 - restore calf strength through full range.Examples of shin splints exercises in Stage 3

Heel raises and heel drops over the side of a step build muscle strength and control through the full range of ankle movement and help restore calf flexibility.

Introducing gentle, passive calf stretches during this stage is usually safe.

What to avoid

  • Still no running or jumping activities.

When to progress

  • When you can walk 30 minutes at a slow pace without pain; and
  • You can do the heel raises with weights that equal about 10% of your bodyweight; and
  • The app sets you 2 hop tests consisting of double and single leg hops. In order to progress, you should be able to perform these tests pain free.

Rehab aims

  • Develop explosive strength in your calves with plyometric exercises.
  • Continue building the strength in your calves with weighted heel raises.
  • Keep building the strength and control in the rest of your body.
  • Maintain cardiovascular fitness.

Examples of shin splints exercises in Stage 4

Continue the weighted heel raises from the previous stages, and now add plyometric exercises (hops and jumps). These should start at a low dose and increase in volume and intensity over several weeks. Avoid doing these too often, as you’ll need ample time to recover after each session – the app plans your training week to allow for this recovery.It's important to include plyometric exercises, like box jumps, in the later stages of your shin splints rehab

What to avoid

It’s best not to run yet.

When to progress

  • When you can walk for 30 minutes at a brisk pace without pain; and
  • Do the heel raises with a weight that equals about 20% of your bodyweight; and
  • You have completed a comprehensive hop program that lasted between 4 and 6 weeks – like the one included in the app.

Rehab aims

  • Ease back into running without re-injury.
  • Maintain the strength and control achieved in the previous stages.

A run/walk program is a safe way to get back to running after injury and to prevent reinjury.Examples of shin splints exercises Stage 5

We find that a run/walk program is the best way to ease back into running and avoid re-injury.

Carry on with strength training, but reduce it so your legs can make a full recovery before each run session.

The app helps you to space the training sessions out effectively.

 

What to avoid

High intensity training sessions.

When to progress

If you’re following the walk/run program in the app, you can progress to the next stage when you can jog 20 minutes continuously at a slow pace.

Rehab aims

  • Regain your previous slow running endurance.
  • Maintain your strength and control.

You should always build your slow running endurance when making a comeback from injury.Examples of shin splints exercises Stage 6

It’s good to continue with a maintenance dose of calf strength exercises.

Aim for 2 sessions of weighted heel raises with weights that fatigue your muscles after 10 repetitions (10 rep max). Slowly build your running volume.

The app includes a maintenance strength training program for injury prevention.

What to avoid

High intensity training sessions e.g. hill sessions, tempo runs and sprints

When to progress

Once you’ve built up your normal volumes of weekly running at a slow pace, you’re ready to start the final stage.

Rehab aims

  • Regain your previous fast running strength and endurance.
  • Maintain your strength and control.

High intensity running sessions should be left for the final stage of rehab.Examples of shin splints exercises Stage 7

Continue with regular strength training sessions to avoid re-injury.

You can also introduce high intensity running sessions now – starting with one per week.

Can you still run with shin splints?

It’s not really advisable or sensible. Many people continue to run with shin splints, but if you want your shin pain to improve and not become a more serious injury, you shouldn’t.

Unfortunately, sometimes any bit of pressure through the legs can make shin splints flare up or become worse. This makes the healing process take longer.

Best practice is to avoid running initially while keeping fit with low impact activities like walking, swimming, aqua jogging, or seated cycling at low resistance.

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

  1. Alfayez, S. M., Ahmed, M. L., & Alomar, A. Z. A review article of medial tibial stress syndrome. Journal of Musculoskeletal Surgery and Research. 2017; 1(1): 2. (Level of Evidence: 4)
  2. Franklyn M, Oakes B. Aetiology and mechanisms of injury in medial tibial stress syndrome: Current and future developments. World J Orthop. 2015;6(8):577-589. Published 2015 Sep 18. doi:10.5312/wjo.v6.i8.577
  3. Lohrer, H., Malliaropoulos, N., Korakakis, V., & Padhiar, N. Exercise-induced leg pain in athletes: diagnostic, assessment, and management strategies. The Physician and sports medicine. 2018
  4. Madeley, L. T.; Munteanu, S. E.; Bonanno, D. R., Endurance of the ankle joint plantar flexor muscles in athletes with medial tibial stress syndrome: A case-control study. Journal of Science and Medicine in Sport 2007, 1
  5. Popp, K. L.; Hughes, J. M.; Smock, A. J.; Novotny, S. A.; Stovitz, S. D.; Koehler, S. M.; Petit, M. A., Bone Geometry, Strength, and Muscle Size in Runners with a History of Stress Fracture. Medicine & Science in Sports & Exercise 2009, 41 (12), 2145-2150.
  6. Verrelst, R.; Willems, T. M.; De Clercq, D.; Roosen, P.; Goossens, L.; Witvrouw, E., The role of hip abductor and external rotator muscle strength in the development of exertional medial tibial pain: a prospective study British Journal of Sports Medicine 2013.
  7. Verrelst, R.; De Clercq, D.; Vanrenterghem, J.; Willems, T. M., The role of proximal dynamic joint stability in the development of exertional medial tibial pain- a prospective study. British Journal of Sports Medicine 2013, 0, 1-7.

 

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