Shin splints, medically known as medial tibial stress syndrome (MTSS), is one of the most common running-related injuries, affecting up to 35% of runners at some point. Understanding the causes and implementing proper prevention strategies can help you stay active and pain-free. At M.O. Therapy in Markham, we help athletes recover from shin splints and prevent recurrence.
Understanding Shin Splints
What Are Shin Splints?
Shin splints refer to pain along the inner edge of the shinbone (tibia), typically occurring in runners and other athletes who engage in repetitive lower leg impact.
Medical Definition:
- Medial tibial stress syndrome (MTSS)
- Pain along posteromedial tibial border
- Exercise-induced pain
- Tenderness over 5+ cm of tibia
Anatomy Involved
The shin area involves several important structures:
Tibia:
- Main weight-bearing bone of lower leg
- Bears 2-3 times body weight during running
- Experiences repetitive bending forces
Muscles:
- Tibialis posterior (main culprit)
- Soleus
- Flexor digitorum longus
- These muscles attach along the inner tibia
Periosteum:
- Outer covering of bone
- Muscle attachments create traction
- Inflammation occurs here
Stress Injury Continuum
Shin splints exist on a continuum of tibial stress injuries:
Stage 1: Shin Splints (MTSS)
- Periosteal inflammation
- Diffuse tenderness
- Pain improves during activity
Stage 2: Stress Reaction
- Bone marrow edema (on MRI)
- More focal tenderness
- Pain may persist during activity
Stage 3: Stress Fracture
- Discrete fracture line
- Point tenderness
- Pain during activity and at rest
Causes and Risk Factors
Training Errors (Most Common)
Overload Issues:
- Rapid increase in mileage
- Increasing intensity too quickly
- Insufficient recovery time
- Running on consecutive days
The 10% Rule:
- Don't increase weekly mileage by more than 10%
- Allows bone and soft tissue adaptation
- Prevents overload injuries
Biomechanical Factors
Foot Mechanics:
- Overpronation (foot rolls inward excessively)
- Increases tibial internal rotation
- Increases stress on medial tibia
Running Form:
- Overstriding
- Heel striking with extended knee
- Low cadence
- Insufficient hip strength
Flexibility Issues:
- Tight calf muscles
- Limited ankle dorsiflexion
- Tight hip flexors
Anatomical Factors
Structural:
- Flat feet (pes planus)
- High arches (pes cavus)
- Leg length discrepancy
- Tibial varum
Bone Density:
- Lower bone density increases risk
- More common in females
- Nutritional factors matter
Environmental Factors
Surface:
- Hard surfaces (concrete, roads)
- Cambered roads
- Sudden surface changes
- Indoor tracks (tight turns)
Footwear:
- Worn-out shoes
- Wrong shoe type
- Lack of cushioning
Other Risk Factors
- Female sex
- Previous history of shin splints
- High BMI
- Smoking
- Low fitness level
- Inadequate nutrition
Symptoms and Diagnosis
Typical Symptoms
Pain Characteristics:
- Dull, aching pain along inner shin
- Typically covers 5+ cm of tibia
- Starts during activity
- May improve during activity initially
- Becomes more constant as condition progresses
- Pain after activity common
Associated Symptoms:
- Mild swelling along shin
- Tenderness to touch
- Stiffness after rest
- Pain when pressing along tibia
Differentiating from Stress Fracture
Shin Splints:
- Diffuse tenderness (5+ cm)
- Pain improves during activity (early)
- No pain at rest initially
- X-ray typically normal
Stress Fracture:
- Point tenderness (1-2 cm)
- Pain during and after activity
- Pain at rest possible
- May show on X-ray (late) or MRI
When to Seek Evaluation
See a professional if:
- Pain doesn't improve with rest
- Pain present at rest
- Specific point tenderness
- Night pain
- Progressive worsening
- Unable to walk without pain
Diagnostic Imaging
X-Ray:
- Usually normal in MTSS
- May show stress fracture
- Rules out other bone pathology
MRI:
- Most sensitive test
- Shows periosteal edema in MTSS
- Differentiates from stress fracture
- Shows bone marrow edema in stress reaction
Bone Scan:
- Shows increased uptake
- Diffuse pattern in MTSS
- Focal uptake in stress fracture
- Less specific than MRI
Treatment Options
Acute Phase Management
Rest and Activity Modification:
- Reduce or stop running temporarily
- Cross-train with low-impact activities
- Swimming, cycling, elliptical
- Return based on symptoms
Ice:
- Apply after activity
- 15-20 minutes at a time
- Reduces inflammation
Compression:
- Compression sleeves may help
- Provides support during activity
- May reduce discomfort
Physiotherapy Treatment
Goals:
- Reduce pain and inflammation
- Correct contributing factors
- Strengthen lower leg muscles
- Improve biomechanics
Treatment Components:
Manual Therapy:
- Soft tissue mobilization
- Calf muscle release
- Joint mobilization (ankle, foot)
- Dry needling (trigger points)
Exercise Prescription:
- Calf strengthening (both gastrocnemius and soleus)
- Tibialis posterior strengthening
- Hip strengthening (especially gluteus medius)
- Core stability exercises
Gait Analysis:
- Assess running form
- Identify contributing factors
- Provide running technique cues
- Gradual implementation of changes
Addressing Contributing Factors
Footwear:
- Assess current shoes
- Consider motion control or neutral based on foot type
- Replace shoes regularly (300-500 miles)
- Consider custom orthotics if indicated
Training Modifications:
- Reduce mileage and intensity
- Increase rest days
- Vary running surfaces
- Follow gradual progression
Other Treatments
Orthotics:
- Custom or over-the-counter
- Address overpronation
- Provide arch support
- May reduce tibial stress
Taping:
- Low-dye taping for arch support
- Kinesiology taping
- Temporary measure
Prevention Strategies
Training Principles
Gradual Progression:
- Follow 10% rule for mileage increases
- Alternate hard and easy days
- Include rest days
- Periodize training appropriately
Cross-Training:
- Include non-impact activities
- Swimming, cycling, elliptical
- Reduces repetitive stress
- Maintains cardiovascular fitness
Surface Variation:
- Mix soft and hard surfaces
- Trail running when possible
- Avoid cambered roads
- Be cautious with new surfaces
Strengthening Program
Calf Strengthening:
Standing Calf Raises:
- Stand on edge of step
- Rise onto toes
- Lower slowly
- 3 sets of 15-20
Seated Calf Raises:
- Target soleus muscle
- Weight on thighs
- Rise onto toes
- 3 sets of 15-20
Single-Leg Calf Raises:
- Progress to single leg
- Increases challenge
- 3 sets of 10-15 each leg
Tibialis Posterior:
Resistance Band Inversion:
- Band around forefoot
- Turn foot inward against resistance
- 3 sets of 15-20
Heel Walks:
- Walk on heels
- 30 seconds at a time
- 3-5 sets
Hip Strengthening:
Side-Lying Hip Abduction:
- Lie on side
- Lift top leg up
- 3 sets of 15
Clamshells:
- Knees bent, lift top knee
- 3 sets of 15
Single-Leg Bridges:
- Progress from double-leg
- 3 sets of 10 each side
Flexibility Work
Calf Stretches:
- Wall stretch for gastrocnemius
- Knee bent stretch for soleus
- Hold 30 seconds, 3 times each
Ankle Mobility:
- Ankle circles
- Dorsiflexion stretches
- Foam rolling calf complex
Running Form Considerations
Cadence:
- Increasing step rate reduces impact
- Aim for 170-180 steps per minute
- Use metronome app to practice
Foot Strike:
- Avoid overstriding
- Land closer to body
- Slight forward lean
Return to Running
Criteria for Return
- Pain-free walking
- Pain-free with single-leg hops
- Full range of motion
- Adequate strength
- Addressed contributing factors
Return Protocol
Week 1:
- Walk-run intervals
- 1-minute run, 4-minute walk
- 20-30 minutes total
- Every other day
Week 2:
- 2-minute run, 3-minute walk
- 25-35 minutes total
- Every other day
Week 3:
- 3-minute run, 2-minute walk
- 30-40 minutes total
- Progress based on symptoms
Week 4 and Beyond:
- Gradual increase in run intervals
- Decrease walk intervals
- Progress to continuous running
- Follow 10% rule thereafter
Frequently Asked Questions
How long does it take shin splints to heal? With proper rest and treatment, mild shin splints typically improve in 2-4 weeks. More severe cases may take 6-12 weeks. Returning to running too quickly often leads to recurrence.
Can I run through shin splints? Running through shin splints often worsens the condition and can lead to stress fractures. Rest or significant activity modification is typically necessary for healing.
Do compression sleeves help shin splints? Compression sleeves may provide comfort and support but don't address underlying causes. They can be helpful as part of a comprehensive treatment plan but shouldn't be relied upon alone.
Should I get orthotics for shin splints? Orthotics may help if overpronation or foot mechanics are contributing factors. A professional assessment can determine if orthotics would benefit your specific situation.
Book Your Assessment
If you're dealing with shin splints, M.O. Therapy in Markham can help you recover and prevent recurrence. Our team will identify contributing factors and develop a comprehensive treatment plan.
Call (905) 201-5827 or book online for your assessment. We offer direct billing and same-day appointments.