Running Injuries (Part 4) - Shin Splints and Stress Fractures

This is Part 4 of our 4 part Running Injuries series. Today we’ll be covering shin splints, all their suckiness, and how to treat them.

Shin Splints are extremely common and a significant contributor to exertional leg pain in athletes. So what the heck are they? “Shin splints” is an umbrella term used to cover many pains in the lower leg. There are two major forms; Medial Tibial Stress Syndrome (MTSS) and Lateral Tibial stress syndrome, MTSS being the more common of the two.

Injury develops when excessive strain is placed on the muscle causing micro-tears on the involved muscle and shin bone's periosteum, the outer layer of bone. While shin splints are not a severe injury, they can quickly progress into chronic compartment syndromes or stress fractures so don’t ignore them. Female athletes tend to show higher incidence of stress fractures due to 3 factors which make up the female athlete triad (amenorrhea, osteoporosis, and insufficient energy availability).

Depending on the severity of the injury, recovery can take a few days to multiple weeks. If stress fractures develop, recovery can require multiple months. Aside from working with a physical therapist for soft tissue mobilization and corrective exercises you can supplement with these other methods at home. The best treatment option of course is prevention. So continue reading to understand the what’s, why’s, and how’s.

MTSS occurs more often in experienced runners and develops due to multiple factors such as training error, biomechanics, and strength deficits. Pulling of the medial posterior shin (tibia) periosteum occurs by the posterior tibialis and soleus muscles. These muscles help maintain foot arch and plantarflex. Pain is usually described as dull and begins about 2-3 fingers width above the medial ankle bone (malleolus) and extends up a few inches. If pain becomes very sharp and localized, it may have already developed into a stress fracture in which activity should be stopped immediately. Consult with your health provider. Compartment syndromes should be considered when sensory or motor loss presents.

Lateral Tibial Stress Syndrome occurs more often in novice runners. Pulling of the anterior lateral shin occurs by the anterior tibialis muscle while working to dorsiflex the foot. Pain again is dull although strong enough to limit participation in activity. Tight calf muscles which performs an opposing action can make the tibialis anterior work harder to achieve foot clearance during gait.

Treatment options should be specific to the type of shin splints being experienced. MTSS requires a serious evaluation of your training program. Make sure you haven’t fallen victim to the “too much, too fast” bug. Just because certain parts of you felt great doesn’t mean other parts were prepared for that level of training. Training volumes of 20mi per week has shown to predispose athletes to overuse injuries, which includes MTSS. Decrease factors such as duration, frequency and intensity. It’s recommended to reduce volume by up to 50% and build your way back up. Also be aware of training surfaces, avoid hard or uneven surfaces.

LTSS pains will benefit from stretching of the calves, strengthening the anterior tibialis, and massaging the lower leg to maintain normal muscle tone.

From a biomechanical stand-point excessive knee collapse, tibial torsion, femoral anteversion, foot arch collapse, leg-length discrepancies, and hyperpronation of the ankle are all common risk factors. Weakness in core musculature including lumbar and hips can alter running mechanics. Consult with a professional to help identify the deficits and address them properly.

Basic Home Exercise Programs can include: straight and bent knee calf stretches, eccentric heel raises, toe lifts/heel walks, foam rolling, glute bridges, side planks, single limb stance variations, arch lifts, toe curls, etc. Also try icing after runs (manage inflammation), cross-training (offload stress on tibia), new shoes (improve shock absorption), and compression sleeves (support musculature).

This concludes Running Injuries Series. If you haven’t looked over my other posts yet, what are you waiting for?! Don't wait until you're in pain! Remember, the best way to treat these injuries is by getting ahead of them, add injury prevention exercises to your routine. Also, please follow my IG account @breakoutppt. Thanks! :)