The Complete Runner's Guide to Recovering from Shin Splints

Introduction

"Shin Splints" (Medial Tibial Stress Syndrome or MTSS) is a very common injury related to increased stress on our shin bone and the surrounding soft tissue structures. This results in inflammation commonly along the inside boarder of your shin bone and ultimately pain. 

It’s very likely that you’ve heard of someone having “shin splints” before. People will often experience this in the face of change, especially in a short period of time. We commonly see this when runners transition from treadmill running to outdoor running, changing surfaces you run on such as adding in trail running, a sudden increase in mileage/pace, or changing sports at the turn of a season (ex. going from court sports to field sports). 

It is extremely important to be properly diagnosed with MTSS so that you can begin an individualized rehab and prevent this from transitioning to a true bone stress injury such as a stress reaction or stress fracture. We will address that in greater detail below. Let's dig in, shall we?!?

What is Medial Tibial Stress Syndrome?

MTSS or Shin Splints is caused by inflammation and stress along the tibia (shin) bone and surrounding tissues. This inflammation can cause pain that may be made worse with activity, specifically running or high impact pounding activities.

If you fall under any of these categories, you may be more prone to experiencing MTSS: 

• Adolescent athlete
• Female
• Higher body mass index
• Previous history of MTSS
• Recent increase in training intensity/volume or change of surface

Common Symptoms of MTSS: 

• Dull-aching sensation in your lower leg generally along the inside edge of your shin
• Diffuse pain to touch along the inside edge of your shin
• Worsening discomfort with activity and weight bearing/pounding 

What Happens if You Ignore It?

It Could Impact Your Performance and Durability

Whenever you have pain, your muscles go into protection mode. They may become tighter or you may have secondary weakness due to the pain. Ultimately, pushing through pain is going to affect your running performance and likely lead to further injury.

It Could Alter Your Running Mechanics

When you have pain due to MTSS, your body may begin to compensate through other joints such as your hips, knees, ankle, or feet in order to get the job done. Eventually, this can lead to pain in other regions of your body. Common secondary injuries may include tendonitis, IT band syndrome, or patellofemoral pain. 

It Could Get Worse

Although MTSS affects the area surrounding our shin bone, it is not considered a true bone stress injury. However, if you ignore it, the repetitive stress can progress to a tibial bone stress injury. A bone stress injury is a much more serious condition in which there has been a small weakening or fracture in the bone that would be identified on physical exam and imaging. Bone stress injuries require a multi-disciplinary approach, time off from your activity, and a slow progressive return to sport guided by a physical therapist and physician. 

How do I know if I have MTSS or a Bone Stress Injury?

While these injuries share some common symptoms, there are very different treatment paths for each of them. It is important to correctly identify if you have MTSS (Shin Splints) or a Bone Stress Injury (BSI). Here are the common identifiers for each injury:

• MTSS (Shin Splints)
  • Common in adolescence
  • Common to feel pain in both legs
  • Recent increase in training volume - specifically long distance running, speed work or surface change
  • Generalized pain along the inside edge of the shin bone 
  • May or may not be able to diagnose with MRI - pain is the greatest indicator 
• Bone Stress Injury
  • Inadequate nutrition and fueling (REDs) often plays a role 
  • Common to feel pain in one leg
  • Localized, pinpoint pain, can feel sharp at times (about the size of your thumb or smaller)
  • Recent aggressive training volume/intensity spike
  • Long term high training volume
  • Higher body mass index
  • History of stress fracture or stress reaction 
  • Able to diagnose from MRI

Rehab Exercises for Medial Tibial Stress Syndrome

Mobility Work

Maintaining full range of motion at your ankles allows for us to properly load through our hip and knee every time we contact the ground, decreasing the stress that might filter towards our shin if we are restricted. When treating patients with shin splints, we commonly identify areas of calf weakness which causes our body to compensate and respond by tightening up. So using active mobility strategies like the videos shown below can help address range of motion deficits you might have that are contributing to your shin splints, or might help prevent your from losing range or motion in the face of injury. 

• Calf Stretching (Gastroc and Soleus)
  • 3-Way Straight Leg Calf Stretch
    
• Ankle Mobility Drills
  • ½ Kneeling 3-Way Ankle Dorsiflexion to Wall
    

Strengthening Exercises

It is important to go past stretching and passive care and use a variety of exercises to get at the cause of your shin pain to get back to running pain free! Commonly there are imbalances in the strength of the lower leg that are contributing to your pain. The stronger you get (ie. the bigger your engine) the more durable your body is!

When we address lower leg injuries we strengthen from the ground up! Your feet are the foundation for how you move and absorb stress. Additionally, we need to work to address lower leg strength and your ability to produce force. But don't stop there! We also need to work to address hip and leg strength and stability to ensure that we are absorbing and producing force well through our entire lower body! Here are some basic at home exercises you can try!

• Foot Intrinsic Muscle Strengthening
  • Towel Scrunches
    

• Tibialis Anterior Strengthening (front of your shin)
  
  • Wall Sit Foot Pick Ups
    
• Soleus and Gastrocnemius Strengthening
  • Double Leg Heel Raise on Step
    
  • Double Leg Soleus Heel Raise
    
  • Tennis Ball Heel Raise (for shin splint pain tendon specific work)
    

• Hip and Glute Strengthening (for improved shock absorption)
  • Glute Bridge March 
    
  • Kneeling Lateral Plank with Top Leg Raise
    

Neuromuscular Control & Running Specific Drills

Altered mechanics and decreased control are common contributions to why we experience shin pain. It is always important to incorporate balance, landing (force absorption) and explosiveness (force production) in your training to prepare your body for the "job description" of running.

• Single-leg balance and stability work
  • Single Leg RDL Kettle Bell Switches (Take shoes off)
    
  • Double Leg Snap Downs (done when pain free)
    
  • Double Leg Wall Drill Load and Lift (done when pain free)
    

Rehab Strategies to Recover and Return to Running

Load Management

MTSS commonly occurs because there with a change in load volume or intensity. Here are some ways you can help manage that variable to regain control of your shin pain. 

• Temporary reduction in running volume and intensity (distance, pace, and frequency are all variables to assess)
• Using a heel lift to temporarily decrease tibial stress
• Wearing a high drop or rocker soled shoe to temporarily decrease tibial stress
• Using pain as a guide to modify activity, you should not feel pain greater than 2/10 (mild soreness) while doing selected activities.
• Guided tibial loading program led by a specialized physical therapist. Muscle strengthens bone! A good tibial loading program should include targeted strengthening exercises and plyometrics that gradually expose your bone to more stress.

Cross Training Options

Cross training using a variety of options is helpful to reduce the pounding volume/stress on your legs, and still maintain your fitness. Especially in the beginning when trying to calm down your pain. Common cross training options include, the bike (stationary or outdoor), swimming, or pool "running" using a flotation belt. Or whatever motivates you and fits your lifestyle!

Gradual Return to Running

When returning to running, you NEVER want to jump in head first! Returning to running is about a slow progression of exposures to allow your shin to tolerate the stress again. Common return to running progressions include walk/run progressions that slowly manipulate the walk/run ratio, as well as increasing in time as well as distance. These are best done under the guidance of a physical therapist as they can help track your response to the reintroduction of running and what the best plan is for you!

Gain Retaining (if needed)

Direct gait retraining is done only on a rare basis as studies have shown that not many changes actually occur over the long term. There is no such thing as a perfect gait pattern; heel, midfoot, and forefoot striking all happen in the world of running. What we care more about is where you strike the ground in relation to your body, and less about how you strike the ground unless it is truly problematic.

That being said, we can manipulate variables such as cadence and pace to positively affect where you are likely to strike the ground in relation to the center of your body, as well as how much time you spend on the ground. The most common variable to play with is cadence.

• Count how many times your right foot hits the ground for 30 seconds and multiply by 4.

There is no such think as a perfect cadence. However is you are experiencing pain, trying taking it up by 5-10 beats per minute and see if that positively affects your discomfort. 

How to Train Around the Injury

One of the most important things you can do is continue to find methods to train while injured and limiting what had caused you to experience pain. Complete rest in the face of injury can lead to further losses in strength and your cardiovascular base, making it more difficult to return to your sport when you are able. Some common ways to accomplish this include:

• Pain free strength training and mobility work
• Alternative cardio workouts are great to maintain endurance while minimizing impact. This can include activities such as biking, swimming or rowing. It is important to maintain aerobic endurance while rehabbing from an injury in order to make your full return to running an easier transition. 
• Using soft surfaces, treadmill running or walking as an intermediate step back to full training. Incorporating these things into your plan temporarily can help maintain your activity levels while decreasing stress on your tibia.

The Benefits of an Objective Evaluation & 3D Running Analysis at Kinetic Sports Medicine

The smoothest road to recovery is to ultimately have a plan and program built specifically for your needs. At Kinetic Sports Medicine and Performance we treat all levels of runners and provide them with an in-depth experience that allows you to get back to running pain free. Our performance running assessment and treatments include: 

• Comprehensive Movement & Strength Assessment: Identifying imbalances that contribute to MTSS. Muscle imbalances can cause increased stress in other areas of the body, resulting in overuse and pain over time.
• 3D Running Analysis:
  • Detecting biomechanical inefficiencies contributing to tibial stress.
  • Making data-driven adjustments to stride, cadence, and impact mechanics.
• Personalized Treatment Plans:
  • A structured, individualized approach for faster and safer recovery.
  • Specific bone loading and strengthening program to get you back to pain free running

Conclusion

If you are experiencing persistent shin pain, don’t wait to talk to a professional. You could save yourself lots of time away from your activity. 

Proper rehab and a full running analysis can help you identify areas of weakness, range of motion deficits, movement compensations, and training errors. Having this knowledge can give you the power to manage your injuries, prevent secondary injuries, and ultimately level up your performance!

If you are in pain and need support, we are here to help you understand what is causing your pain, get you out of pain and get back to the things you love pain-free. If you would like to learn more, call us to book an injury consultation call or a visit with one of our Doctors of Physical Therapy today!