How to get rid of shin splints
Expert advice from one of our physiotherapists on how to safely get rid of the pain from shin splints, and aim to prevent it from coming back.
Shin splints is one of the most common lower leg problems in runners. The tricky thing with shin splints, is that it is not really a diagnosis, and simply means “shin pain”. There can be many different causes of shin pain, but the most common is a condition called Medial Tibial Stress Syndrome (MTSS).
In some cases, the pain can be caused by a stress fracture of the bone, or a condition called compartment syndrome. We will cover these in a later blog and we must really emphasize - the advice here is NOT for these conditions.
What causes shin splints?
The causes of medial tibial stress syndrome are not fully understood. Evidence suggests there is a spectrum of “stress injuries” that occur, and often several factors that contribute to the condition.
It is common for people with shin splints to have imbalances in strength and flexibility in the muscles of the lower leg. This can can cause a pull from the muscular attachment and cause abnormal strain through the shin bone .
Chronic repetitive loads such as running can cause inflammation on the surface of the shin bone (periostitis), especially so when there is tightness or weakness of the surrounding muscles.
How do I know if I have shin splints?
Pain is usually felt along the inner border of the shin bone and tends to be at the lower end, towards the ankle. The pain tends to be nagging and will occur during and after exercise, and when you press on the affected area. Often the pain is worse when you first start exercise, may reduce as you continue, and then worsen after you have stopped.
Sometimes, although much less common, the pain can be felt in the outer, muscular part of the shin
A large proportion of the time, shin splints occur when you ramp up the mileage too quickly. Have a look at our blog, “Reducing the risk of running injuries” to see if there is anything you can be doing going forwards to reduce issues when you run. Prevention is better than cure and we want to help you make sure any problems do not return!
What can I do about shin splints?
If your pain is reasonably mild and only comes on with running, then it is likely you are suffering from Medial Tibial Stress Syndrome (MTSS). This tends to occur in people who have just started running, or those that have increased their mileage or intensity.
If you have severe or rapidly increasing shin pain, or a small specific point of pain on the bone do not continue running and call your GP for an urgent appointment. You may be suffering from a stress fracture or compartment syndrome. If you are not sure, play it safe. Stop running and speak to your physiotherapist.
Step 1 - Rest!
Because MTSS is generally caused by overuse, it’s usually advisable to have a period of rest from running. Your physiotherapist will be able to advise you how long is best, depending on the symptoms that you have and their assessment of your legs.
You may be able to continue running without pain with lower mileage, frequency or intensity, but be cautious here that you are really reducing the stress on your legs. You could consider a softer running surface such as a treadmill or grass for a short period to reduce the impact through the shin bone.
Compression socks or sleeves can be really helpful for improving pain with MTSS, but they will not cure any condition if this is the only thing you are doing to help your injury.
Step 2 - Check your shoes
Make sure the shoes you are wearing for physical activity are not too old and have good support. Some people find they wear down one side of the shoe more than others. You may want to consider seeing a podiatrist for some insoles if this is you.
A few of our top tips for checking your running shoes:
Bend the sole of the shoe to see if it is rigid. If it becomes bendy, this suggests there is reduced shock absorption
If you feel your shoes have lost their “spring”, it’s probably time for a new pair.
Look at the sole of the shoe for signs of wear and check they still have a reasonable grip.
Change your shoes every 300-500 miles of running (try to roughly keep track).
Step 3 - Reduce tightness in any surrounding muscles
Often with MTSS the muscles of the calf are tight and this results in excessive strain on the shin bone. Using a foam roller over these muscles can be a really good way of releasing any tightness.
If you don’t already have one, we recommend the Edge Sports 2 in 1 Foam Roller and ball. This is a great set as it comes with one hollow design rumble roller and one softer smooth foam roller. The softer one may be a good place to start if you are very stiff as this can be a little sore to start with!
Stretching is another good way to target tightness in the muscles around the shin. Be mindful that with irritable shin splints, stretching and foam rollers may actually make your pain worse, especially if you haven’t factored in time to rest before starting the rehab. Take it slowly, stop if it causes more pain and consult your physiotherapist.
Calf stretch on a step
Standing on the edge of a step, with your heels hanging over the edge.
Slowly lower your heels until you feel the stretch in your calves. Sometimes you can feel more of a stretch if you do this one leg at a time.
Hold for 20-30 seconds.
Repeat 3 times
Step 3 - Improve endurance of the muscles
The muscles of the calf are really important when running to absorb the impact of each step. These muscles need strength, but also endurance to prevent fatigue when running for longer distances.
Muscle fatigue can lead to reduced support for the tibia, more stress and therefore more symptoms! Again, this can often be an issue for novice runners who increase the mileage too quickly.
One quick way to check for muscle endurance of your calves is repeated single leg heel raises. Stand on one leg, and come up onto your toes. Then lower to the count of 3. See how many you can do before your calf muscle starts to tire, and then try on the other leg. Is there a difference in the leg that you are having issues with?
Eccentric calf strengthening: Straight leg
Standing on one foot (make sure you are holding onto something!) with your heel hanging over the edge of a step.
Raise up onto your toes. Then slowly lower your heels over the edge of the step to the count of 3.
Repeat 15 reps x 3, or build up to this as you feel able.
Eccentric calf strengthening: Bent leg
This is exactly the same exercise as above, but completing with a bent knee (around 30°)
This targets a slightly different muscle, the soleus, which is a deeper part of the calf muscle attaching to the shin bone.
Lower slowly to the count of 3.
Repeat 15 reps x 3, or build up to this as you feel able.
If things do not improve with the above advice within 4-6 weeks, go to see your physiotherapist. There are many other factors that can contribute to shin splints that they will be able to assess for you. These include balance, hip and core strength, foot position and ankle joint movement, which can all contribute towards MTSS and working on these can often make a big difference.
This is absolutely not written to substitute medical advice and it is always important to see a qualified health care professional for a formal diagnosis. If any of the exercises cause pain during or after the exercise, discontinue and consult a physiotherapist.
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