by Alice Hunter, Specialist Sports & MSK Physiotherapist
Most runners would have encountered shin splints at some point during their lives, whether experiencing it themselves or in a fellow runner. It can be incredibly painful, and if not managed properly can have a significant effect on your performance and quality of life. It’s not just running however - shin splints is often seen in other sports too, such as football, basketball and dancing.
WHAT IS IT?
The name ‘shin splints’ is quite misleading – you’re bone is not actually ‘splinting’. You might hear it referred to as ‘medial tibial stress syndrome’ by healthcare professionals. Research suggests there is a range of injuries involved, such as an actual bone stress reaction – where your shin bone – or tibia, becomes irritated (micro-damage) and struggles to heal normally as a result of overloading. Other changes that could contribute to presentation include tendinopathy, periostitis (inflammation to the tissue around the bone) and muscular dysfunction, particularly of the tibialis posterior, anterior or soleus.
HOW DO WE DIAGNOSE IT?
The most common sign of shin splints, is pain along the inner border of your shin bone, usually >5cm or more. You’ll struggle with loading your leg (pain with hopping, jumping, jogging and running). This pain tends to worsen if you push through it with exercise, but often alleviates with rest.
Other important factors in the diagnosis of shin splints, is looking at the history. Has there been a change to your exercise routine, running mileage, intensity, pace, surface or footwear. Training errors are often a common risk factor with shin splints, for example doing too much too fast.
The research shows we don’t need an MRI to diagnose shin splints, a thorough history taking alongside a physical assessment will often give a healthcare professional enough information to make a comprehensive diagnosis. However if the pain persists, it is important to get an assessment to exclude any other cause for your symptoms. Whilst shin splints does not mean a fracture, if left untreated and not managed appropriately, there is a risk of developing a bone stress fracture, (an MRI might then be required to rule this out). It’s always important if you’re not sure on how to manage an injury to seek medical advice and assessment.
Research shows we don’t need an MRI to diagnose shin splints, a thorough history taking alongside a physical assessment will often give a healthcare professional enough information to make a comprehensive diagnosis
OTHER FACTORS TO CONSIDER:
We’ve discussed the main cause of shin splints – overloading to the bone. However we know there are other contributing factors that can increase the risk of injury and slow down recovery:
Sleep - if your body is not getting enough time to recover between training sessions it probably won’t be doing a good job at healing (most remodelling of bone occurs in sleep). Most adults require 6 – 9 hours’ sleep a night to maintain a healthy lifestyle.
Recovery and fatigue – fatigue can increase bone stress, and less recovery means less healing time. Planning rest days, recovery sessions and recovery cycles can prevent injury and assist with recovery.
Diet – Poor nutrition can be a risk factor for bone and overloading injuries. Vitamin D helps build bones whilst calcium helps absorption – both vital in good bone health. Ensuring adequate intake of macro-nutrients (carbohydrates, proteins and fats) means your body has the tools to provide energy and repair tissue. (If you are unsure about your current diet we can provide you with nutrition support: https://www.ldnphysio.co.uk/nutrition-support.
Past medical history including previous injuries, previous and current medication, bone health and Relative Energy Deficiency in Sport (Red-S). As these can increase your risk of getting injured. For further information on Red-S: https://www.ldnphysio.co.uk/post/red-s-relative-energy-deficiency-in-sport.
WHAT DO WE DO ABOUT IT?
Rest – shin splints aren’t like other injuries, you can’t ‘warm it up’, exposure to further load often makes shin splints hang around for longer and contributes to overall irritation. Resting with a slow, graded return to activity is important when on the road to recovery.
Ice (cryotherapy) – ice can be applied directly over the painful area (being careful with ice burns), reducing blood flow to an area can help with inflammation and pain, normal optimal management is application for 15-20 minutes after exercise.
Pain management – in severe cases, non-steroidal anti-inflammatories (such as ibuprofen) can be helpful in managing the pain, but it’s always recommended to speak to a Doctor or Pharmacist if you’re unsure.
Modification of activities – keeping active can be important for all parts of your recovery journey. Keeping up fitness with low impact exercise can speed up your return to normal training. Exercise like swimming or cycling can maintain fitness and strength whilst allowing for bony recovery. However in more severe presentations, you may be advised for complete rest.
ON THE ROAD TO RECOVERY (how do I get back to running)?
Strengthening - One of thoughts behind shin splints is that the pain is caused by the force of the bone as it bends with impact. By strengthening your calf muscles, there is more support to reduce tension through the bone. Other muscle groups that are particularly important to target are the quads and glutes as they can help with stability of your legs. As we mentioned, muscular dysfunction can also be a cause of shin splints, so a targeted programme which strengthens muscles such as tibialis posterior, anterior and soleus can be vital in recovery.
Graded bone loading – including plyometrics (at a later stage). Loading of the bone stimulates bone growth and healing, and graded impact is vital in return to sport. It’s key to think about what the bone can tolerate and to work within your pain thresholds. Your Physiotherapist will be able to guide you on this, but examples are; graded walking, gentle jumping, progressing to hopping, multi-directional movements and running.
Little and often, as you start to increase your impact activity (and return to running) they key thing is to introduce ‘little and often’, allowing lots of time for recovery between sessions and more opportunity for bone adaptation.
Gait re-training: your physio can look at the way you are running and if indicated can help adjust this, for example if someone is over striding, reducing their step rate to reduce bony impact and prevent injury re-occurrence.
Footwear and insoles – this is not to adjust foot position but can help reduce stress on the tibia and provide more shock absorption for the leg. The literature varies, but it’s usually recommended for runners to change their footwear every 250-500 miles, as trainers can lose significant amounts of shock absorption over time.
Other helpful treatments:
Stretching – useful when coupled with strengthening, stretching can help alleviate muscle tightness and discomfort especially where changes in your muscles can contribute to shin splints.
Foam rolling – rolling out tight muscles, and targeting areas such as your calves, quads, hamstrings and glutes can help with pain relief and reduce tension in your legs.
Massage and soft tissue mobilisation – reducing muscle tightness into the surrounding tissues can help with alleviating pain.
Taping – can help given feedback, provide offloading, and work as an additional component to rehabilitation.
If you think you might have shin splints, or are struggling with pain when you exercise, then we recommend consulting with either your GP or a Physiotherapist. If you have any questions or concerns, or would like further advice you can either book in with us online or feel free to contact us via email; firstname.lastname@example.org.
Galbraith, R.M., Lavallee, M.E. (2009). Medial tibial stress syndrome: conservative treatment options. Curr Rev Musculoskelet Med 2.
Winters M, Burr DB, van der Hoeven H, Condon KW, Bellemans J, Moen MH. (2019). Microcrack-associated bone remodeling is rarely observed in biopsies from athletes with medial tibial stress syndrome. J Bone Miner Metab. https://pubmed.ncbi.nlm.nih.gov/30066165/.