How to prevent and treat shin splints

Plagued by shin pain? We explain the symptoms, treatment and rehabilitation of medial tibial stress syndrome so you can beat shin splints for good and keep on running.

How to prevent and treat shin splints

Many of us have been there: training is going well, until you feel a nagging pain in your shin towards the end of a run. It may go away when you stop, but returns with a vengeance when you start running again.

A painful, frustrating and mysterious injury, shin splints can affect runners of all levels. In fact, shin splints account for up to 20 per cent of all running-related injuries. We take a look at what shin splints actually are, how to treat them and how to avoid getting them in future.

What are shin splints?

We asked Lauren Bradshaw, specialist sports physiotherapist at Progress, The Cambridge Centre for Health & Performance and Andrew Carrothers, a consultant orthopaedic surgeon at Spire Cambridge Lea Hospital with a specialist interest in sports injuries, to give us the low down.

The medical term is Medial Tibial Stress Syndrome (MTSS). It usually makes itself known in the form of pain or swelling on the inner edge of your shin bone. What’s really happening is that the periosteum, or lining of the tibia bone is overstressed and inflammation develops.

If this inflammation is ignored and continual load is placed on the inflamed tissue, it will worsen and take longer to heal. Worst case scenario: ultimately a stress fracture may develop in the tibial bone, meaning months out of action, or even permanent damage.

What causes shin splints?

There are often multiple factors involved when it comes to MTSS. According to Lauren, ‘the causes usually involve a sudden increase in training load, frequency or intensity alongside poor lower limb biomechanics and running style. Other factors can include inappropriate footwear and the types of surface you run on as well as quality of diet and the amount of recovery and rest between sessions.’ 

As surgeon Andrew Carrothers explains, ‘a sudden increase in intensity or frequency in activity level fatigues muscles too quickly. Tired muscles cannot properly absorb the shock from the impact. They are less elastic, forcing the tibia and its lining to absorb most of the impact.'

How can you ease the pain of shin splints?

Normally with shin splints the pain is only felt during running or immediately after. If you do experience shin pain, stop running immediately, elevate and apply ice to the affected area for 15-20 minutes to reduce the inflammation. You can also take an anti-inflammatory painkiller (see your GP).   

Do you have to stop running if you get shin splints?

Lauren advises any runner with MTSS to ‘stop or reduce their running if this is the main contributory pain factor (which it often is). The amount of rest prescribed will vary from patient to patient depending on the level of pain they are in and obviously the severity of their shin splints.’

If the shin splints are fairly mild, two weeks complete rest may be enough. For worse cases, with a suspected stress response, recovery will take longer. Lauren recommends around 6-12 weeks off running. 

‘If shin splints are not treated properly, or if exercise is resumed too early or aggressively, shin splints can become permanent,’ warns Andrew.

‘In worst case scenarios they can progress to a stress fracture, which may need operative intervention. Any leg pain not responding to appropriate treatment after 6-8 weeks should be evaluated and investigated by a specialist orthopaedic surgeon.’

The good news is that most cases of shin splints heal on their own with enough rest. Rarely is surgery necessary. But it’s important not to ignore the pain as it will only mean more time off later.

Recovering from shin splints

It’s frustrating to be out of action with an injury but with shin splints you can do other low impact forms of exercise, such as swimming and cycling. You can also do leg strengthening exercises such as calf raises, which will make you less likely to get shin splints in the future.

It helps to stretch the shin area gently. Try this:

Kneel on a carpeted floor, or on a yoga mat with your toes pointing behind you and lean back gently, pressing down on your ankles. Hold for 30 seconds. If you feel pain, stop.

Returning to running

When you think you are ready to return to running, take it very slowly. Your first session should be very gentle: warm up properly and stretch well, then run slowly for 1-2 minutes, before walking for 5 minutes, checking in with your body and seeing if there’s any pain. Repeat twice more if all is well, for a first workout of around 20 minutes. 

It’s important to allow sufficient rest time between sessions. Take at least a full day’s rest before your next session. Increase the running times gradually until you can run 20 minutes without pain. If at any time you feel shin pain, stop immediately and take another 2 or 3 days of complete rest.

How to avoid shin splints in the future

While you are on the mend, take the time to overhaul the various aspects that can contribute to shin splints.

  • If your shoes are worn out or not suited to running long distances, get new ones with adequate cushioning. It’s a good idea to go to a running shop and get your gait analysed. Learn more about your running gait here
  • Work on your running form to ensure you’re not stressing your lower legs with improper technique. Try to reduce over striding and relax your feet more so the muscles are not pulling unduly on the tibia. Your feet should land beneath you, not in front of you. Check out these 6 ways to improve your running technique
  • Make sure you are getting plenty of calcium in your diet to strengthen your bones. As Andrew says, ‘women should take particular care as they are 5 to 3.5 times more likely to progress to stress fractures from shin splints, due to the higher incidence of diminished bone density and osteoporosis.’
  • Try and run on soft, even surfaces where possible. Avoid always running on a slant in the same direction, for example along the edge of a sloping road.
  • Take the time to stretch properly before and after your runs.
  • Focus on strengthening your lower leg muscles.

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