Fix Your Shin Splints - Heal & Prevent Shin Splints | Medial Tibial Stress Syndrome

Fix Your Shin Splints - Heal & Prevent Shin Splints | Medial Tibial Stress Syndrome

What are shin splints?

If you’ve ever stepped onto the track, only to feel your lower legs throbbing with every step, it is likely you’ve experienced one of the injuries that are commonly referred to as shin splints. Typically referred to as Medial Tibial Stress Syndrome, shin splints are a chronic overuse injury which typically affects runners and jumpers.

What are the symptoms of shin splints?

Most commonly, shin splints presents are sharp or dull throbbing pain in the lower leg which is aggravated by walking, running, jumping, etc. The pain is typically felt in the medial or inner part of the lower leg, especially present behind and along the shin bone. The pain is caused by small tears and inflammation in the muscle, connective tissue, and bone tissue of the leg.

Why do athletes get shin splints?

In my experience, shin splints result from some combination of poorly progressed training, problems with running or jumping technique, and a lack of strength and tissue resilience in the foot and lower leg. Improper shoe selection may play a role as well.

Shin splints tend to arise after athletes return from summer break and begin their fall training, or during times where training volume is increased dramatically, or the frequency of intense training is increased.

Poor Ground Contact Qualities & Chronically Overloaded Tissues

While medial tibial stress syndrome is a chronic overuse condition, my personal belief is that it is heavily influenced by how one’s foot interacts with the ground when they run and jump. Shin splints are more common in less experienced athletes who tend to have less skillful ground contact mechanics than more experienced athletes. Beyond that, training loads which are too high or progressed too soon can also contribute heavily to shin splints.

When athletes are too “toey” when they jog, run, or jump, aka being too forefoot dominant in their movements, they put excess strain on the calf, posterior tibialis, peroneals, anterior tibialis, and other muscles of the lower leg. Over time, these tissues become overworked and will tighten up as a defense mechanism.

These athletes who are forefoot dominant tend to exhibit a ground contact where their foot is moving forward at impact, which generates large braking forces that have to be endured by the lower leg musculature. Instead of approaching the ground with a dorsiflexed ankle and rolling from heel to toe at low movement velocities, these athletes will be plantarflexed at contact and will not benefit from the natural shock absorbing qualities that the foot and lower leg typically provide.

Over time, the combination of bad mechanics and overloaded tissues leads to the chronic injury pattern we know as shin splints or medial tibial stress syndrome. Your calves get swollen, it hurts to walk or jog, and any chance of performing high quality training has to get thrown out the window. Many athletes try to train through shin splints, only to see their condition get worse and their ability to perform to deteriorate.

Fortunately, there are ways to resolve and prevent shin splints, which is what we will discuss next.

Resolving & Preventing Shin Splints

If you’re dealing with shin splints, here is what I would suggest you do to resolve them:

Reduce or eliminate training volumes of exercises which aggravate the condition. 

This means you need to stop running, jumping, and other high impact forms of training. You can temporarily replace running with stationary bike workouts to maintain your aerobic or anaerobic qualities that are typically targeted through running. By removing the chronic stressors, we can get the body to calm down, reduce pain, and reduce inflammation. It would be wise to ingest anti-inflammatory foods and supplements, such as eating leafy greens, mushrooms, and possibly taking a supplement like Curcumin.

Replace the aggravating activities with something that does not bother you, such as using a stationary bike to replicate running workouts, or using bodyweight and medicine ball circuits for a general strength and fitness stimulus.

Introduce non-offending exercises and work on ground contact technique.

Once you feel you can walk without serious pain, it would be wise to introduce activities that can help bring you closer to being able to run again, while also being diligent to correct technique issues which led to the shin splints in the first place.

Athletes can use dribbles to progress back from stationary biking toward something that is similar to running, while minimizing impact and emphasizing proper ground contact mechanics. When we dribble, we dorsiflex the ankle and roll from heel to forefoot, making sure the foot is moving down or down and back when it meets the ground. In this manner, dribbles can help teach the athlete how to properly contact the ground when they run, while also strengthening and conditioning the tissues of the lower leg. 

If you cannot dribble without pain, try doing a high squat walk. In my personal experience, improving flexibility of the feet, calves, and hamstrings tends to help take pressure off of the afflicted area and reduce pain.

Progress Exercises To Build Strength & Increase Movement Velocity

With any injury, the ultimate goal of rehab is to return to play and then return to peak performance. To do this, we must bridge the gap between where we are and where we need to be by progressing through exercises, ranges of motion, and velocities in the direction of what we are seeking.

If we want to return to running, we need to progress from walking and walking pace drills (such as dribbles) to exercises performed at higher velocities. One can progress from walking paced ankle dribbles to jogging pace ankle dribbles, from a walking pace A-March to an A-Skip performed at a faster velocity, and jogging can be introduced if there is no pain.

Foot and ankle strength also needs to be worked on by athletes returning from shin splints. Athletes can use bands, ankle weights, cables, and more to build strength in the foot, ankle and lower leg. Athletes should perform exercises that include dorsiflexion, plantarflexion, inversion and eversion of the foot, internal and external rotation of the lower leg, as well as exercises that target the intrinsic muscles of the foot. For example you can grab a band with your toes and try to pull the band along the long axis of the foot, pull a band down from above using the toes, etc.

Returning To Performance

Once some basic progressions have been performed and pain is still not an issue, athletes need to continue to progress back to their primary sport activity. If you are a sprinter, this means you need to progress back to sprinting. At first, this may be performed in flats and on grass, with a primary emphasis being put on proper technique and execution of high quality ground contacts.

Athletes in this phase need to be disciplined with their dorsiflexion at ground contact, as well as making sure to bring the foot down and back to the ground rather than crashing forward. This will be easier to work on at lower velocities, but needs to remain a focus as the athlete progresses back to peak performance.

It is important that in this period athletes do not implement running volumes that are extreme, and care should be taken to avoid going back to the workloads which were present when the shin splints became an issue. For example if you were sprinting 500 meters worth of volume in your sessions when the shin splints popped up, maybe you need to drop it down to 200 meters of sprinting at first, with bike workouts or other plan B activities being used for athletes who feel they need a greater metabolic stimulus but are worried about recurrence of shin splints.

Eventually, with sane progressions, disciplined technique, and patience, athletes will be able to return to using more volume in their program. It is important though that you be aware of the signs of shin splints returning, such as feeling a lot of pressure in the lower leg after your workouts, and that these signs not be ignored. 

You may have to reframe in your mind how much work is enough, and you may never actually be able to utilize the volumes you want in your training. Just because we tell ourselves we need X amount of sprinting or running in our program, does not mean that this is objective truth. There are many ways in which people fool themselves in this world, and one of those ways can be in convincing oneself of how much work they “need” to perform. Preconceived notions about workloads can be the downfall of many a great athlete.

Conclusion

To wrap things up, here is a recap of how I think we can deal with shin splints.

First, we want to reduce or eliminate training volumes of exercises which aggravate the condition. This means we need to stop running and jumping, but maintain work that does not bother the condition such as lifting weights or using a stationary bike.

Next, we want to introduce non-offending exercises and work on ground contact technique. We need to maintain training but do so by utilizing exercises that do not aggravate the shin splints, while also helping us prevent the issue in the future. This is where walking and jogging pace drills can be used if there is no pain. Care should be taken to emphasize proper ground contact mechanics, such as avoiding being forefoot dominant at contact and making sure we have access to good ankle dorsiflexion range of motion.

Eventually we want to progress exercise velocity, range of motion, and complexity, while also using exercises that strengthen the foot and lower leg. The enhanced strength and motor control that comes from doing basic strengthening exercises will help prevent shin splints in the future, so long as workloads and ground contact mechanics are in a good place.

Once you feel that you are progressing well and the pain is not returning, you can finally progress back to sprinting, jumping, running fast, etc. If the pain begins to return, assess your movement technique, ground contact mechanics, and reconsider how much volume or training frequency you can handle. Maybe you can handle the volume but need an extra day or rest, or maybe you need to split the volume up over more days, with less volume being performed on any given day.

Ultimately, shin splints can be resolved, but only if care is taken to ensure you are moving well and loading the body optimally, not maximally.