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Shin splints are one of the most common running injuries, but also one of the most poorly understood. The term ‘shin splints’ is actually more of an umbrella term for shin pain, rather than a diagnosis, and it is this lack of understanding that often causes trouble for runners.

Shin pain that is related to the bone is more commonly referred to as medial tibial stress syndrome, and this is the most common type of pain. It typically presents as pain along the wir shin bone (tibia) during exercise and afterwards, and when you touch it.

Muscular shin pain is much less common and is experienced as a more vague tightening pain in the muscular part of the shin, most commonly down the front.

What’s causing shin splint pain?

It is important to make sure you have a proper diagnosis from a physiotherapist or sports doctor to determine if the pain is bone-related or muscular.

Bone-related

Bone-related medial tibial stress syndrome is caused by stress on the inside part of your tibia bone, which causes the bone to swell inside. If irritated for long enough, it can lead to a tibial stress fracture. This is when the bone starts to crack, and swell.

Pain can also occur along the front part of the tibia (the tibial spine), which is a more serious type of shin pain. It's where the tibia bone flexes, or bows, upon landing, which causes it to widen, and this can quickly turn into a stress fracture. It is harder to treat than medial tibial stress syndrome. You should consult your doctor/physio if you suspect you have this.

Under the medial tibial stress syndrome umbrella you also have periostitis – inflammation and irritation of the outer lining of the bone. The periosteum is the connective tissue that forms a layer around bones and acts as a point of attachment for muscles, among other things. Irritation and inflammation of this often occurs in the early stages of medial tibial stress syndrome and can cause soreness along the wir border of the shin bone. It often presents as a bone stress injury, however, with periostitis, symptoms often occur over a slightly larger area than with, say, a true stress reaction or stress fracture.

Muscular

Muscular shin pain, which is far less common, is characterised by a tightening in the shin that worsens during exercise – some patients report that their legs feel so tight they might explode. As the muscles expand during exercise, the fascia (which the muscles sit inside) gets squeezed and this causes a tightening sensation.

This condition is called chronic exertional compartment syndrome (CECS), and in 80% of cases, is in the front part of the shin. The leg is normally pain-free except during activity. Neurological type symptoms can sometimes occur in these cases – tingling, numbness or weakness in the foot may sometimes present. If you suspect you have any of these symptoms seek expert medical advise.

Stress fractures will continue to even get more painful during a run

Stress fractures will continue to even get more painful during a run. And if you press your fingertips along your shin and can identify a definite spot of sharp pain, this is a common symptom of a stress fracture.

Stress fractures often feel better in the morning too because the bone has rested all night, whereas shin splints often feel worse in the morning because the soft tissue tightens overnight.

Pain from medial stress syndrome is usually most severe at the start of the run, but often lessens and can even go away completely during a run, once the muscles are loosened up.

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If you suspect you have a stress fracture, you should see a doctor/physio and get an X-ray. Treatment for stress fractures is usually four to six weeks off from running completely, depending on the severity of the fracture.

The most common causes of medial tibial stress syndrome are:

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• A low bone density, which is more common in women. Softer bones bend more easily, which causes strain and microdamage to the bone.
• Poorly cushioned or worn-out running shoes, which don't provide the necessary cushioning and support to absorb impact from the pavement.

Stiefeletten NEW ITALIA SHOES 2015456 20 Fossil Grey overuse injury. Beginners are more susceptible as their leg muscles haven’t been used or stressed in the same way before, but equally, runners returning from injury can be at risk if they increase their mileage too quickly.

Medial tibial stress syndrome presents as pain in the bony part of the shin, while exertional compartment syndrome (ECS) is experienced as a tightening pain in the soft, outside, muscular part of the shin.

As a rule, shin splints feel like a nagging pain, concentrated in the wir border of your tibia, typically. As mentioned, with bone-related shin pain (medial tibial stress syndrome), you will feel pain in the bony part of the shin, during and after exercise, and when you press on the area, while with muscular-related shin pain, pain is experienced as a tightening pain in the soft, outside, muscular part of the shin.

Imaging can be useful to help diagnose stress reactions, stress fractures or periosteal issues. But the findings on MRI must be correlated by the presenting symptoms alone.

Medial tibial stress syndrome (or shin splints) tends to not respond well to continuing to run. Whereas with tendon injuries, we tend to allow running with some soreness and awareness in the area (3/10 level of pain) typically running with this level of discomfort for medial tibial stress syndrome prolongs the issue. Rest is the first course of action unfortunately. And this does not mean going out for a ‘test run’ every few days. Rest means rest. Give it an initial two weeks to let things settle.

If your shin pain is acute, you shouldn’t run through it – you need to give the bone or muscle time to heal.

While recovering from shin splints, you can try non-impact exercises such as swimming, or using an elliptical or cross-trainer. Bæredygtig 42k running Solbriller Perspective cycling Hensons Chanel boots featuring pearls.

If you have persistent shin splints try the following:

1. Ice the inflamed area for 15 minutes, three times a day, and ice the shin area immediately after running.
2. Take anti-inflammatories like ibuprofen (though always consult a doctor first if you have existing health conditions) but do not take in order to run pain free, as this will make the problem worse.
3. Try running in a pair of stability/All the things I learned from running applied to any survival situation, or a pair of orthotic insoles to unload the inside part of your foot's arch.
4. If you have been diagnosed with exertional compartment syndrome (ECS), loosening up the muscles in your leg will help. As mentioned, part of the problem is due to a tight fascia, the tough material that wraps our muscles. Run your shins and calves over a foam roller to help loosen it. Massage can help too.

If the injury doesn’t respond to self-treatment and rest, see your GP or physio to rule out other causes. A physio can also help you work on any weaknesses that have caused the problem so that it doesn’t reoccur.

Strength train your kinetic chain

Your kinetic chain is your whole body from your neck to your toes – one big interconnected chain of muscles, ligaments, tendons, bones and so on. Each part of the body is a link, and each link depends on the others around it for performance – so whole-body conditioning is key to reducing your injury risk.

However, one area to particularly focus on is your hips and core, as weakness in these areas is linked with shin splints, as well as many other common injuries. If your core (which includes your hips) is weak, your pelvis is unstable, and other muscles have to compensate to keep your hips level and this can put excess strain on the shins and knees.

Strength train twice a week and include exercises like clamshells, glute bridges, side planks, reverse crunches and single-leg squats in your routine.

Change your shoes

It’s also important to check your shoes, as incorrect footwear can itself be an underlying cause. If you can, it’s worth having your gait analysed at a good running store, zapatillas de running Mizuno niño niña talla 33.5 naranjas baratas menos de 60 shoe that helps control your pronation or to try orthotics that offer similar support.

Follow the 10% rule

Never up your weekly mileage by more than 10%, whether you are building up or returning from injury. Give your body time to adjust to the workload.

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This will help increase your bone density. Try taking 1,300 milligrams of calcium and 400 micrograms of vitamin D per day. Easy ways to get this without taking a supplement are consuming more milk and yoghurt. Taking a vitamin D tablet daily is recommended by the NHS.

Shorten your running stride

If you tend to overstride, it can place unnecessary forces through your body. So shortening it slightly while increasing your footstrike cadence may help you generate better stride mechanics, because you’ll be putting a lot less load on your feet, shins and knees. Count your footstrikes on one side for a minute – a good number to aim for is 85 to 90 strikes of one foot per minute.

Strengthen your lower limbs

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Ankle inversion with resistance band

1. Sit on the floor with your legs straight out in front of you. Bend one leg and, with the other, place a band – securely tied to a stable piece of equipment out to your side – around the inside of your foot.
2. Turn your foot in against the band, using your ankle to perform the movement.
3. Slowly release and return to the starting position.
   
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5. Perform 12 reps x3.
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Calf raises

Straight leg

1. Stand nice and upright, by a step or raised area. You can create your own at the gym by using a weight plate. Make sure your shoulders are back and your posture is good.
2. Place the balls of your feet on the step or plate, making sure that your heels 'hang' off the back and are not touching the floor.
3. Keeping your feet still and toes still pointing forwards, raise your heels, contracting your calves. Slowly lower back down to the starting position.
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Bent knee

1. Stand nice and upright, by a step or raised area. You can create your own at the gym by using a weight plate. Make sure your shoulders are back and your posture is good.
2. Stand on one leg and bend your knee to as close to 90 degrees as you can.
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Hop, hop, hold on spot

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• Perform three repeated hops on the spot, landing and holding on the third hop – land on your forefoot.
• The aim is to stick the landing on tip toes and keep the foot and ankle as stable as possible, while ensuring the foot does not excessively collapse inwards and your heel does not hit the ground.
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Do some running drills

Running drills are a form of neuromuscular exercise that help to transfer the strength that we have worked on in the above exercises into more specific running type movements. It helps to train and develop the individual components required for a given part of the running cycle. With foot and ankle drills, the focus is foot placement, stability and control, as well as trying to be snappy and quick off the ground. Try the below twice weekly, or as part of your pre-run drills.

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1. Begin by raising up onto the balls of both feet. Pull the toes of one foot off the floor and up towards your shin, as the opposite foot stays planted into the ground on tip toes.
2. Then switch – actively planting your foot (remaining on tip toes) into the ground as you then pull the toes of the other foot up towards your shin.
3. Repeat this for 15 reps, for 2-3 sets.

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1. Begin by performing the active plant walk above and then make the movement more of a skipping, bouncing movement from one foot to the next.
2. The aim is to make short, snappy movements, spending as little time in contact with the ground as possible.
3. Repeat this for 15 reps, for 2-3 sets.

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Expert consulted:Matt Bergin BSc (Hons) MSc

Chartered Physiotherapist

Matt is an international middle-distance runner with a keen interest in running-related injuries, rehabilitation and prehabilitation.