How to Avoid Shin Splints When Running
What Are the Best Exercises for Shin Splints?
What are shin splints?
Shin Splints, aka Medial Tibial Stress Syndrome (MTSS), is a common leg injury in running and jumping athletes. With shin splints, runners will experience inner shin pain that is aggravated by activity and relieved with rest.
How to know if I have shin splints or a stress fracture
With shin splints, pain is usually felt at the beginning of a run and decreases as the run continues. Pain typically increases with movement and decreases with rest. The discomfort usually gets worse the next day following a run, but improves over time with rest. Runners with shin splints usually experience soreness or pain in both legs at the inner side of the shin, usually in the middle to lower shin. According to this research article, pain from shin splints is reproduced with palpation (pressing on the bone) along the inner shin and will span 5 consecutive centimeters.
In contrast, runners with a stress fracture typically experience localized shin pain with discomfort and swelling, according to this research review. The discomfort will typically last longer into the run, and may last beyond the cooldown and into one’s daily activities.
Why do runners get shin splints?
There are many factors that contribute to the development of shin splints in runners. Below are some of the most common findings we observe in our runners who are experiencing shin splints.
Training Error is Associated with Shin Splints
The most common factor we see is training error. The runner will come to us after increasing their overall volume by a large percentage. According to this study, increasing overall volume by > 30% over a 2-week period puts runners at an increased risk for running-related injuries. We also see runners come in with shin splints when they suddenly begin to introduce speed work into their training. This is necessary if we want to improve our speed and break personal records. We are not suggesting that you avoid speed work, but we are saying that most runners introduce it improperly.
For example, if this is your first experience with speed training, we recommend short strides on level surfaces, or tempo runs with proper warm up and cool down running at easy paces. What we often see is a runner who began to introduce 800 meter intervals when they have no speed training experience. Another common circumstance is when we see intermediate runners begin to introduce a 2nd speed day into their training. This type of training error is a combination of excessive volume AND intensity (speed).
Biomechanical Factors Are Associated with Shin Splints
The common faults we see in runners with shin splints during our treadmill analysis is an increased foot inclination angle, and an extended tibia angle that is associated with heel striking.
Increased Foot Inclination Angle Associated with Shin Splints
An increased foot inclination angle is when your ankle is pointed too far up towards your face when you’re landing. This causes the tibialis anterior muscle to work super hard eccentrically to control the lowering of your foot to the ground.
Tibialis Anterior
Foot Inclination Angle
Extended Tibia Angle & Heel Strike Pattern Associated with Shin Splints
Extended Tibia Angle
An extended tibia angle is also associated with shin splints, as those who overstride are doing so via a heel strike pattern. This study suggests that a midfoot strike pattern decreases the activation necessary from the tibialis anterior. Therefore, a modification from rear foot / heel strike to a midfoot strike may be advisable in the short term for those attempting to run while managing shin splints. It is worth noting that any time one lever is pulled to offload one part of the body, another lever is affected. For example, midfoot striking will result in greater load to the bones/joints of the foot. This study additionally found that converting to forefoot striking decreased average and peak loading rates when running. According to another study heel striking and these increased loading rates are associated with tibial stress fractures.
However, the more recent literature is conflicting. For example, this study suggests that calf muscles have a greater contribution to tibial bone loading than impact forces from the ground. The researchers suggested avoiding a forefoot strike pattern, as it increases calf forces, and therefore tibial bone stress.
We rarely advise our runners to switch from a rearfoot to a forefoot strike suddenly, as that can set the runner up for other orthopedic injuries throughout the forefoot metatarsal bones and the Achilles tendon.
Which muscles are weak with shin splints?
We often find weakness and a lack of muscular endurance in the foot intrinsics (often, but not always associated with excessive pronation), triceps surae aka calf complex (gastrocnemius and soleus), and hip muscles (gluteals).
Which muscles are tight with shin splints?
The calf muscles are most commonly tight in runners with shin splints. This causes a major problem because the antagonist muscle (tibialis anterior) has to work extra hard to point the ankle up while running. The body wants equilibrium, so the opposing muscle group is overworked, resulting in overuse injury to the shin.
How do you prevent shin splints when running?
Start out slow: start with no speed work initially. Give your bones, muscles, and tendons time to adapt to the new stresses of running at an easy pace with at least a day of rest in between. Gradually build up your weekly running volume before increasing speed over a period of weeks/months depending on your running goals.
Build calf strength: Our muscles and tendons are much better at absorbing forces than our bones. Adequate calf strength helps to prevent excessive pronation. According to this review, excessive pronation may be associated with shin splints.
Avoid an excessive foot inclination angle: This is how far the foot points up upon ground contact. The cue would be to land with a foot that is more parallel to the ground.
Avoid overstriding: This is when landing in front of one’s pelvis, which typically leads to excessive heel striking (landing aggressively on the heel). These runners typically run with a very upright torso. Some helpful cues would be to run with a 5 degree forward lean coming from the ankles and shorten your stride.
Increase your running cadence: Consider increasing your cadence by 5-10%, which will decrease the excessive heel strike and the amount of time your foot is in contact with the ground (especially if your cadence is low - below 160 steps per minute). The cues here are to shorten your stride and take more frequent steps.
No forefoot strike pattern: a forefoot strike will increase calf forces and therefore tibial bone stress.
Wear a running sneaker with rocker bottom sole: this is for easier transition between phases of running.
Consider a stability shoe: this is especially true if there is excessive pronation seen on the affected side (while simultaneously strengthening your calf, hip, foot intrinsics, etc.).
Replace your running sneakers: you should replace your running sneakers every 300-500 miles, depending on running surfaces, according to the American College of Sports Medicine (ACSM)
Shoe Rotation: have a rotation of daily trainers instead of wearing the same pair every day.
Is it okay to run with shin splints?
Running with shin splints is okay as long as we have ruled our stress reaction injuries (i.e. stress fractures). If we suspect a stress injury to the tibia, we refer to trusted orthopedists for imaging (i.e. x-ray, MRI). If we rule out a stress fracture, then we use a pain monitoring scale in which we don’t want pain to exceed a 2/10 when running. We typically keep our runners running, and we modify the variables such as no speed work, less time on feet, increased rest time between each run, etc. There are cases in which prolonged running still irritates the clients’ symptoms, in which we start with a run:walk protocol.
As we modify the running protocol, we simultaneously introduce the muscular endurance, strength and flexibility interventions based on our evaluation findings. We then progressively re-expose the runner to greater distances, then frequency, and then speed last.
What does a physical therapist do for shin splints?
A physical therapist can help treat shin splints by identifying muscles that are restricted (tight) and muscles that are weak. They will create a plan to address these findings so that you have a smoother running experience. The techniques utilized include hands on manual therapy, corrective exercise, stretching, and functional movements that translate to running (i.e. single leg squats, toe walking, etc.).
A physical therapist is a movement expert, so they will watch you walk and run during a gait analysis. Based on their findings, your physical therapist will cue your running form and make recommendations on ways to optimize your technique. This will make you a more efficient runner that is less likely to experience shin splints.
What are the best exercises for shin splints?
A full assessment helps to determine which exercises are needed for each individual runner. Here are some of the best exercises for shin splints that we often prescribe to our running clients.
1. Calf Stretching (straight & bent knee)
2. Calf Raises
Double Leg Calf Raises
Double to Single Leg Calf Raises
Single Leg Calf Raises
3. Heel Walking & Toe Walking
Heel Walking
Toe Walking
4. Foot Doming & Toe Yoga
Foot Doming
Toe Yoga
5. Runner Clocks
6. Lateral Step Down to Runner’s Pose
Closing Remarks
We hope you found this article helpful. As always, consult with an expert in this field so they can advise and guide you.
If you would like to work with us to resolve your shin pain, contact us below to speak with a physical therapist.
Disclaimer: This is not intended to be formal medical advice. Your individual needs should be met by the appropriate health care practitioners. Please consult with a trusted provider.
Dr. Paul Nasri PT, DPT, OCS, COMT
Dr. Vincent Liu PT, DPT
Doctor of Physical Therapy
The Game Plan Physical Therapy