Q: How long will my recovery take?

If only your muscles feel sore and tight without pain along the shin bone, recovery will likely take 6 to 12 weeks. For anterior tibial stress syndrome , the length of time your recovery takes usually depends on how long you waited before starting the correct rehab plan: If your symptoms started less than 4 weeks ago: 3 to 4 months If your symptoms have been present for 4 to 12 weeks: 4 to 6 months If your symptoms have been present for longer than 3 months: 6 months, or more If you have compartment syndrome , it will likely take 3 to 6 months to build enough strength in your supporting muscles and safely change your running style.

Question 1

What is anterior (front) shin splints?

Accepted Answer

People use the term "anterior (front) shin splints" to refer to several different conditions, including anterior tibial stress syndrome, anterior chronic exertional compartment syndrome, or when they've simply overworked the front shin muscles (tibialis anterior and extensor digitorum longus muscles).

The rehab plan in the app can be used for all 3 of these injuries.

Please note that this rehab plan is not appropriate if you've been diagnosed with a stress fracture, tendinopathy, or tendonitis.

Question 2

Symptoms of overworked front shin muscles

Accepted Answer

The main symptoms indicating an overuse injury of the muscles in the front of your lower leg include:

Pain and stiffness in the muscle bellies (the soft, squishy part) of the tibialis anterior and extensor digitorum longus muscles.
The pain you feel is dull and more like a tired feeling — it doesn't feel sharp or tingly.
Pressing along the front of the shin bone or its outer border doesn't hurt.
You may have felt these symptoms come on slowly during a session or noticed it afterward or the next day.
The symptoms usually feel worse when you try to move after sitting still for longer periods or sleeping, but it doesn't cause pain while resting.
It is usually OK if you're standing still or walking slowly — fast walking is more uncomfortable.
Hopping on one leg does not cause much pain.

Question 3

Symptoms of anterior tibial stress syndrome (ATSS)

Accepted Answer

ATSS often starts with symptoms similar to those of overworked shin muscles but then intensifies as the injury progresses. Typical symptoms include:

Pain along the front outer border of the shin bone where the muscles attach.
The pain is spread over an area of 10 cm or more.
Initially, you may feel the pain at the start of a running session, but then it disappears as you warm up.
If you continue to irritate it, the pain may reappear later in a session. Eventually, you may experience pain that doesn't disappear and even remains after your run.
It usually doesn't hurt when you're at rest (e.g., sitting or lying still), and the pain will not wake you up at night.
Depending on how irritated the injury is, you may feel the pain when walking. It is usually more prominent after resting and then getting up to move.
Hopping on one leg does not cause much pain.

A shin bone stress fracture can often be misdiagnosed as shin splints, but the pain from a stress fracture feels different. It tends to be very localized, with a particularly painful spot you can press on in your shin bone. And it will usually hurt when you hop on that leg.

The App's rehab plan is not appropriate for stress fractures.

Question 4

Symptoms of anterior chronic exertional compartment syndrome (ACECS)

Accepted Answer

The main characteristic that sets ACECS apart from the other conditions is that the symptoms are only present while you exercise and disappear completely after a few minutes of rest.Typical symptoms may include:

Pain, numbness, tingling, a dead feeling, or a tired feeling in the front of your shin while you run.
You may struggle to lift your foot (dorsiflex).
These symptoms tend to start after a set time into a run and usually force you to stop the run early.
The symptoms then disappear completely after resting for a few minutes.
Doctors and physios can usually not find any clear cause for your symptoms when they assess you, except if they test you immediately after you stop a running session.
Hopping on one leg does not cause pain.

Question 5

When to see a doctor

Accepted Answer

You should consult your doctor or physical therapist before using the App to ensure you have the correct diagnosis and are 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 pain at night that keeps you awake or interrupts your sleep — this may mean that you have a stress fracture
You feel a sudden sharp pain in your lower leg during activity — this may mean you've strained something, and the App's program may no longer be appropriate
You notice bruising — shin splints do not cause bruising
Any part of your leg (thigh, calf, or foot) is swollen, red, hot to touch, or throbs with pain — these signs can indicate a blood clot, and you should have it investigated as soon as possible
You feel pins and needles or tingling in your leg that remains after your running session — this can indicate an injured nerve, and the rehab plan may not suit you
Your symptoms are getting worse
Your injury is not recovering as expected (see expected recovery times below)

If you have a chronic condition, e.g., osteoporosis, heart disease, or an inflammatory condition, the rehab plans in the App are likely not appropriate for you. Please check with your doctor before using the App.

Question 6

Common causes for anterior shin pain

Accepted Answer

The most common cause of front shin pain is overloading or overworking the front shin muscles and bone.

This overload can happen suddenly, during one intense training session (acute overload), or slowly over several training sessions (gradual overload).

Typical things that can contribute to the overload include:

Overstriding when you run (placing your foot far out in front) can cause you to land with your foot more dorsiflexed (toes pulled to shin), which works the front shin muscles more.
Overstriding also causes a braking force in the leg, increasing the impact through your whole leg.
Running with taller runners can force shorter runners to stretch their strides, resulting in overstriding. Increasing step rate (cadence) is usually a better option.
Ramping up your running volume or high-intensity run sessions too quickly.
Not allowing enough recovery time between training sessions or races.
Switching to heavier shoes makes the front shin muscles work harder. If you switch too suddenly, it can cause them to overload.

With compartment syndrome, genetics may also play a role.

When we exercise, our muscles expand and more blood flows into that area — the harder specific muscles work, the more they expand. A thick layer of fascia (sinewy tissue) surrounds our muscles. This fascia is meant to expand and stretch slightly to compensate for the increased muscle size and blood flow.

However, with compartment syndrome, the fascia can't expand enough. As the muscles expand, the pressure inside the fascia pocket increases to the point where it cuts off the blood flow and compresses the nerves.

As soon as you stop the exercise, the muscles reduce in size, causing the pressure to decrease, and all the symptoms disappear.

Even though genetics may predispose you to this injury, overworking the front shin muscles often triggers it or makes it worse. Hence, the same treatment plan used for front shin splints often also works for compartment syndrome in the front of the shin.

Question 7

Best treatments for anterior shin pain

Accepted Answer

Contrary to popular advice on the internet, you should actually avoid strength training exercises that specifically target the front shin muscles (typically done with resistance bands). These muscles are already working too hard when you run and strengthening them often just makes things worse.

The research shows that one of the most effective treatments for front shin pain is changing a runner’s running style slightly, so they don’t overstride as much when they run.

Reducing overstride involves shifting a bit more work onto the calves, hamstrings and glutes. So to make this transition safely, you have to ensure that the other muscles in your legs are strong.

A well-rounded treatment plan for front shin pain should include the following:

Relative rest: Cut out aggravating activities and reduce your training program to allow your injury to settle
A slow, progressive strength training plan: Strengthening the muscles in your legs and core that are meant to support your front shin muscles when you run and laying the foundation to transition safely to a slightly different running style
Mobility and range of movement exercises: Gain and maintain good mobility in all your lower body joints and muscles, especially the front shin muscles
Movement retraining: Learn how to use your whole kinetic chain (all the interconnected parts of your body) optimally while running, specifically during the landing phase
Adjusting your running style: Small changes can have a big impact, but you must lay the foundation through strength training before making these changes
Easing into running with a run-walk plan: Allow your body the time to learn, strengthen and adapt to your new running style

The rehab plan in the App includes all of these components. It starts with low-load exercises that help settle your pain, then slowly increases the exercise intensity as your injury heals. Finally, it helps you ease into your new running style with a run-walk plan.Other treatments you may encounter:

Complete rest: May calm your pain initially, but resting for prolonged periods is not advised as it can cause you to lose strength
Massage: May help reduce pain and stiffness
Strength exercises for the tibialis anterior muscle: Not recommended by the research
Electrotherapy (like ultrasound): Not recommended by the current research
Shockwave therapy: May help in some cases, but research shows contradictory results

Not all cases of anterior chronic exertional compartment syndrome (ACECS) will resolve using the above conservative treatment plan. Because genetics often contribute to this condition, surgery may sometimes be necessary.

Question 8

How long will my recovery take?

Accepted Answer

If only your muscles feel sore and tight without pain along the shin bone, recovery will likely take 6 to 12 weeks.

For anterior tibial stress syndrome, the length of time your recovery takes usually depends on how long you waited before starting the correct rehab plan:

If your symptoms started less than 4 weeks ago: 3 to 4 months
If your symptoms have been present for 4 to 12 weeks: 4 to 6 months
If your symptoms have been present for longer than 3 months: 6 months, or more

If you have compartment syndrome, it will likely take 3 to 6 months to build enough strength in your supporting muscles and safely change your running style.

Question 9

How can I avoid getting pain in the front of my shins?

Accepted Answer

You may reduce your risk of front shin pain if you keep your body strong and avoid common training errors. We recommend that you:

Allow enough recovery time between hard training sessions.
Avoid sudden increases in training volume or intensity.
Do strength training twice a week — the stronger your core and leg muscles, the less strain your lower legs take.
Maintain good hip mobility — tight hip flexors limit how far your hips go back and can contribute to overstriding
Avoid overstriding when you run.
Get plenty of sleep and adapt your training intensity when you feel tired — you are more likely to injure yourself when physically or mentally tired.

Once you've completed your rehab, maintain your progress by switching to the Mobility and Strength plan in the App — we designed it with all of these elements in mind.

Question 10

Research references

Accepted Answer

Bonasia DE, Rosso F, Cottino U, Rossi R. Exercise-induced leg pain. Asia Pac J Sports Med Arthrosc Rehabil Technol. 2015 May 2;2(3):73-84.
Tucker, A. K. (2010). Chronic exertional compartment syndrome of the leg. Current reviews in musculoskeletal medicine, 3(1), 32-37.
Tucker, A. K. (2010). Chronic exertional compartment syndrome of the leg. Current reviews in musculoskeletal medicine, 3(1), 32-37.
Buerba, R. A., Fretes, N. F., Devana, S. K., & Beck, J. J. (2019). Chronic exertional compartment syndrome: current management strategies. Open access journal of sports medicine, 71-79.
Vogels, S., Ritchie, E. D., van der Burg, B. B., Scheltinga, M. R., Zimmermann, W. O., & Hoencamp, R. (2022). Clinical consensus on diagnosis and treatment of patients with chronic exertional compartment syndrome of the leg: a Delphi analysis. Sports Medicine, 52(12), 3055-3064.
Kaplan, S., Olivier, B., & Obiora, O. L. (2021). Effectiveness of surgical and non-surgical management strategies in patients with chronic exertional compartment syndrome of the anterior compartment of the leg: a systematic review protocol. JBI evidence synthesis, 19(11), 3198-3205.
Jensen, C. T., Stonerook, E., Andreski, A., Goldsmith, K., Vallejo, C. S., Tran, L. M., ... & Gillette, C. (2024). Diagnosis and Management of Lower Extremity Chronic Exertional Compartment Syndrome in the Active Adult Population. JBJS Journal of Orthopaedics for Physician Assistants, 12(1), e23.
Breen, D. T., Foster, J., Falvey, E., & Franklyn‐Miller, A. (2015). Gait re‐training to alleviate the symptoms of anterior exertional lower leg pain: a case series. International journal of sports physical therapy, 10(1), 85.
Gaudette, L. W., Bradach, M. M., de Souza Junior, J. R., Heiderscheit, B., Johnson, C. D., Posilkin, J., ... & Tenforde, A. S. (2022). Clinical application of gait retraining in the injured runner. Journal of Clinical Medicine, 11(21), 6497.
Barton, C. J., Bonanno, D. R., Carr, J., Neal, B. S., Malliaras, P., Franklyn-Miller, A., & Menz, H. B. (2016). Running retraining to treat lower limb injuries: a mixed-methods study of current evidence synthesised with expert opinion. British journal of sports medicine, 50(9), 513-526.

Strong Shins: Anterior Stability