"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?!?
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:
Common Symptoms of MTSS:
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.
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.
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.
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:
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.
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!
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.
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.
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!
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!
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.
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.
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:
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:
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!