This blog discusses current trends around the treatment of runners with lower leg pain and does not constitute medical advice. If you have pain associated with your running activities, please consult with a clinician for a proper assessment.
Identifying, Treating, and Overcoming Medial Shin Splints
In the words of ultrarunning legend Dean Karnazes, "There is magic in misery. Just ask any runner." There’s no way to sugarcoat the fact that running injuries are miserable. But to every runner dealing with an injury, let us remind you: this setback is temporary and the magic of pain free running will come.
Today we dissect Shin Splints – or what your doctor might refer to as Tibial Stress Syndrome.TSS is the sweeping term for lower leg pain that occurs below the knee, but above the ankle. Depending on the location of your discomfort, Shin Splints can be further diagnosed as either:
Anterior Shin Splints – when pain persists on the front outside part of the lower leg, or
Medial Shin Splints – when pain persists on the front inside part of the lower leg.
Because Medial Shin Splints plague more runners than Anterior Shin Splints, this blog post is dedicated to defining, identifying, and treating Medial Shin Splints – also known as Medial Tibial Stress Syndrome(MTSS).
While this blog will provide you with expert insights and guidelines for treatment, there is no substitute for a visit to your doctor or physical therapist. Every runner’s road to recovery will look slightly different, so always consult your preferred physiotherapist for additional guidance.
DEFINE What are Medial Shin Splints?
If you’ve been following our monthly injury series, you know by now that most running-related injuries can be summed up in a few short words: too much, too soon. Medial Shin Splints follow the same overuse theory and occur when the shin endures repetitive stress that exceeds the body’s ability to recover.
To complicate our conversation for a moment, because we like to do that in medicine: Medial Shin Splints and Tibial Stress Fractures share a common cause, but are two separate injuries. We will address Stress Fractures in a future blog, but for now just know that, if left untreated, Medial Shin Splints can result in a bone stress injury.
IDENTIFY What are the symptoms?
One or any combination of the following symptoms may be an indication of Medial Shin Splints:
Soreness or tenderness along the inside edge of the shin bone or tibia.
Aching feeling in the calf muscle.
Mild swelling in the lower leg surrounding the shin.
Early Stages: Experiencing pain at the beginning of a run, but discomfort decreases throughout the run. It’s also common to experience pain more frequently during slower pace runs due to prolonged contact time between your foot and the ground.
Late Stages: Pain present at the beginning of a run and continuing through the duration of your training. You may also experience discomfort throughout your normal daily activities or when direct pressure is applied to the shin bone.
RECOGNIZE What are the causes?
There are a number of risk factors that can make runners more susceptible to Medial Shin Splits including training errors, excess pronation, glute weakness, poor calf muscle strength, and more. But the two leading causes of Medial Shin Splints that we will focus on are Bone Overload and Traction.
Bone Overload occurs when the body endures too much wear relative to repair. For example, logging back-to-back high mileage training days without giving your body enough time to recover.
Traction happens when the muscles and tendons surrounding the shin (e.g., Posterior Tibial Tendon, Soleus, or Flexor Digitorum) pull on the bone upon a runner’s foot hitting the ground. Over time, this pulling – this traction effect – causes stress to the area and results in pain.
UNDERSTANDING How much pain is too much?
As we’ve covered in previous posts, pain is your body’s internal warning system (or traffic light) that tells you when to push, when to back off, and when to rest completely. Running and balancing pain associated with Medial Shin Splints is no simple task. Because Shin Splints put runners at a greater risk for developing a bone stress injury, staying aware of your pain is critical. Our chart below will help you make more informed decisions about your training:
Timing: Progress to Phase II once you are waking up, walking, and performing daily activities in the Safe Zone of pain.
Goal: Keep running, but remain in the Safe Zone of Pain during all activities. This will likely mean decreasing the volume, intensity, or frequency of your training in less severe cases, but more severe cases may call for temporarily stopping all running.
Next, you’ll want to reduce your Medial Shin Splint risk factors. Just like our treatment protocol for Achilles Tendinopathy, start with the risk factors easiest to accomplish first.
PWR Pro Tip
There are no “hacks” or overnight fixes for Medial Shin Splints, or any injury for that matter. Like running, progression doesn’t happen immediately. Remember to invest more in yourself and less into cryotherapy, compression gear, lotions, potions, or pills!
PHASE II: LOADING Building Dynamic Strength & Capacity
Timing: Progress to Phase III once you can walk for over an hour 3-4 times per week pain free, complete 3 sets of 15 Single Leg Step Downs in the Safe Zone of Pain, and complete 4 sets of 8 Single Leg Bent Knee Heel Raises in the Safe Zone of Pain.
Goal: Increase muscle and bone capacity and resiliency through a running and injury-specific strength and bone loading program.
Single Leg Step Downs For this exercise, we’re giving you two variations, Anterior Step Downs and Posterior Step Downs. For both variations, use a step that’s approximately 6–8 inches high and focus on maintaining a slow controlled tempo (about 5 seconds). Sets: - Beginner: 3 sets x 10-15 reps - Intermediate: 3 sets x 6 - 8 reps with a weight that makes completing a full set challenging - Recovery: 1-2 minutes in between sets
Frequency: 2-3 times per week with at least 48 hours in between sessions
Single Leg Bent Knee Heel Raises From a standing position, start by balancing on your right leg and holding the weight in your left hand, raise up on your toes, then come back down to the ground. Complete the set and then repeat on your left leg. For both levels, select a weight that makes completing a full set challenging.
Sets: - Beginner: 3 sets x 12 reps - Intermediate: 4 sets x 6-8 reps - Recovery: 1-2 minutes in between reps
Frequency: 2-3 times per week with at least 48 hours in between sessions
Plyometric Drills Incorporate these three basic plyometric drills into your pre-run routine about 3-4 times per week. Plyometrics can help improve your lower leg’s ability to store & release energy:
a) A-Skip – 3-4 x 20-30 meters b) Ankle Dribble – 3-4 x 20-30 meters c) Pogo Jumps – 20-30 jumps. As you get comfortable with the exercise, slowly add additional weight by holding a dumbbell.
PHASE III: OVERCOMING Return to Running
Finally, the moment you’ve been waiting for: the Return to Running phase! During this phase you should continue the exercises outlined above while you transition back into running. When increasing your training load start by increasing the frequency of short runs. Next, build up the length of these runs, and finally introduce intensity and variability (e.g., speed sessions and hill workouts).
As a general rule, start with running every other day or three times per week. But remember, each injury is unique and so is each runner, so we highly recommend consulting your preferred physiotherapist for personalized help.
PWR Pro Tip
You are the CEO of your body. You are 100% responsible for your health, well-being, and longevity of your running career. So fill your executive team with individuals, aka doctors and physiotherapists, who will support you and help you make informed decisions for your body.
Let us help you take the guesswork out of managing your training load with our PWR Lab Dashboard. Simply sync your Garmin, Suunto, or Polar GPS watch and immediately get a personalized visual of your training. Not a member yet? Sign Up today and your first month is on us.
About Dr. Jeff Moreno
Jeff, co-founder of PWR Lab, is a Doctor of Physical Therapy and Board-Certified Orthopedic Clinical Specialist. Passionate about running and playing, Jeff fundamentally loves people and movement of any kind. He strives to raise the bar in sport by finding ways to proactively prevent injuries and prioritize the long term development of athletes. He has been successful in employing a data-driven, hands-on approach to physiotherapy with National, World & Olympic Championship medalists in Track & Field from USA, China, Canada, and Mexico as well as many NFL, NBA, MLB, NHL, Judo, and Triathlon athletes