Everything You Need to Know About Shin Splints

Medial tibial stress syndrome (MTSS) is commonly known as shin splints and refers to exercise induced pain "along the distal two thirds of the medial tibial border". This is the fancy way of saying the inside of your shin hurts. MTSS symptoms often present as worse with physical activity and better with rest. A significant finding from Winters et al is that one third of people with MTSS also presented with other concurrent lower limb injuries which means they don’t happen in isolation often.

MTSS is the most common running related injury according to research, but the nature of how MTSS occurs is not well understood and is thought to be related to bone stress overload issue however there is also the suggestion it could be due to anatomical and biomechanical factors. It has been suggested and now commonly thought that it is most likely due to an error in workload, and the body is unable to adapt to the load it is undertaking. This can be due to many different reasons but the most common are: certain training factors, a lack of strength/mobility, poor bone health, lack of sufficient rest/recovery, and hormone imbalance.

Training Factors:

• Sudden increase in training volume and/or intensity  
• Insufficient rest and recovery 
• Low training exposure 
• Previous history of shin pain 
• lack of adequate strength or mobility to complete the load you are attempting

Bone Health 

• Low bone density 
• Relative Energy Deficit (RED-S) 
• Vitamin D Insufficiency 
• Females 

Biomechanics

• High BMI
• Greater ankle plantar flexion  
• Greater hip external rotation 
• Greater Navicular drop

It is important to note that most injuries including shin splits are due to a combination of factors and it is highly unlikely one issue will be solely responsible. 

How to Treat Shin Splints

The most important way you can treat shin splints is to modify your load. What does this mean? It sadly means you will have to temporarily reduce or stop the high impact activities that are the aggravating. Switching these out for low impact activities to maintain fitness is an option (such as cycling, or swimming). Additionally, ensuring your rest and recovery in between sessions is a must for proper recovery. 

Additionally, as discussed above - ensuring your bone health is sufficient by eating enough calories, having appropriate levels of calcium and vitamin D (see your GP if you feel you need supplementation), and keeping your hormones balanced. 

Finally, as a physio I can't write an article without giving advice to strengthen and stretch. Strengthening the muscles of the lower limb, such as ankle dorsiflexors, foot muscles, calves, quads, and glutes. Stretching is less helpful in the research however it has no adverse effects so stretching out the muscles of the lower leg can be added as well. 

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Kris x