Preventing Shin Splints: Podiatrists Top Tips

You’re just getting in the swing of exercising regularly, whether that’s getting out for runs or jogs or getting to the gym, when you feel that crippling, frustrating pain at the front of your shins. Could it be the dreaded ‘shin splints’ that many talk about - and what are shin splints anyway?

Shin splints describe a painful and frustrating injury that affects one third of active people at some point in their lives, including around 70% of runners.^[1]  Most people best know shin splints as the pain comes on at the front of the shins during physical activity, which is correct, although there’s a lot more than meets the eye when we talk about shin splints from a podiatry perspective. Unlike other medical diagnoses we give you that are quite specific, shin splints are interestingly a non-specific term that can refer to three separate conditions:^[2] 

1. A tibial stress fracture (the tibia is the shin bone)
2. Exertional compartment syndrome
3. Medial tibial stress syndrome

A Tibial Stress Fracture

Repeated stress and pressure exerted on a bone, specifically the shin bone in this case, is what ultimately gives rise to a tibial stress fracture. Stress fractures commonly manifest during activities involving running and jumping due to their repetitive and high impact nature. They’re also exacerbated by contributing factors such as the unique biomechanics of a person's feet and legs, any muscle imbalances, and errors in training techniques, among other factors.

The initial stages of a stress fracture involve tiny cracks (so small that they are not initially visible on x-ray) with minimal symptoms or pain, evolving swiftly into more pronounced, severely painful or uncomfortable fractures that can leave you sidelined during your favourite activities. The pain and tenderness is felt along the shin bone, with swelling present in some but not all cases. The pain tends to intensify with physical activity while subsiding during periods of rest. As identifying a stress fracture in its early stages can go a long way in shortening your recovery time, you should always report and check shin pain as early as possible.

Exertional Compartment Syndrome

The next condition often referred to as shin splints is compartment syndrome - specifically chronic exertional compartment syndrome. Looking at your lower leg, you actually have four different muscle compartments, distinctly separated by tissues (fascia) within the leg. Each compartment only has so much space to house its muscles, arteries, nerves and other tissues - much like a childrens lunchbox with its different sections - you can only fit so much food into each section.

When the muscles within the front (anterior) compartment become injured, they naturally swell, as all muscles tend to. Unfortunately the swelling within a compartment that already has limited space means that there’s an increase in pressure within that compartment, which causes pain, discomfort, a feeling of tightness, and a swollen appearance of the front of the lower leg. As the muscles within the anterior compartment are heavily used during running sports, these symptoms often start during or after exercise. 

The good news is that with rest, the muscle swelling typically subsides, which should ease your symptoms. But this isn’t a cure - the next time you’re active, the pain often eventually returns - and the injury can worsen.

Exertional vs acute compartment syndrome
When discussing compartment syndrome, let us quickly make a clear distinction to the other type of compartment syndrome: acute compartment syndrome. Unlike chronic exertional compartment syndrome that subsides and gives you relief, acute compartment syndrome does not. This means that the swelling continues, restricting blood flow to the area, and putting your leg at a serious risk for permanent damage. As such, acute compartment syndrome is a medical emergency and you should be seen at the emergency room at your earliest convenience. Signs to look out for are severe pain in your lower leg, a pale skin tone at the leg, numbness (or tingling), a faint pulse and weakness when trying to move the affected leg. 

Medial Tibial Stress Syndrome (MTSS)

Finally, we have the most common shin pain of the three: medial tibial stress syndrome. This is typically what health professionals are referring to when they talk about shin splints in a general sense. MTSS develops when there is simply too much stress or strain to the front and inside of your shin bone, typically to the ‘leading’ foot (the one that goes first when you start walking or running). 

The stress that leads to the pain of shin splints is typically caused by either overusing the muscles that attach to the shin bone, or from excess stress on the lining of the bone itself (called the periosteum). Either way, it all leads to irritation, degeneration and the onset of your uncomfortable symptoms. Many experience discomfort, pain and swelling that may stay mild, or become severe enough to stop you in your tracks during or after physical activity. 

Common causes for overusing the muscles at the front of the shins include overtraining or training errors, biomechanical problems in the feet or legs (like overpronation - excessively flat feet), muscle tightness (like in the calves) and a history or previous lower limb injuries. When this is paired with running or jumping activities, the strain on the shins is greatly exacerbated, tipping a person beyond their standard “easy repair” threshold. Interestingly, some researchers are now attributing heavily-cushioned footwear to be one of the causes of shin splints due to their high-tech engineering that allows athletes to land on their heels and place excess force through the lower legs.

Shin Splints Causes

While we’ve described the condition-related causes of shin splints above, generally speaking the most common contributing factors for shin splints that our podiatrists see include:

• Foot and leg biomechanics - issues like gait abnormalities, alignment issues and flat feet can make you more prone to developing shin splints as they may alter the distribution of forces along the lower leg, leading to your lower leg muscles having to work harder to stabilise your feet and legs during movement, hence becoming overused. Flat feet in particular tend to increase the stress on the inner side of the shin bone when you’re active on your feet.

• Training errors - drastically increasing your training intensity, duration, frequency or the type of training you’re doing (like suddenly switching to hill running) without adequate preparation also increases your shin splints risk. You should increase your activity intensity and duration gradually to allow your body to adapt safely.

• Muscle imbalances - if there is weakness in the muscles surrounding the shins and calves (as well as the calf muscles themselves), it can place uneven stress onto the shinbone, increasing susceptibility to inflammation, pain and the development of shin splints.

• Poor running technique - poor running biomechanics, such as improper foot placement, stride length, or running form, can disrupt the natural distribution of impact forces during each stride. The repetitive nature of running magnifies the impact, causing irritation, microtrauma, and inflammation at and around the shins. Inadequate shock absorption and an inefficient transfer of forces through the lower limbs create a biomechanical environment that elevates the risk of developing shin splints.

Poor footwear choices - your shoes offer your feet and legs a great deal of shock absorption to keep you exercising safely. Your feet also rely on your shoes to provide adequate support throughout both the feet, arches and ankles. Without this support and shock absorption, the stress on the muscles, joints and bones in your feet and lower legs can increase significantly, transferring excessive stress to the shinbone and surrounding structures.

How To Prevent Shin Splints

While nothing can guarantee that you will prevent shin splints, there are several steps you can take that will help reduce your risk of developing this pain and discomfort. This includes:

Gradual Training Progression
A key strategy to reduce the risk of shin splints is the gradual progression of your training intensity, duration, and frequency. By allowing your body the necessary time to adapt to new demands, you minimise the likelihood of overuse and the subsequent strain on the shinbone. This approach is particularly important for those involved in running or jumping activities, where repetitive impact plays a significant role in the development of shin splints. Gradual training progression supports the overall resilience of the lower limbs, aiding in injury prevention and promoting long-term musculoskeletal health.

Proper Footwear
Investing in appropriate athletic footwear is a crucial step in mitigating the risk of shin splints. Well-fitted shoes with adequate arch support and shock absorption play a pivotal role in minimising the impact forces on the lower legs during physical activities. The cushioning provided by proper footwear helps distribute forces more evenly, reducing the strain on the shinbone and its surrounding tissues. 

Warm-Up And Stretching
Incorporating a comprehensive warm-up routine, including dynamic stretches for the lower legs, is an effective preventive measure against shin splints. A proper warm-up increases blood flow to the muscles, enhances joint flexibility, and prepares the body for the physical demands of exercise. This means you can reduce the tension and stiffness in these areas, promoting better shock absorption and reducing the risk of microtrauma that leads to shin splints.

Strength Training For The Lower Legs
An essential aspect of shin splint prevention involves incorporating strength training exercises that target the muscles in the lower legs, including the calf muscles and those along the shin. Strengthening these muscle groups enhances their ability to absorb and distribute forces during weight-bearing activities. Specifically targeting the muscles surrounding the shinbone helps create a more robust support system, reducing the strain on the bone and minimising the risk of inflammation and injury.

Cross-Training
Diversifying your exercise routine through cross-training with low-impact activities is a valuable strategy to reduce the risk of shin splints. Engaging in activities like swimming, cycling, or elliptical training provides a break from the repetitive stresses associated with high-impact exercises like running. Cross-training allows for active recovery, reducing the cumulative stress on the shinbone and surrounding structures. By incorporating alternative forms of exercise, you’re able to maintain your cardiovascular fitness while minimising the risk of overuse injuries, contributing to a more balanced and sustainable fitness regimen.

Appropriate Running Technique
Focusing on a midfoot strike, shorter strides, and an upright posture helps distribute impact forces more evenly throughout the feet and legs. Having a correct running form minimises the strain on the shinbone, reducing the risk of irritation, microtrauma, and inflammation. Be consistent with your form and technique.

Rest and Recovery
Prioritising adequate rest and recovery between high-intensity workouts is also fundamental to preventing shin splints and other overuse injuries. Continuous stress without sufficient time for the body to repair and adapt can lead to cumulative strain on the shinbone and its surrounding tissues. Incorporating rest days into your training schedule allows for the resolution of microtrauma, reducing the risk of inflammation and injury. Adequate sleep, hydration, and nutrition also play crucial roles in the recovery process. 

Biomechanical Assessment With Your Podiatrist

Finally, one of the most important prevention tips for shin splints is having a biomechanical assessment with your podiatrist. Biomechanical assessments are clinical exams that help to identify and address risk factors for shin splints, with your podiatrist being able to put systems or therapies in place to help mitigate that risk. Gait abnormalities, foot arch issues, and other biomechanical factors can contribute to uneven stress distribution on the shinbone, increasing the susceptibility to injury. 

Already Have Shin Splints?

No worries - your podiatrist is the perfect person to help with this too. Treating shin splints starts with relieving your initial symptoms, and creating a comprehensive treatment plan that addresses what has caused the shin splints in your specific circumstances. To do this, we may use one or a combination of:

• Custom foot orthotics
• Strapping, splinting or bracing
• Footwear changes to more stabilising and supportive shoes (with the right level of shock absorption)
• A custom stretching and strengthening programme to address muscle imbalances, tightness or weakness
• Changes to your gait or training schedule

If you’re unsure if shin splints are the cause of your leg pain, or if it's something else, we can help. Start by booking your appointment with us by calling 03 355 9481 or emailing reception@merivalepodiatry.co.nz

^[1]Medial-Tibial-Stress-Syndrome:-A-Review-Article

^[2]Compartment-Syndrome-and-Shin-Splints