Have you ever noticed pain along your shin bone while running? Have you ever felt aching pain on the inside of your lower leg that just lingered after exercise? If so, it is possible you have experienced shin splints. Shin splints, known formally as Medial Tibial Stress Syndrome, are common in running and jumping athletes. They can affect people of all ages and athletic abilities.
But what causes shin splints?
Well, research hasn’t provided us with a hard and fast answer yet. However, research has provided a list of 5 risk factors for Medial Tibial Stress Syndrome.
- Increased Weight: In multiple studies, people of heavier weight were more likely to have shin splints than people of lower weight when performing the same activities.
- Higher Navicular Drop: How much your foot rolls in and your arch collapses is measured by a navicular drop test. Those that have more of a change in arch height between sitting and standing are more likely to develop Medial Tibial Stress Syndrome.
- Previous Running Injury: Any previous running injury, whether it was an ankle sprain, hamstring strain, or something else, increases the likelihood you may get shin splints.
- Increased Hip External Rotation Range of Motion: External rotation is the motion that allows you to place one ankle on the opposite knee. In the reviewed studies, people who had over 65 degrees of hip external range of motion (45 degrees is normal) had higher rates of shin splints.
- Female Sex: For a reason we have not yet determined, females are more likely to be diagnosed with Medial Tibial Stress Syndrome. Some theorize this could be due to different running mechanics between sexes. Others theorize it could be a hormonal impact.
Prevention of Shin Splints
If you have suffered from shin splints before, you probably understand the pain and discomfort it causes. While physical therapy for shin splints does provide immense relief, it’s good to know what can be done in order to avoid experiencing it in the first place. Even though we don’t have an absolute answer on the cause of shin splints, there are a few ways to decrease your chance of getting Medial Tibial Stress Syndrome. From footwear, insoles and exercise routines, here are a few suggestions to prevent shin splints:
- Footwear: Increased shock absorption has been shown to reduce incidence of shin splints. This has been shown both in shock absorbing shoes and separately purchased insoles as well. When looking at running shoes, with the goal of reducing shin splints, you want to look for a shoe with a lot of cushion. Most major tennis shoe brands and many speciality brands have shock absorbing shoes on the market. You could also add insoles to your current running shoes if you need more shock absorption.
Another component to make sure your shoes have is comfort. Not every “good” shoe fits everyone well. So, try on different shoes that have cushion along the bottom of the sole, especially the heel, and buy the pair that feels most comfortable to you.
- Insoles: How much your arch flattens can put you at greater risk of developing shin splints. Wearing insoles or orthotics to help support your arch has been shown to help Medial Tibial Stress Syndrome. Some shoes advertise “arch support” and depending on your foot that might be enough. Or it might be beneficial for you to add an orthotic that is specifically made to maintain your arch during exercise activities. You can find over the counter insoles at most stores where shoes are sold, at drugstores, and at major retailers.
Sometimes it is necessary to get a custom orthotic made specifically for your foot. In this case, you would need to see an orthotist.
If you are hesitant to go out and buy insoles, you could try taping your arch first. Kinesio tape has been shown to help maintain the arch when walking. Simply apply Kinesio tape from the bottom of your arch to the inside of your lower leg. You will want to apply tension from the bottom up to give your arch the most support. Kinesio tape can be found online, sport apparel stores, and most drug stores.
- Exercise Routines: Another common prevention strategy studied is gradual progression running. It is important to ease into a running routine. If you are new to running, or any form of weight bearing exercise, it is important to start slow and pay attention to your body along the way. Going from not running to running miles in a week can significantly increase your chances of getting Medial Tibial Stress Syndrome. The general rule of thumb is to make sure you can run a short distance without any pain before increasing your distance. Increases in distance should be less than 10% each progression. If at any point while training for your running distance goal you have pain, it is important to rest and reevaluate your running plan. You can find more exercises, in detail, in one of our previous blogposts.
- Strengthening Exercises: It seems like common sense that you want to be strong enough to perform your recreational or sport activities. However, we frequently forget to strengthen all components needed for certain activities. Specifically when discussing Medial Tibial Stress Syndrome, it is important to make sure you have strong plantar flexors (gastrocnemius and soleus muscles), the muscles that run between your ankle and the top of your calf. These are the muscles strengthened by performing heel raises. Think of your plantar flexors as your natural shock absorbers. When these muscles are strong, your body is able to control your force as your foot hits the pavement while running. To strengthen your plantar flexors, start with 20 heel raises. If that is easy, try them on one foot at a time. Are they still too easy? If so, add weight by holding dumbbells or a bar, or increase your repetitions until you feel a good burn in the back of your lower legs.
- Stretching: While performing regular stretching of your legs can help reduce your likelihood of getting other lower extremity injuries, it won’t decrease your chance of shin splints. However, stretching won’t increase your chance of shin splints either. Since there is no harm in relation to Medial Tibial Stress Syndrome and there are other benefits, go ahead and stretch out those ankles and legs. A couple helpful stretches are:
- Calf Stretch: This stretch can be performed in standing or sitting. In standing, place one foot further back than the other and lean forward into a lunge while keeping the back leg straight and heel on the ground. In sitting, use a towel or strap to pull your toes toward your nose, while keeping your knee straight.
- Crossover IT Band Stretch: For the right IT Band, put your right foot on the left side of your left foot and lean to the left. You should feel a pull along the outside of your right hip and thigh. Switch feet and lean to the right to stretch the left.
Hopefully, these suggestions help you to never experience shin splints. But if you happen to get aching pain along the inside of your shin bone that is tender to touch, and gets worse with activity, then it is advised to seek physical therapy for shin splints. A physical therapist is a trained expert in human movement and injury rehabilitation. They can provide a thorough evaluation and determine the best course of action.
- Reinking, M.F., Austin, T.M., Richter, R.R. & Krieger, M.M. (2017). Medial Tibial Stress Syndrome in active individuals: A systematic review and meta-analysis of risk factors. Sports Health, 9(3):252-261.doi: 10.1177/1941738116673299.
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- Naderi, A., Degens, H. & Sakinepor, A. (2019). Arch-support Foot-Orthoses normalize dynamic in-shoe foot pressure distribution in Medial Tibial Stress Syndrome. European Journal of Sport Science, 19(2):247-257. doi: 10.1080/17461391.2018.1503337.
- Griebert, M.C., Needle, A.R., McConnell, J. & Kaminski, T.W. (2016). Lower-leg Kinesio tape reduces rate of loading in participants with Medial Tibial Stress Syndrome. Physical Therapy in Sport: Official Journal of the Association of Chartered Physiotherapists in Sports Medicine, 18:62-67.doi: 10.1016/j.ptsp.2014.01.001.
- Madeley, L.T., Munteanu, S.E.& Bonanno, D.R. (2007). Endurance of the ankle joint plantar flexor muscles in athletes with Medial Tibial Stress Syndrome: A case-control study. Journal of Science and Medicine in Sport, 10(6): 356-362. doi: 10.1016/j.jsams.2006.12.115.
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