This is an area that has become quite prevalent within the running community particularly in 2020. I feel this is largely to do with the fact that people are out walking, running and doing home HIIT home workouts more so there has been an increase in 'lower limb impact activities'. Low impact sports such as swimming, yoga and Pilates have not been as accessible and so instead, the km’s have increased on the pavement. This has meant the number of “repetitive overload” injuries of the lower limb have sky rocketed.
If you’re not a runner but have just started you may have launched into it all guns blazing, and if you already a runner, you may have spiked your mileage to stay sane in iso and just as a general fun challenge…. either way, the impact load has increased and this may present in the form of shin pain (medial tibial stress syndrome) AKA Shin Splints.
The pain often starts humble enough, and may even warm up as you start to jog. You may be able to run through it for a while....
BUT, the reality is:
Unless measures are taken, shin splints are a persistent injury that need to be respected and (in my clinical experience) cannot just be “run out” or ignored.
Firstly, let us define what MEDIAL TIBIAL STRESS SYNDROME, or as it is colloquially known as: SHIN SPLINTS.
MTSS/Shin Splints is an inflammation of the muscles, tendons, and bone tissue around your tibia. Pain typically occurs along the inner border of the shin bone (tibia), where muscles attach to the bone. Shin splint pain most often occurs on the inside edge on the lower two-thirds of your tibia.
The pain is non-focal but extends over “at least 5 cm”, which is different to a tibial stress response/fracture which is a pin pointed small area of pain directly over the bone. Shin splints is often bilateral (but not always) and can be felt on direct palpation of the affected area and on impact activities such when impacting the ground when running.
Shin splints is an overload injury most commonly seen in sports where there is repetitive lower limb impact such as running or dancing.
It typically gets worse when you run or perform any impact activities and improves when you stop, but can reappear after cooling down due to the inflammatory component of this condition. When shin splints get worse the pain can remain during exercise and also could be present for hours or days after cessation of the activity.
Important to note:
*What to look out for:
The most common complication of shin-splints is a stress fracture, which shows itself by tenderness of the tibia in very focal spot, and may even have a small lump on the bony surface.
The pain is worse when you stand up or exercise, and it takes a while to improve afterwards. It is caused by muscle pulling on the shinbone and eventually causing the bone to crack. This can be diagnosed with a scan after getting an assessment from your doctor/physio.
*Other conditions such as tendinitis and compartment syndrome can also cause symptoms like shin splints.
It's important to get a handle on your specific diagnosis so you can start a treatment plan to get back on track!
How did we end up here?
There can be several causes of shin splints, and all of them vary slightly from person to person, but one thing that shin splints are certain of is that they occur from OVERLOAD.
Your lower limb is not tolerating the impact dosage. The running has overloaded your lower leg muscles, tendons and the attachments at the tibia and micro trauma has occurred and accumulated.
Internally a chronic inflammation of the muscular attachment along the posterior medial tibia and bony changes are considered to be the most likely cause of the medial tibial stress syndrome.
Here are some likely causes: (it’s likely at least 2-3 of these are relevant)
Once we have confirmed that shin splints are the cause of our pain and discomfort when running, the golden question is HOW DO WE FIX THEM? Also: how do we keep them under wraps and keep them from coming back!?
The first thing to note is: GETTING ONTO SHIN SPLINTS EARLY IS KEY IN A QUICK RECOVERY!
The longer they linger, the more imbedded they can become. Inflammation and mechanical compensatory issues can start to occur. It’s important not to ignore them.
If you have been bitten by shin splints, it’s crucial to formulate a strategy for prevention of their reoccurrence. Looking at implementing a solid weekly strength regime (1-2 whole body Pilates classes or a functional strength regime) can be a great way to address whole body weaknesses/imbalances.
It is widely proven that core/pelvic strength and trunk stability has a great impact on what happens further ‘down the chain’. It can be easy to address the symptoms around the feet/ankles due to this being the pain location, but getting strength further up the body can give your lower limb a great preventative mechanical advantage.
Strength: Example program for a MTSS/shin splint client:
When can I return to Running?
This question will vary from person to person and will take into account your own running and injury history, your current symptoms (and length of time of symptoms), and how you respond to the treatment outlined above. This is a good checklist to see when you are ready for impact load activities:
1) You have full range of motion in the injured leg compared to the uninjured leg.
2) You have full strength of the injured leg compared to the uninjured leg.
3) You can walk without pain or limping, (at least 30mins comfortably without aching.)
4) You can hop with less than 2/10 pain on x10 single leg hops
This is when a walk jog program can commence. *see my previous blog post on retuning to running after injury for a walk jog program.
Shin Splints can literally stop you in your tracks, and, if left untreated can drag on for months and even develop into a bone stress injury.
If you pull them up quickly and treat them early, you can recover quickly and get back on the trails. There is lots you can do to TREAT medial tibial stress syndrome and (even better) PREVENT them altogether.
One of the most common ways to strengthen the whole body in a functional and specific way to stay robust is through home mat Pilates. If you think your body could do well with this, I can help you out. I am now offering live and on demand Running Specific Pilates Sessions online weekly. It’s a sure fire way to get your whole body conditioned within the comfort of your own living room.
If you are still battling with Shin splints after trying all of the aforementioned treatment techniques, or you would like more information in regards to Pilates, email me below!
FREE SESSION- Pilates for Runners:
Are we talking a Chris Hemsworth 6 pack or shredded abs of any form? I’d love to say yes… but quite honestly as a runner and a physio, I am definitely more interested in function, posture and form.
We need core strength to simply live and function at a basic level, but for higher level performance (running) and injury prevention, we need optimal evenly distributed strength around the torso and pelvis.
Runners, listen up! Let's get to the core of the matter....
RUNNING! It's a wonderfully addictive sport and as far as km's go you can feel like a kid in a candy store who's saved a tonne of pocket money. We discover new trails and parks, run longer/faster/harder and it almost becomes a game of 'running roulette': how far can we go and still tolerate the impact?
Maybe not straight away but, inevitably, we fall victim to injury and niggles at some point to varying degrees which can be multifaceted in cause.
BUT! How do we bounce back safely and effectively without running the risk of re-injury? What does a 'Return to Running' program look like?
Here are my thoughts....
If you are a runner, inevitably someone has said something along the lines of:
"Oh No! Your poor joints. How do your knees hold up?!"
We can often dismiss this, but the question does not go unwarranted....
There IS a knee condition that is close to my heart and can side line you from running which is called patellofemoral pain or RUNNERS KNEE. It doesn't mean you are going to have "bad knees when you're old" but if you ignore this condition it can kneecap your training for months (pun intended) and take the buzz out of your training. Been there.
Here is the low down!