With running events featuring in the back half of the year, such as Run Melbourne (unfortunately postponed!) and the Melbourne Marathon, or even just running for some lockdown exercise, running is really ramping up. 

Around 1 in 5 people experience shin splints, so it is highly likely you or someone you know has experienced Medial Tibial Stress Syndrome (a.k.a shin splints).  

It is a very frustrating injury that can hinder participation and progress in running, and typically presents as a broad pain up and down the shin.  

The symptoms of this condition are linked to inflammation of surrounding soft tissue and microtrauma of the tibia (shin bone). This means that if left unchecked, shin splints can progress into a more serious injury such as a stress fracture.  

Shin splints typically present when the level of running or activity we do exceeds the capacity of our body over time – aka overuse. Completely resting can help in the short term, but if we return to exactly what we were doing before, the problem is highly likely to recur.  

Fortunately, with a good plan in place, shin splints can be well managed.  

Here are 3 important factors that should be included in your plan: 

LOAD MANAGEMENT – progress over time

A significant increase in running load can predispose you to shin splints. It is very easy to get carried away in session, trying to constantly go faster and further with every single run. However, it is important that progression is gradual to give our bodies time to adapt: too fast and too soon can result in various aches and pains. The appropriate amount to progress a program depends on a lot of factors including previous running history, muscle strength, previous history of injury and your goals.  

It is important to keep in mind that progression with running can be in multiple forms such as running further, running faster or tackling more challenging terrain (e.g more hills). It is not just as simple as kilometres per session. 

Having a properly designed running program can go a long way in reducing your risk of shin splints. 

Where do I start?

It is extremely helpful if you have a record of your running, whether that is a smart watch, mobile app or even a diary. The more information available, the more precise we can be with your plan to keep you running as much as possible without flaring up your injury. 

If you think you may be developing shin splints, make note of what point in the run that symptoms come on, whether that relates to distance, speed or terrain, and use that to determine when you should pull back. For example, if you notice symptoms at the 10 minute mark, keep your runs to this distance and monitor your response. Monitor how you feel post run, as sometimes symptoms can be delayed. 

STRENGTHENING – Build up your foot, ankle, knee and hips

If you have had this condition before, you may notice that when you take time off running, the pain goes away. That is until you attempt running again! This does not mean by any stretch that you are doomed to experience this forever. This may be an indication that you have poor capacity of the muscles and joints that help us run. Strengthening these important muscles allows them to better cope with the demands of running, which will in turn mean they do not get as sore. 

The muscles that need to be strengthened will depend on your specific deficits. Some important muscles for running include the calf muscle, particularly the soleus, quadriceps and the gluteus complex. 

Where do I start?

Ideally, you should participate in strengthening two to three times per week, however any is better than none. The exercise should be at a high enough intensity to make the muscle fatigue. This is what makes it adapt and become stronger.  

If you have never done strength training before, a good place to start could be to perform one ankle, knee and hip exercise and build from there. Some examples include calf raise, hip thrust, lunge and step up. 

RUNNING MECHANICS – take more steps!

Recent evidence has demonstrated that increasing your step rate is an effective way to reduce your risk of a bone stress injury. Research has found that increasing your step rate by just one per minute can reduce your risk by five percent. Taking more steps means that each stride is shorter, and therefore overall ground reaction forces around the shin bone are reduced. 

Where do I start?

Simply try to consciously take more steps while maintaining the same running pace. Have a play around and see what feels good for you. If you have had significant issues with shin splints before, you might want to take a more precise approach and increase by even more steps per minute. Use of a metronome can help with proper pacing as a change in running technique can sometimes feel awkward at first. 

These are just some practical tips to get started. For the best results you should see a professional for a comprehensive assessment and tailored treatment plan. Our CSSM team is available to help keep you running!

Don’t let shin pain get in the way of your running! 

About the author

Hugh Feary has always been interested in how the body works, sport and strength training. Physio was the perfect fit. Hugh has previously worked in GP clinics as well as a variety of local sporting teams including the Fremantle Dockers in the AFLW. Spending a lot of time strength training in the gym, Hugh enjoys helping others who have any niggles or injuries to modify their program to keep them moving. 

References: 

Franklyn M, Oakes B. Aetiology and mechanisms of injury in medial tibial stress syndrome: Current and future developments. World J Orthop. 2015 Sep 18;6(8):577-89. doi: 10.5312/wjo.v6.i8.577. PMID: 26396934; PMCID: PMC4573502. 

Kliethermes SA, Stiffler-Joachim MR, Wille CM, et al. Lower step rate is associated with a higher risk of bone stress injury: a prospective study of collegiate cross country runners. British Journal of Sports Medicine Published Online First: 14 May 2021. doi: 10.1136/bjsports-2020-103833 

Winters M. The diagnosis and management of medial tibial stress syndrome : An evidence update. Unfallchirurg. 2020 Jan;123(Suppl 1):15-19. English. doi: 10.1007/s00113-019-0667-z. PMID: 31098646.