Have you ever experienced that nagging pain along the inside or outside of your shin bone during a run that you just can’t shake? Often, this type of pain starts as more of an annoyance than a true limitation. Like most runners, you might try to "run it off" and at first you may feel like things are getting better when you warm up but the pain only gets worse with more miles. If you've been a runner for a while or have a history with impact sports, you've likely heard or used the term "shin splints" to describe this irritating injury. In the medical world, we refer to it as Medial Tibial Stress Syndrome (MTSS).
MTSS is an inflammation of the muscles surrounding the shin and the outer layer, or periosteum, of the tibia (your shin bone). This typically occurs on the inside of your shin but can also present on the outside, spanning a distance of around 5 cm or more, usually along the distal or bottom two-thirds of your leg. Symptoms can include pain that worsens during or right after activity and improves with rest. Pain may also be reproduced by pressing along your shin bone and surrounding muscles in the front of your lower leg and ankle. If you are experiencing this type of pain regularly, you should schedule an evaluation with a physical therapist or your physician to get a definite diagnosis, as this is an injury that can become chronic and more serious if not properly treated.
Like many other running-related injuries, shin splints mostly result from doing too much too soon, either after a period of inactivity or with a sudden spike in training volume. Any significant increase in your running intensity, distance, or frequency without appropriate progression can lead to an increase in stress that exceeds the capacity of your bones to handle it, resulting in pain and inflammation.
Pain intensity is often low during the initial onset, which is why many runners may attempt to "muscle through" to finish their run or continue training through the symptoms. However, it is important to note that ignoring this pain while continuing to run can lead to further breakdown, eventually resulting in a stress fracture if not addressed. If allowed to progress to a stress fracture, this will ultimately take you out of running commission for much longer. Once at that stage, there must be a period of activity restriction and even possible immobilization to allow for full healing of the bone, followed by rehab with a physical therapist. Therefore, a diagnosis of shin splints should not be ignored, and you want to take action before making matters worse!
Recovery Steps
What should you do to get rid of this pain and get back to training? The key to recovery with any inflammatory condition is load management. Depending on the severity, early in the recovery process, you will likely need to take a temporary break from the aggravating factor to prevent things from getting worse. Yes, that means a break from running. However, if you listen to the guidance of your physical therapist, they will get you back on the road, trails, or treadmill as quickly and safely as possible.
Just because a break from running may be necessary does not mean you should be sitting on the couch. Cross-training will be extremely important to continue challenging your cardiovascular system and prevent a significant setback in your progress. Runners can still engage in physical activities that are lower impact, such as cycling or swimming, to avoid disrupting the healing process while staying in shape. Strength training is another absolute must during recovery. Our muscles act as shock absorbers, and you want them to be strong and durable to attenuate as much force as possible when getting back to running.
Long-Term Strategies
Once you have taken steps to address the problem and are working with a licensed physical therapist or coach to reintroduce running, there are additional factors they will likely discuss with you. Specific metrics such as running cadence, strike patterns, and stride length, as well as environmental or equipment factors, may all be relevant to discuss to help reduce the risk of future injury. Since shin splints are generally a load issue, it is important to progress miles and intensity gradually and to optimize recovery when getting back to training. This means you will likely have to start back at a lower weekly frequency and mileage than you were previously at and work your way back up to your prior volume.
If you are a runner experiencing the frustration of shin splints, remember to be patient with the process, follow the guidance of a trained professional, and trust that you will be back better and stronger than ever in no time!