In this article, we cover:
1. What are shin splints
2. What puts you at risk for shin splints
3. How to treat shin splints
4. How long recovery takes
5. Why people keep getting shin splints
6. How our app can help you improve your shin splints
1. What Are Shin Splints:
Shin splints are one of the most common injuries athletes develop, occurring in about 16-25% of all runners.
However, despite how common they are, their cause is still debated.
Different studies have shown different underlying reasons. Some declare shin splints are caused by the breakdown and pain of fascia whereas others have found bone overload and repair inability to be the issue. In fact, even imaging cannot differentiate between those that have shin splints and those that do not.
Since shin splints, more formally known as medial tibial stress syndrome (MTSS), cannot yet be diagnosed by imaging, they are diagnosed by clinical presentation.
Thus, MTSS is defined as:
Exercise induced pain located along the posteromedial tibial border (the insides of your shin bones) with pain upon palpation of that border for ≥5 consecutive centimeters.
You won’t have any swelling, cramping/burning pain, numbness, or tingling with only MTSS. If you do, it’s generally something else.
2. What Puts You At Risk For Shin Splints:
No matter the exact cause, the breakdown of tissue and lack of recovery are due to overuse that can be compounded and made worse with certain risk factors. Specifically, you have an increased risk for developing MTSS if you:
· Are female
· Have a heavier bodyweight
· Have an increased navicular drop (think flat foot and decreased strength/control)
· Have a previous running injury
· Have greater hip ER with hip in flexion (think decreased hip mobility and control)
· Have fewer years experience in sport
Some of these risk factors can be changed, like heavier body weight and greater hip external rotation. Unfortunately, others can’t, like being female and having a previous running injury.
3. How to Treat Shin Splints:
Now that you know what MTSS is, how do you treat it?
Unfortunately, the evidence here isn’t great. Systematic reviews (papers that summarize the results of many studies) show that things like lower leg bracing, gait training, rest, ice massage, electrical stimulation therapy, injections, stretching and strengthening, and graded running programs all are of pretty low evidence and not strongly supported for MTSS treatment.
What then, should you do?
In cases like this, where the evidence isn’t strong for treatments, you stick to the facts and the basics.
MTSS is a load intolerance issue due, in the end, to overuse. Other risk factors may make you more likely to develop it (like being overweight), but they themselves don’t cause it.
The best course of action would be appropriately, and slowly, loading the area. Concurrently, you need to ensure proper education on MTSS (like what you’re doing right now) and understand the recovery process.
4. How Long Does Recovery Take:
It takes about 3 months before patients who have had chronic MTSS are able to run 20 minutes continuously with minimal pain at a moderate pace. However, for more athletic and higher volume activities, it may take up to 9-12 months to return to sport from shin splints.
This is often much longer than people expect. Unfortunately, expectations don’t affect reality and when people try to return to sport and activity sooner, they often relapse.
5. Why People Keep Getting Shin Splints:
During the recovery process, careful loading is crucial. Often, loading is added too fast too soon and pain returns with increased intensity. Again, knowing and avoiding this is extremely important. Generally, increasing volume of non-painful activity 10-30% or less per week has been shown to work well without aggravating symptoms.
Why does loading/exercising work when loading was the original problem?
Movement helps to restore strength, structure, and integrity to damaged tissues (like muscle and bone) as it stimulates healing, blood flow, and tensile organization. However, there is a sweet spot. Overloading the tissue will break it down faster than the body can repair. Not loading the tissue enough for extended periods will cause less healing and more degeneration due to the “use it or lose it” principle.
This is why only resting does not work, simply continuing to workout as usual does not work, and only resting and then going straight back to your usual volume does not work.
The tissue needs to be reloaded slowly and appropriately.
6. How We Can Help:
Your best bet for helping your shin splints would be to visit a local physical therapist. However, if you do not have the time, money, or inclination to do so, we welcome you to utilize our tailored rehab programs in our app, Renegade Rehabilitation. In the case of shin splints, you’d use our ankle programs.
After filling out a serious of questions to inform us about your specific pain and situation, we create a tailored program for you, going through the exact process just described.
We tell you exactly what to do for each day, sets and reps, and show you how to do each exercise. We guide you through the natural phases of your body’s healing and progress you to increased loads and intensities. We also help strengthen your body’s other weak points, helping fix some of the risk factors for MTSS noted above in an effort to prevent long term reoccurrence!
Coupled with a smart walking/running progression program and good education on the topic (already done!), we believe the Renegade Rehabilitation app is instrumental in helping you get rid of your shin splints and, more importantly, keeping them from returning!
References:
Reinking MF, Austin TM, Richter RR, Krieger MM. Medial Tibial Stress Syndrome in Active Individuals: A Systematic Review and Meta-analysis of Risk Factors. Sports Health. 2017;9(3):252-261.
Moen MH, Tol JL, Weir A et al (2009) Medial tibial stress syndrome: a critical review. Sports Med 39:523–546
Mulvad B, Nielsen RO, Lind M, Ramskov D (2018) Diagnoses and time to recovery among injured recreational runners in the RUN CLEVER trial. PLoS ONE 13(10):e204742
Winters M. The diagnosis and management of medial tibial stress syndrome : An evidence update. Unfallchirurg. 2020;123(Suppl 1):15-19.