Shin Splints: The What, How, And Why For Treating Medial Tibial Stress Syndrome

It can be difficult to work out if you are suffering from shin splints because this is a pretty broad term that is used to identify a range of aches and pains that you can get from playing sports.

This does make the term seem very loose as it could cover a range of injuries. But here, we are going to break things down and show you that shin splints are not as scary as they sound.  

Shin Splints: The What, How, And Why For Treating Medial Tibial Stress Syndrome

So, if you are suffering from pain as soon as you touch the bone of your lower leg? This is likely to be shin splints.

Or, if you are experiencing pain at the front of your lower leg then this is probably shin splints. Or, if you are feeling pain right in the inside part of your lower leg then you will most likely be suffering from shin splints.

Shin Splints: The What

When it comes to breaking down exactly what shin splints are, this is pretty straightforward: they are a pretty common injury that most runners will suffer from.

Shin splints are a lower extremity injury that is also referred to as medial tibial stress syndrome. The problem with shin splints is that they can be caused by a variety of different conditions, there is not just one set thing that can trigger shin splints.

In fact, research does suggest that shin splints can be any of the following ailments: periosteal inflammation which is a condition that subsequently results in inflammation of the band of tissue that surrounds your bones, known as the periosteum.

This condition tends to be chronic and is shown through tenderness and also through swelling of the bone, along with pain. Shin splints can also be myofascial strain which is a chronic muscular pain disorder that affects skeletal muscles in the body.

The pain or inflammation is in the connective tissue that covers the muscles. Alternatively, shin splints can be a bone stress reaction.

It is true that the precise tissues and the exact muscle structures which are affected can vary from person to person. It is just believed that shin splints will mainly affect the calf muscles, and the flexor digitorum longus – this is a calf muscle that bends the toes, or the tibial muscles.

When pain is taken into account, shin splints have two categorizations. This is all to do with whether the pain is anterior or whether the pain is frosterior.

In other words, this is all to do with whether the pain is at the front or at the back of the calf area. By identifying where exactly the pain resides in your lower leg, you can then work out what exact areas are affected.

You can then really trace back to how you think you have injured yourself, and this will help you to decide what recovery method will be the right one for you, and that will help you to heal your shin splint the best you can.

Shin Splints: The How

In this section, we are going to delve into how exactly shin splints are caused. It is most widely accepted that shin splints are most likely due to forces of high impact.

Or, shin splints can occur through a sudden increase in mileage when you are running. It is difficult to pinpoint the exact causes of shin splints just because they present themselves in a wide variety of different ways.

The closest we can get to identifying how shin splints are caused is by breaking this down into anterior shin splints and posterior shin splints.

The anterior shin splint is an indicator of your tibial anterior muscle or tendon being overused. This is usually as a result of overstriding, and this happens when the foot strikes the ground just ahead of the runner’s center of mass.

If we then look at this from a biomechanical perspective, an overstride will need the tibial anterior to contract while it is in a lengthened position.

What does this mean? Well, when a muscle contracts over the duration of a stretched position, then you are actually imposing forces upon the muscle when it is in a vulnerable position.

So, this means that the more that an athlete over strides, then the more plausible it would be for said athlete to suffer from a tibial anterior injury.

This injury would cause shin splints, so it is really important that when you are running that you do not overstride. This will help you to avoid injury to the tibial anterior area.

Now, on to the posterior shin splints. This type of shin splint will be more likely to appear along the inside of the lower leg, and also the back of the lower leg.

Can you guess what area this usually affects? Yeah, this affects the tibialis posterior. This is the muscle which has a key role in supporting the medial arch muscle as you put weight on it. This is the inner muscle in the arch of your foot, by the way.

The more common causes of posterior shin splints are your training intensity, or whether you increase your running distance, or in some cases these shin splints can be caused by having flat feet.

Ultimately, the longer that you run, or the faster that you run can have an effect on shin splints. This is all to do with the impact forces that the body must absorb. This can in turn overwhelm the tissue, which will then cause an injury. Not ideal. 

Let’s explore this further. When you increase the distance of your run by essentially adding more steps to your run, then you are landing more often. You are not landing harder.

By running faster, you are creating much more impact forces over each and every step that you make. Time to get all sciencey here: if force equates to mass multiplied by acceleration, then increasing the speed at which you hit the ground subsequently increases the landing force.

We briefly mentioned that having flat feet can also make you more prone to getting shin splints. This is somewhat similar to the anterior shin splint causes, in that flat feet can put a strain and stress upon the tibial posterior muscle and the tendon.

This results in the muscle being lengthened. If you do not properly activate or if you do not sufficiently strengthen the foot core muscles, then flat feet can contribute to over-pronation, along with inward knee collapse. Both of these ailments aggravate shin splints.

Shin Splints: The What, How, And Why For Treating Medial Tibial Stress Syndrome

Shin Splints: The Why

‘The Why’ of shin splints is relatively extensive, and there is much more to this than flat feet. That’s right, having flat feet is not the only thing to blame for shin splints. There are actually a range of common risk factors that can induce the development of shin splints.

There are a selection of risk factors that can make you more susceptible to shin splints. An example of this is if you are new to running, as this strain will be new to your body and depending on how much you push your body this could determine whether or not your body can cope with running.

If this is the case and you are new to running, then you must make sure that you ease your way into it and that you listen to your body. Know and respect your limits. Alternatively some other risk factors can include increased hip external rotation and over-pronation.

Additionally, some other risk factors are over-pronation, or if your family has a history of shin splints. If this is the case, there is a strong chance that you could be affected by shin splints. Shin splints are more prone in individuals with a high body mass index, and they are also prone to females.

In case it was not obvious, we know that not all of these risk factors can be altered in any way. However, if you are aware of them then you can work out what factors you can actually improve and work on in your training, or alternatively in physical therapy sessions.

If you are especially new to running, and you know that your family does have a history of shin splints then you can take measures that are preventative.

Undertaking physical therapy can help your running because you can actually improve your technique and the efficiency of your form. This in turn will mean that you will have better shock absorption, and this will ultimately reduce the amount of stress that is pumping through your bones and through your body. 

Shin Splints: Related Injuries

As we said before, the term shin splints does cover a pretty wide range of injuries. So, it is critical that you do not get shin splints muddled with other tissue injuries or injuries that are bone-related.

This is important because you need to make sure that you have diagnosed yourself with the right injury before you attempt to treat it. Let’s break these related injuries down.

Shin splints can be confused with bone stress injuries, which usually occur from continuous loading. What this means for you is that each time your foot makes contact with the ground, which in the perspective of a run is a lot more than a thousand times.

So, the body then has to not only absorb your body weight, but it has to absorb other external forces such as gravity. So, when the body is not able to absorb these forces sufficiently, then other tissues which would usually be more passive – such as bones and ligaments – will actually step in to ensure that the forces are absorbed.

The problem with this is that the passive tissues were not made to be able to have enough capacity to absorb such a great force, and the result of this is that over time they become damaged.

Additionally, long-term problems can inflict microscopic damage along with small cracks in bones. This is important to note because there are several bones in the leg that can develop not just stress reactions, but they can develop stress fractures too.

When it comes to defining a stress reaction, well, this is pain which might feel tender when touching the bone. However, this injury will noticeably lack an intense damage to the bone itself. When it comes to defining stress fractures, these are essentially smaller fractures in the bones.

These smaller fractures are extremely painful each time you apply weight on or pressure to your leg. It is clear that stress reactions and stress fractures are not the same as shin splints. However, we mention these to stress how unmanaged shin splints can lead to either of these injuries.

A smaller fracture can end up cracking the bone entirely and this can result in a full fracture throughout the entire bone. It is important that if you think you have a stress fracture, then you should book an appointment to see your doctor immediately.

Stress fractures can be picked up by an x-ray, or by an MRI scan. However, x-rays are not recommended due to the fact that they are much less likely to spot a stress fracture in its earlier stages.

So, the most typical places where stress fractures can be found are the tibia, or the bone that is in the middle of the foot – the navicular, and also they can be found in the second and the third metatarsal bones of the foot.

Shin Splints: Treating Medial Tibial Stress Syndrome

Shin Splints: Treating Medial Tibial Stress Syndrome

When you have reached the stage where you have been able to rule out all other medical conditions, and that you have determined that you have shin splints, you now need to focus on the treatment of the shin splints. Or even better, you need to focus on treating the shin splints and ensuring that they do not return.

The recovery process for shin splints can be effective, however when it comes to recovering the time it takes is pretty extended. Also, this time period can be really achy along with being really extensive.

Shin splints can often end up taking months to heal fully. This is naturally something that differs for each individual, but you need to ensure that you listen to your body. You must not attempt to accelerate the healing process, because you could end up exasperating the healing process by doing this.

You will be pleased to know that this extensive recovery process does not mean that you have to stop running. It is true that shin splints might be painful, but people do still run with them.

Like we said earlier, you must ensure that you know your own limits and that you listen to your body. By pushing yourself too hard you could reverse any recovery phases that you have already undertaken.

You must ensure that you adjust your usual run so that it is not as long, and so that it is not as intense, and so that there are not as many hills. This will mean that your shin splints will not need to stop you from working on your endurance and your stamina any time soon.

It is important to note that there are some instances where running would not be recommended.

If you are experiencing severe or chronic pain, or if you have the suspicion that you might have a stress fracture, or if you suspect that your blood circulation has decreased, then you need to speak to a professional. This will confirm whether or not it is safe for you to run, and this will allow you to manage the symptoms that you feel. 

Now, we can move on to actually treating shin splints. Where treatment is concerned, the principal goal is to manage the symptoms that you are suffering with.

The use of ice, and also compression, and elevating your leg early on would be key places to begin. This is a key combination for successful management of any pain or any swelling that you are experiencing.

To help you along with this you can buy your own shin splint ice packs, which can be key to boosting your symptom management. Additionally, if you are keen to extend the cold compressions or if you are looking for colder relief, then you should buy a cryo ball to help your muscles recover, repair and rejuvenate.

Resting To Aid Your Recovery

When it comes to resting to aid your recovery, this needs some clarification. With shin splints, you will often find that complete rest is not all that necessary.

In fact, you can aid your recovery by ensuring that you gradually build up the intensity of your exercise just so you do not totally lose muscle strength. Additionally, this helps with tendon recovery. You will more than likely have to give your training plan an overhaul and restructure of some kind.

Also, it is crucial that you fully evaluate your training plan, and that you attempt to pinpoint exactly what has caused the shin splints in the first place. Once you have worked this out, you can adjust your training plan accordingly.

If you are struggling to identify what has caused your shin splints, maybe work out if you have increased your running distance too much, or if you have incorporated too much speed into your training. By editing your workout plan you can correct the training-based causes of shin splints.

This stage may sound counterproductive, but the damage to the muscles and the tendons of the lower leg can actually improve the rate of the healing process.

It sounds deranged that in order for a tissue to heal, it first has to be damaged – but what is actually occurring is that by putting the tissue through a controlled volume of deliberate stress then you are actually capable of breaking up some of the tissue adhesions that may have built up.

This process of essentially clearing out the waste will heighten blood circulation and it will also promote healthier muscles and tendons.

It is especially important that this is done carefully, and that it is not just damage for the benefit of blood flow. If you should consult anyone about this, then that individual should be a physical therapist. They are especially well-trained in soft tissue mobilization along with trigger point release.

Physical therapists can also perform cross friction massages along with sports massages – and these are great ways of stressing the tissue which can subsequently get a positive outcome.

These kinds of massages are not recognized for being the most appealing, but they are especially effective for muscles and for tendons that are injured.

It is also important to introduce soft tissue techniques at the pivotal moment in your recovery process. Performing these techniques at a stage that is too early can actually end up resulting in more pain and more swelling.

It is important not to rush into this, you must follow the recovery process no matter how long it takes. Alternatively, you can buy your own foot rocker to help stretch out your calves. This will help achilles tendinitis along with heel, feet and shin splints. Also, using a muscle roller can also really help ease shin splints too.

Whilst tissues are recovering, you can turn your focus to what exactly has caused your shin splints. This might be due to your form when you are running. But, there are lots of things that you can do to help you on your daily runs.

You can buy your own calf compression sleeves to help with shin splints, or alternatively you can even purchase your own adjustable neoprene shin splint and leg compression support strap to help you run with shin splints.

These might not quite work for you, so you could try these running insoles which can help reduce shock and prevent common running injuries. It is also important that you make sure that you tape up when you head out on your next run!

Overall, shin splints are a tricky business – but if you have taken anything from this piece it should be that shin splints take some time to heal, but you do not have to take out that much time as part of the recovery and rehabilitation process.

Listen to your body and do not push yourself too hard, or this could be detrimental and debilitating to your recovery.

Matt Williams