Question 1

Overview of the anatomy

Accepted Answer

Shin splints, also known as medial tibial stress syndrome, is a painful condition that develops on the inner part of the tibia (shin bone) where your calf muscle attaches. Researchers are still uncertain whether the bone or fascia causes the pain.

It’s an overuse or overload injury, which means it develops because the shin takes more strain than it can bear. It can be due to a sudden overload, for example, during a single intense training session (an acute overload). Or it can happen over time, for instance, if you do several high-intensity activities over consecutive days (a cumulative overload).

Question 2

Shin splints symptoms

Accepted Answer

The most common symptoms include:

Pain along the inner border of your shin bone, spanning an area of about 10cm or more when you press on it.
It may initially hurt during exercise only, but it can be painful after exercise or while walking or doing daily activities as the injury progresses.
It usually doesn’t hurt when you’re resting, and the pain doesn’t wake you up at night.
Often downhill running hurts more than running on flat or hilly surfaces.

Question 3

When to see a doctor

Accepted Answer

You should consult your doctor or physiotherapist before using the app to ensure your diagnosis is correct and your injury is ready to start rehab exercises.

If you have any concerns about your injury after you've started your rehab, schedule a review with your doctor, particularly if:

Your leg hurts when you’re lying down, or you have night pain keeping you awake or interrupting your sleep. If this is the case, it could mean that you have a stress fracture.
Any part of your leg (including your thigh, calf, or foot) is swollen, red, hot to touch, or throbs with pain. It can indicate that a blood clot has formed, and you should investigate it as soon as possible.
You feel pins and needles or tingling in your leg, which may indicate an injured nerve. In which case, our rehab plan may not be suitable for you.
Your symptoms worsen.
Your injury is not healing as anticipated (see expected healing times next).

Question 4

Causes of shin splints

Accepted Answer

Overload is the primary cause, but it can also occur due to:

Muscle weakness or lack of control around the hips and pelvis, causing your leg to turn in more when you run
Muscle weakness or lack of control in your ankle and foot, forcing you to over-pronate
Sudden changes in training load like increasing your running volumes too quickly or doing too much downhill running
Unsupportive shoes that don’t resist over-pronation
Training on hard surfaces like Astroturf

Question 5

Rehab, recovery times & prevention

Accepted Answer

Run/walk plan

You’re now ready to start a return to running program. The safest way to ease back into running is following a program that alternates between short running and walking intervals.

Use these sessions to focus on your running form, trying not to rush your progress. If you do not feel completely comfortable in a session, it’s always better to stay on that level and repeat the same session next time. Please do this until it feels that you can complete it 100% satisfactorily.

Workouts

The focus in your strength sessions will shift to maintenance, and their frequency will reduce as you run more, helping you prevent overloading your shins.

Rehab

The right combination of rest and exercise, tailored to the individual, is the most effective intervention for shin splints. The best rehab program includes:

Load reduction: Meaning you reduce your activities to pain-free levels, allowing your injury to settle and recover. For example, you may need to switch running out for cycling or swimming.
Strength, balance, and control training for your core and other leg muscles early, started early on in your rehab. It can improve your movement patterns and off-load the injured area.
Foot and ankle strengthening exercises only once your initial injury has settled.
Calf stretches only once your injury has adequately settled. Stretching sensitive tissues will only agitate them more.

Other options that you may encounter:

Complete rest can be helpful to calm your pain at first. However, it’s best not to rest for a prolonged period because it will weaken your muscles even further.
Massage can help to make your pain feel better, but it does not strengthen the injured area.
Electrotherapy is currently not recommended.
Supportive insoles that reduce pronation may be of use if you over-pronate.
Shockwave may be helpful in cases not responding to exercise therapy.

Healing times

The length of your recovery will depend on how long you waited before starting the correct treatment. Estimated healing times are as follows:

If your symptoms began less than 4 weeks ago, your recovery could take 12 to 16-weeks
If you’ve had for 4 to 12 weeks, your recovery could take 6 months
If you’ve had symptoms for longer than 3 months, your recovery could take 6 months or longer

Prevention

Do strength training twice a week. The stronger your core and leg muscles are, the less strain there will be on your lower leg.
Include balance exercises into your training program. They help improve your movement patterns and control.
Allow enough recovery time between heavy training sessions.
Avoid significant increases in training volume or intensity.

Make sure that you get enough sleep and if you feel tired, adapt your training intensity accordingly. You are more vulnerable to injury when you’re physically or mentally fatigued.

Question 6

Research References

Accepted Answer

Capt Christopher J. Couture & Kristine A. Karlson (2002) Tibial Stress Injuries, The Physician and Sportsmedicine, 30:6, 29-36, DOI: 10.3810/psm.2002.06.337
Galbraith, R. Michael; Lavallee, Mark E. (7 October 2009). “Medial tibial stress syndrome: conservative treatment options”. Current Reviews in Musculoskeletal Medicine. 2 (3): 127–133. doi:10.1007/s12178-009-9055-6. ISSN 1935-973X. PMC 2848339. PMID 19809896.
Hamstra-Wright KL, Bliven KCH, Bay C. Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis. British Journal of Sports Medicine 2015;49:362-369.
Lohrer H, Malliaropoulos N, Korakakis V, Padhiar N. Exercise-induced leg pain in athletes: diagnostic, assessment, and management strategies. Phys Sportsmed. 2019 Feb;47(1):47-59. doi: 10.1080/00913847.2018.1537861. Epub 2018 Nov 5. PMID: 30345867
Lopes, A.D., Hespanhol, L.C., Yeung, S.S. et al. What are the Main Running-Related Musculoskeletal Injuries?. Sports Med 42, 891–905 (2012). https://doi.org/10.1007/BF03262301
Patel, Deepak S.; Roth, Matt; Kapil, Neha (2011). “Stress fractures: diagnosis, treatment, and prevention” (PDF). American Family Physician. 83 (1): 39–46. PMID 21888126. S2CID 1736230. Archived from the original (PDF) on 12 February 2019.

Shin splints rehab plan