Ask the physio: Shin splints

What's behind shin splints and how can they be avoided?

by Paul Hobrough
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Q. What are the best ways to deal with shin splints? I’m training for a 10K and I find it frustrating to not run.
Helen Tiller, via webchat

The problem:

Shin splints are extremely prevalent. This particular problem is a soft tissue injury, where the key muscles that control the slow lowering of your foot at each step – and also control and maintain the longitudinal foot arch – are being put royally through their paces.

The main muscle groups in question are the tibialis anterior and the tibialis posterior. Most soft tissue injuries are caused because the muscles are too weak and too short to do the job they’re designed to do, so when you increase the mileage, they start to break down. Each muscle has an outer layer called the periosteum, and while you know the injury as shin splints, the clinical term is periostitis – meaning inflammation of the periosteum of the muscles.

Many see this as a precursor to higher levels of damage, such as stress response or a stress fracture to the tibia. Think of a stress response as like the white lines you would see in a plastic ruler if you repeatedly bent it back and forth, and think of a stress fracture as when this turns into a definitive crack.

Can you still run with shin splints?

If you have to keep running, please do so on a treadmill with the incline set to five. This is much better for the shins as the forefoot has less distance to travel to the floor and therefore the muscles have less work to do. Don’t run downhill as this will aggravate the pain. Run for five minutes, then do the calf stretches (below). Repeat this up to five times as long as you have little or no pain. As pain reduces, increase the duration of the runs and then start to remove some of the stretch stops. If your pain continues and you feel like it’s getting worse and/or more specific, seek specialist help as you may have a stress response or even a stress fracture.

The fix

Assuming your pain is shin splints and hasn’t developed into an issue with the bone itself, you’ll get great results by strengthening the tibialis posterior and tibialis anterior, along with stretching both the anterior and posterior muscles of the shin. I’m also a fan of looking at foot control. Overpronators tend to have a higher risk of shin splint symptoms, so it’s worth looking at footwear, or even an insert for the shoe that corrects overpronation.

Heel raises from a step

Stand with both feet on a step, heels hanging off it. Lower your heels as low as possible, then raise up onto your toes. Repeat for a total of three sets of 20 reps, morning and evening.

Calf stretches with straight and bent knee

These are two separate stretches which work he gastrocnemius and soleus respectively. 
Hold each for 30 to 60 seconds, repeating four times per day.

Toe raises

Stand with your back flat against a wall, and your feet roughly a foot away from it. Raise your feet up and down for three sets of 20 reps, then sit on your knees to stretch the anterior shin. Do these in the afternoon only.

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stress fracture, running with shin splints, running injury, most common running injury, physio, calf exercises, shin splints, shin pain

Discuss this article

Are the pictures and words for 4 and 5 mixed up? 

Posted: 22/04/2014 at 22:03

I think my problem may have gone past the shin splint stage and progressed to a response or even fracture. I feel pain when i press a spot on the inner aspect of tibia. I have got an X-ray done. Tibia/fibula normal. I have seen a physio who set me up with hip and ankle strengthening exs. I have also been doing aqua jogging 3 times per week. Why do I still have the pain? What am i doing wrong? It has been two months since I last ran. My physio told me to minimise time on feet but that is quite difficult given my job in the community. Any advice greatly appreciated! 

Posted: 07/11/2015 at 17:57

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