Shin Splints While Running: Causes, Symptoms, and Non-Medical Treatments

Learn about shin splints: their causes, symptoms, and proven treatments. Get the insights you need to prevent and manage this common running injury so you can get back into action.

Ben Bunting BA(Hons), PgCert., AAPTI.

10/8/20248 min read

What are Shin Splints?

Shin splints, also known as medial tibial stress syndrome, are a condition that runners and other high-impact athletes all too often experience.

This condition is characterised by pain along the shinbone (tibia), caused by strain on muscles, tendons and bone tissue in the lower leg.

Shin splints are particularly prevalent among runners, and estimates indicate that 10-15% of them experience this form of discomfort during training sessions.

Shin splints tend to occur during physical activities that involve repeated impact, such as running or jumping.

Initial signs may include mild discomfort in the shin area, which may worsen into more intense discomfort during and after exercise.

Pain typically is focused in the lower third of the tibia and may include tenderness, swelling or stiffness.

While overuse may be the main culprit, additional contributing factors can include improper footwear, inappropriate training surfaces and ineffective warm-up/stretching practices.

An injury to the Achilles tendon can severely reduce performance and lengthen recovery times significantly, creating further setbacks in training and recovery timeframes.

Data reveals that shin splints do not exclusively impact elite athletes; recreational runners can also suffer from this condition.

Reports indicate that shin splints account for approximately one-third of running-related injuries, underscoring the importance of creating awareness and developing preventive strategies among runners.

Understanding shin splints is vitally important to both new and experienced runners alike, as early recognition can lead to timely interventions and reduce the risk of more severe injuries.

Proper education and proactive measures are key elements in maintaining an enjoyable running regimen.

Causes of Shin Splints

Shin splints are caused by overworking the muscles and bones (periosteum) and are often caused by sudden changes in activity. These can include:

  • An increase in the frequency of your workouts, for example by increasing the number of days per week.

  • Changes in duration such as longer distances

  • Changes in intensity such as running uphill after only running on flat surfaces

The following factors can also cause shin splints:

  • Flat feet or abnormally rigid arches

  • Exercising in worn-out or improper footwear

The most common group at risk is runners. Other groups that are frequently affected by the condition include dancers and recruits in the military.

What is Medial Stress Syndrome?

Medial Tibial Stress Syndrome (MTSS) is an increasingly prevalent overuse injury affecting the lower extremities.

This syndrome is characterized by pain along the anteromedial aspect of the tibia that arises with exercise and represents the beginning stages of tibial stress fractures.

MTSS is an overuse injury caused by excessive stress on the tibial bone and accompanying periostitis, and most often seen among individuals participating in activities with repeated impacts such as running, jumping sports or military training.

Prevalence estimates range from 13.6%-20% among runners and up to 35% among military recruits.

Significant increases in training intensity, workout duration or activities with high impact can put individuals at increased risk for Musculoskeletal Stress Syndrome and related bone stress injuries.

Studies of military recruits undergoing basic training have uncovered an association between vitamin D deficiency and an increase in stress injuries.

MTSS is a common source of exercise-induced discomfort, typically manifesting itself with pain along the inner back part of the shin which can be felt while performing activity and when touched, covering an area greater than 5 cm.

MTSS is most likely caused by excessive strain placed upon the medial tibia, with inflammation of the periosteum potentially exacerbating symptoms.

This condition arises from tendons exerting sustained tension on the periosteum of the tibia, creating an effect known as "traction periostitis."

Periostitis is a medical condition characterized by inflammation of the periosteum - the connective tissue layer covering bones - surrounding them.

Stress fractures must be distinguished from chronic bone conditions like this one by tenderness, swelling of the affected bone and persistent aching pain.

MTSS may develop into a full tibial stress fracture due to microtrauma to the cortical bone, leading to microfractures and finally complete fracture.

Although not everyone with MTSS will experience a tibial stress fracture, some will.

MTSS typically presents as pain at the medial edge of the tibia, increased discomfort during physical activity, and sharp pain upon palpation.

Shin splints remain poorly understood, though several hypotheses such as fascial traction and tibial bone overload have been widely circulated as possible causes.

This condition may be the result of inflammation caused by overexertion of muscles, tendons, and the periosteum encasing the tibia during training sessions; often worsened by repetitive action.

The theory of tibial bone overload suggests that repeatedly overloading the tibia leads to micro-injuries and abnormal loading, ultimately leading to changes in biomechanics and muscle soreness typical of shin splints.

Diagnostic of shin splints typically requires an evaluation of a patient's medical history, an in-depth physical exam and possibly medical imaging methods such as computed tomography.

Risk factors associated with the development of shin splints include intrinsic factors, such as being female, having a body mass index of 30 or above, having a navicular drop and irregular gait patterns and being overweight or obese.

Extrinsic factors, such as extended walking or running sessions, also contribute to this condition.

At the stance phase of running, researchers discovered that people living with MTSS experienced greater maximum eversion moments of the ankle than those without this condition.

Notably, even after their symptoms have subsided, people with MTSS continue to have different running biomechanics from those who have never experienced the condition.

Symptoms of Shin Splints

Symptoms typically include tenderness, swelling of the affected area and persistent discomfort.

Shin Splints typically present with pain along the border of the tibia and mild swelling in that area.

Shin splint pain may range from sharp and razor-sharp, to dull and throbbing; occurring both during and after exercise; worsened by touching the area.

Lateral side pain is frequently described as dull and uncomfortable.

Characteristics

Pain typically arises at the start of an exercise routine and diminishes as time progresses, increasing with movement but diminishing with rest.

It will usually become worse the following day, but should eventually go away on its own.

Under severe and chronic medial tibial stress syndrome, pain may even be felt while sitting still.

Dysesthesia and radiation to the foot have both been observed, with similar signs and symptoms seen with stress fractures or overuse injuries.

Preventing Injury: Avoiding Shin Splints

According to a study published in the European Journal of Applied Physiology in 2016, "Downhill Running induces severe tissue damage in lower limbs, which is indirectly demonstrated by massive increases of plasma creatine kinase/myoglobin or inflammatory markers."

Shin splints, more commonly referred to as medial tibial stress syndrome, are an increasingly prevalent problem for runners tackling uphill and downhill terrains.

Pain in the lower leg often results from overuse, improper running techniques or insufficient preparation.

Understanding the primary causes of shin splints is key to developing effective preventative strategies and plans.

Preparing the Body

One of the primary factors behind shin splints is insufficient warm-up and cool-down routines.

An effective warm-up increases blood flow to muscles, making them more flexible and therefore less likely to sustain injuries during running.

A proper warm-up should include dynamic stretching patterns that reflect running's movement patterns.

Cool-down routines serve to return the body to a resting state and aid muscle recovery, with a focus on static stretching and gentle exercises designed to relieve tension in calves and shins.

Strength training exercises targeting lower leg muscles can significantly enhance stability and endurance for hill workouts.

Exercise such as calf raises and toe taps can help develop strength for uphill and downhill running.

Footwear plays an integral part in preventing shin splints. Selecting shoes that provide sufficient cushioning and support tailored to each runner's foot type can reduce impact stress.

Furthermore, you'll be lucky to get more than 800km out of a pair without the cushioning capabilities being diminished.

Keeping up with the theme of footwear, making sure the shoes fit different terrains - whether running uphill on rocky paths or downhill on soft surfaces - is also key to reducing the risk of injury.

Speaking of terrain, consider running on gravel tracks or grassy areas that can absorb some of the impact.

I would also encourage cross-training with other sports such as swimming and cycling. These are low-impact activities and can help improve your cardiovascular fitness.

Risk Factors for Developing Shin Splints

Shin splints can have a dramatic impact on running performance and health, with various risk factors increasing the chance of them occurring, with training frequency being of primary concern.

Increase trainingA sudden change in training such as an increase in volume or intensity can cause shin splints. Shin splints can occur early on when people begin or intensify their training.

Hyperpronate

When the majority or all the weight of the body rests on the inner sole of the shoe, this is called excessive pronation. Hyperpronation may cause an increased eccentric load on the soleus and the tibialis anterior muscles of the calf. This can result in shin splints.

Flat feet (pes planus)

People with flat feet (also called pes planus) tend to place more pressure on the inner soles of their feet, just like people who hyperpronate.

Leg lengths are slightly different

It is possible to have slightly different legs without being aware of it. The biomechanics of running can be affected by a relatively small difference in leg length. This could lead to repetitive injuries such as shin splints.

Wearing improper footwear

Running shoes with inadequate cushioning and proper foot mechanics can encourage shin splints. If you are like me, discovering the correct footwear for my foot type was a game changer. I tend to opt for shoes by the Altra brand.

Running on Hard Surfaces

Constantly running along pavements and other hard surfaces can place real pressure on your musculoskeletal system.

Running on uneven surfaces

Running on uneven surfaces or trails can cause the body to constantly adjust, leading to strains and shin splints.

You have bad running form

Poor form can cause shin splints. It may be time to reach out and use a running coach to correct any issues. Joining a running club would be a good first port of call.

Non-Medical Treatments for Shin Splints

Managing shin splints effectively often involves a combination of various non-medical treatment options that focus on alleviating symptoms and promoting recovery. These methods, while not replacing professional medical advice, can significantly improve comfort and aid the healing process.

One prominent approach is the application of ice therapy. This involves using ice packs or cold compresses on the affected area for 15 to 20 minutes at a time, several times a day.

Ice therapy helps reduce inflammation, numb pain, and limit further swelling. It is essential to ensure that ice is wrapped in a cloth to prevent skin damage.

Physical rehabilitation exercises play a critical role in recovery. Stretching exercises, particularly for the calf muscles and Achilles tendon, can enhance flexibility and reduce stress on the shin.

A recommended routine includes the standing calf stretch and towel stretch, where individuals pull a towel back towards their body while maintaining a straight leg.

Strengthening exercises, like toe raises and ankle dorsiflexion, can also be instrumental. These exercises target the muscles around the shin, aiding in injury prevention and improving overall strength.

Compression techniques, such as using compression sleeves or wraps, can be beneficial in providing support and reducing swelling. Properly fitted compression gear can enhance blood circulation in the legs, leading to improved recovery times.

Using anti-inflammatory treatments such as ibuprofen or aspirin can help alleviate the pain. However, it is important not to use these types of painkillers religiously before you run as it may mask an injury.

Similarly, sports massages can help relax tight muscles and improve blood flow, facilitating recovery.

When to Seek Medical Attention

It is important to know when you should consult a medical professional. Many cases of shin splints can be treated by resting and taking care of yourself, but certain signs indicate that the condition is more severe and may require medical attention.

Understanding these red flags will help you make timely decisions, which are vital to preventing further injury.

Persistent pain is one of the most important indicators. It may be a sign of underlying issues if shin pain persists for more than a few days, increases with physical activity or doesn't improve after rest and recovery.

If the pain is so severe that it interferes with daily activities or even normal walking, then you should seek professional advice.

If you experience symptoms like numbness, tingling, or pain in your lower leg or foot or if the bones are deformed, it is important to seek immediate medical attention.

You must also be careful to notice any significant changes in your biomechanics or running form. Over compensated movements caused by pain can cause other injuries.

A medical professional will be able to identify any issues in such cases and provide runners with the appropriate advice on recovery, injury management, and treatment.

Conclusion

It is not uncommon for individuals suffering from shin splints to experience a sensation of stiffness or tightness in the legs, particularly after prolonged periods of inactivity.

Observing changes in symptoms during rest is crucial; for some, pain may diminish significantly within a short time after ceasing physical activity, only to return upon resuming.

Additionally, swelling or tenderness along the shin area may be present, which can escalate with continued activity.

Recognising these symptoms early is essential for preventing the progression of shin splints and ensuring a timely and effective response to the condition.