How do I prevent and/or treat shin splints?

Question

Any pre/post run stretching that you could recommend? Do worn out shoes contribute to the problem?

Answer 1

When you decided to get really serious about your training earlier this year, everything went smoothly for several weeks, but one day you felt a dull ache on the inside, lower portion of your shin as you began your workout. The discomfort went away once you had warmed up, so you weren't overly concerned.

Unfortunately, the pain returned on the following day - and lasted for a longer portion of your workout. As the days went by, pain was present for the whole training session, as well as your cool-down - and even hung around during your regular daily activities. When you used your fingers to probe the area near the back, inside edge of the lower part of your tibia (the main bone in the lower part of the leg), you felt tenderness but no major swelling, and the pain seemed to centre in the tissues (muscles and tendons) near the tibia, not the tibia itself. What was wrong?

Of course, you had developed a classic case of 'shin splints', an injury which is more accurately called medial tibial stress syndrome (MTSS). Many experts believe that shin splints (MTSS) is the most common injury among athletes whose sports involve extensive amounts of running (e.g., runners, soccer players, rugby players and other participants in field sports); indeed, research shows that up to one in five injured runners are 'on the shelf' because of shin splints ('Relieving Painful Shin Splints,' The Physician and Sportsmedicine, vol. 20(12), pp. 105-113, 1992). And it's an especially troubling injury, because it can stop quality training in its tracks and also tends to recur, defying conventional treatments. The actual site of injury in the shin area can be muscle, tendon, bone - or the connective-tissue wrappings which surround your muscles and bones.

Some exercise scientists contend that MTSS is almost inevitable, since each shin absorbs a force equal to two to three times body weight with every footfall during running - about 700 times per shin per mile, mile after mile. The cumulative effect of this repetitive stress on the muscles and connective tissues in the shin area is believed to be the origin of MTSS. For that reason, MTSS is often called an 'overuse' injury, although as you'll see in a minute, the real problem is not so much overuse as it is a lack of preparation for use. Specifically, shin splints occurs because the ankle dorsiflexors - the shin muscles which in effect pull the top surface of the foot toward the shin and also (as part of their eccentric functioning) keep the foot from being pulled away from the shin too rapidly - are not functioning as well as they should.

The key role of these ankle dorsiflexors during running is in fact to control and limit plantar flexion - the movement of the foot away from the shin. During the very earliest part of the footstrike portion of the gait cycle - right after the foot makes contact with the ground, there's a tendency for the foot to slap hard against terra firma. In a 'heel-striker,' for example (a runner who first makes contact with the ground with his heel), forward momentum tries to slap the rest of the bottom of the foot against the ground very quickly and forcefully, an uncoordinated and energy-wasting action which is resisted by eccentric contractions of the dorsiflexors.


The sound of slapping feet
If a runner has weak ankle dorsiflexors, you can often 'hear him coming a mile away', because his feet actually make slapping sounds against the pavement (of course, such a runner will be at high risk for MTSS, because the rapid downward movement of the foot will tear at and overstress the dorsiflexors). In contrast, the runner with strong, functional dorsiflexors will seem to pad softly along, even if he is running on rock-solid concrete. Watch some of the elite Kenyans running, for example, and compare their foot-to-ground patterns with those of elite Brits or Americans or the average recreational athlete. The Kenyans build up tremendous dorsiflexor strength and functionality because they spend their initial years of life running and walking endless miles while barefooted, instead of moving around with their feet clamped into fluffy midsoles which shield the feet from hard work - or sitting around with feet propped up on a soft hassock. As a result, the Kenyans waste very little energy during the stance phase of the gait cycle - and seldom hobble off the track or roads with a shin injury.

In addition to controlling plantar flexion, the dorsiflexors must also deal with side to side motions of the foot and ankle during running - as well as the rotational motions which are a natural part of the gait cycle. Any tendency of the foot to pronate must be controlled by the shin muscles. Any tendency of the foot to supinate must also be reined in by the dorsiflexors. If there is relentless, stressful motion in any direction, the shin muscles can be damaged. That's why many of the shin splints exercise routines which supposedly prevent shin splints don't work so well; they often emphasize only front-and-back motions, rather than the side-to-side and rotational activities which are routine aspects of the biomechanics of running. The bottom line is that if you want to prevent shin splints, you can't merely develop general strength in your dorsiflexors - or strength which exhibits itself in only one plane of motion: your dorsiflexors must actually be stronger while you are running. More on that in a moment!
That's why the classical mode of treatment for shin splints - RECEIPT (rest, elevation, compression, easy stretching of the muscles, icing, and possibly taping) - works fairly well at relieving symptoms but does a very poor job of keeping the injury from recurring. Only by improving the functional strength of the dorsiflexors and the strength and coordination of the entire ankle area can one be confident that MTSS will be held at bay. If your dorsiflexors are strong enough to handle your total training load, and they aren't yanked around too badly by poorly controlled ankle movements, your training year should be un-marked by the pain and disruption of shin splints.


Try these MTSS-preventing exercises
So what should you actually do to lower your risk of MTSS? Well, simply utilize our shin-splint-preventing exercises, outlined below:
1. Wall Shin Raises. Simply stand with your back to a wall, with your heels about the length of your feet away from the wall. Then, lean back until your buttocks and shoulders rest against the wall. Dorsiflex both ankles simultaneously, while your heels remain in contact with the ground. Bring your toes as far toward your shins as you can, and then lower your feet back toward the ground, but do not allow your forefeet to contact the ground before beginning the next repeat. Simply lower them until they are close to the ground, and then begin another repetition. Complete about 12 to 15 reps.

Once you have finished the reps, maintain your basic position with your back against the wall, dorsiflex your ankles to close to their fullest extent, and then quickly dorsiflex and plantar flex your ankles 15 times over a very small range of motion (smaller than the nearly full range you use for the basic reps; the emphasis here is on quickness). These short, quick ankle movements are called pulses.

As you gain strength over time, make the wall shin raises progressively more difficult by advancing from one set of 15 reps to two and then three sets of 15 (for the basic raises and the pulses). It's OK to walk around for 15 to 30 seconds between sets.


Now the single-leg raise
Once you can quite comfortably complete 3 x 15 of the double-leg raises (both basic and quick), progress to the single-leg wall shin raise. The basic position for this exercise is as before, except that you begin with only one foot in contact with the ground; the other foot rests lightly on the wall behind you. Now, full body weight is on one foot - as it is during running - as you carry out the overall routine, and the exercises are considerably more difficult. Begin with 12 to 15 reps per foot (both for the basic exercise and pulses), and progress to 3 x 15 (basic and pulse) on each foot as your strength increases. There's no need to rest between sets; simply carry out 15 reps on one foot plus the pulses, shift over to the other for 15 repetitions and pulses, return to the original foot, and so on until you have completed three sets with each foot.

2. Heel Step-Downs These are simple but devastatingly effective exercises for preventing MTSS. Begin with a natural, erect body position, with your feet about shoulder-width apart, and then step forward with one foot. The length of the step should be moderate - as though you were walking in your normal manner. When your heel makes contact with the ground, stop the foot from fully plantar flexing, ie, use your shin muscles to keep the sole of the foot from making contact with the ground. After heel contact, the ball of your foot should descend no more than an inch toward the floor or ground; your foot is held in check by the eccentric contractions of your dorsiflexors (shin muscles). Return your foot to the starting position (back by the other foot), and repeat this basic stepping action a total of 15 times. Then, shift over to the other foot and complete 15 steps. As with the wall shin raises, progress to three sets of 15 reps over time.


Now with longer steps
Once you have mastered the basic heel step-downs, perform the same exercise - but with dramatically longer steps. Using lengthier steps will increase the accelerating forces placed on the dorsiflexors and force them to work more forcefully and quickly, as they must do during running. Start with one set of 15 reps of long steps per foot, and progress to 3 x 15 on each foot over time.

Finally, you will be ready to carry out the heel step-downs from a high step, which will increase the forces on your shin muscles to the greatest extent - and build the greatest amount of strength. Use a bench or exercise platform which is about four inches off the ground to carry out your stepping. Aside from beginning each step from a bench, your movements are the same as they are in the basic step-downs; the idea is to land on the heel of the forward foot and then to use the shin muscles to prevent the sole of the foot from making contact with the ground (again, don't let the ball of the foot move downward by more than an inch). The actual length of the step is moderate at first (you can progress to long steps later). As before, begin with 15 reps per foot, and progress to three sets of 15 reps as you gain strength and coordination.

Both the wall shin raises and heel step-downs can be carried out three to four times a week, along with your other strength-building exercises (you can complete them more often if you've had lots of problems with MTSS in the past; don't do them to the point of pain, however).


Warm up to stronger shins
The following portion of the shin-splint-preventing routine can be completed during the warm-ups preceding your regular workouts. The prescribed exercises develop shin strength and resiliency, as well as overall ankle coordination, and thus are great antidotes for your ankles' desires to begin hurting during strenuous training. It's also a good idea to include the exercises in your warm-ups; doing so transforms the warm-up from humdrum routine into an important strength and coordination session. Here's what to do:
1. Walk on your toes with your toes pointed straight ahead for about 20 metres, getting as high up on your toes as you possibly can. Your legs should be relatively straight as you do this, and you should - at least initially - take fairly small steps.

Then, cover 20 metres high up on your toes, but with your toes pointed outward. Your legs should rotate outward from the hips when you perform this movement; don't merely turn each foot at the ankle - the whole leg is involved.

Finally, walk 20 metres high on your toes, but with your toes pointed inward. As you do so, rotate the entire leg in from the hip, not just the ankle. Repeat each of these activities (toes pointed ahead, toes pointed out, toes pointed in) at least one more time before going on to the second exercise.

2. Walk on your heels with your toes pointed straight ahead for about 20 metres, getting as high up on your heels as you possibly can. Your legs should be relatively straight as you do this, and you should - at least initially - take fairly small steps.

Then, simply proceed as you did with the toe walks, walking 20 metres on your heels with toes pointed outward and then 20 metres on heels with toes pointed inward. Repeat each of the heel walks (toes straight ahead, toes pointed outward, toes in) at least one more time.

As the toe and heel walks become easy for you, graduate to doing the three variations of each exercise while jogging lightly, instead of walking! At least at first, you should make certain you are on a padded or grassy surface when you jog on toes and heels.

3. Skip for 20 metres, landing in the mid-foot area with each contact with the ground, and with toes pointed straight ahead. Then, do the same, but with toes pointed out for 20 metres, and then with toes pointed in for 20 metres. Repeat the sequence at least one more time.

4. Then, get well up on your toes and skip for 20 metres with toes straight ahead, pointed out, and pointed in.


Now skip on your heels
Once the skipping exercises are comfortable, try some light skipping on your heels. Gradually build up your ability to heel-skip with toes straight ahead, pointed out, and pointed in for 20 metres at a time. Heel skipping is a great way to build dorsiflexor strength, but carry it out only on a padded or grassy surface to avoid impact injury to your heels.

Answer 2

Treatment for shin splints is basically rest. I have had major issues with shin splints in the past and found that the only real cure was low impact training until they healed. You can put compression sleeves on them while running and this will decrease the pain some but does not help them heal.

For me, and I'm not a Dr or Physician, I found the cause to be using a shoe that did not fit my type of foot or running style. I would suggest that you take an old pair of shoes and visit your local running store. They should be able to look at the way you walk and how your old running shoes wore and recommend the correct shoe for your feet/body.

This will go a long way to resolving your problem. Also, you need to change out your shoes every 400-500 miles, depending on how "heavy" a runner you are. (By "heavy" I mean how hard your foot strike is, not how much you weigh.)

Good Luck!

Answer 3

I used to get shin splints and there is a couple things I did to cure the problem. First of all, I got a new pair of running shoes that were tailored to my running style. Since I supinate, I purchased shoes that were tailored toward this style as opposed to pronation. You can tell if you supinate or pronate by looking visually at your old shoes and seeing which way they lean and how the shoe wears on the bottom. My treads wear on the outside of the shoe. Next, there are exercises I did for shin splints. While sitting, I placed one foot over the top of the other foot and moved the bottom foot up against the tension of the top foot. I did this about 20 times or so and until the leg started to get a burning sensation. I repeated a few cycles of 20 or so on each foot.

Good luck.

Answer 4

Shin splints are a chronic condition from running. The constant pounding puts stress on the anterior portion of the femur.People have tried hot and cold compresses,creams and other treatments. The only thing that really works is to stop running for a while,and let rest do its healing.

Answer 5

Buying new shoes is a good idea...but there is something entirely different that worked for me when I ran track. After we would run our mile warm-up, I would run about 3/4 of a lap backwards. It strengthens the main muscle that is involved with shin splints. It sounds strange, but it really does work. Good luck!

Answer 6

I had them when I was in the Marines

1. There is no cure.
2. Treatment = anti-inflammatories, don't run or march (heavy walking) everyday, and cris-cross medical tape in the shape of Xs all the way down your shins. That gives them support because all they are is the muscle tearing away from the shin bone.
3. Buy very good tennis shoes

Answer 7

shin splints are the worst!
to prevent them i would say do excersises like lying stomach down on a bed with your feet hanging off the edge. then pull your foot out straight and then push the top of your foot against the bed edge. ive always had shin splints until i started this exersise so good luck. also walking on your toes and walking on your heels helps.

Answer 8

well running on shoes that have no support can really hurt your situation. If you already have shin splints then elevate the leg with ice after you run. You can tape your shins up with special tape for when you run. A few runners on my XC team run with tape on. Good luck.

Answer 9

what i do is take an ice cube and put it in a cloth and just massage your legs with it 5 minutes each.. works like a charm for me
shin splints are caused from tight caves stretch them out by putting your foot against a wall and lean forward

good luck

Answer 10

I've found that just changing shoes helps me out the most.

Answer 11

rest or cut down on your miles, ice a lot, and do exercises such as lifting your toes in the air like heel rises but the opposite.