What are some practical strategies to manage shin splints?

Written by: Waldo Cheung, Stridewell Physiotherapy

By far one of the most common pains runners encounter when they start running, increasing their pace or volume is shin splints. Colloquially we describe shin splints as a dull achy pain above and around our ankles that gradually gets worse and worse as we continue to run. But how do running physiotherapists like myself characterize medial tibial stress syndrome? And what are our recommendations for prevention and management for our clients?

Medial tibial stress syndrome (MTSS) is pain from the tibia (shin bone) that arises from irritation to the bone’s outer layer called the periosteum. As the calf and shin muscles surround the tibia on the back and front the periosteum is subjected to traction forces by these muscles when we run but also compression forces when our foot lands and absorbs impact from the ground.

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Why does it hurt?

The cells around the periosteum have a certain limit or gas tank before it breaks down and signals to the nearby nerves in the bone that there is damage, so if you are running too fast or too far without proper recovery you will deplete these cells’ gas tank and pain will ensue. Other factors that deplete the gas tank includes running technique (footstrike, vertical oscillation), training frequency, and footwear but that’s for another blog post.

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How do I prevent or treat it?

I have treated hundreds of runners that have suffered from MTSS and they have all tried many different therapies including laser, shockwave, needling, and graston without long-term success. Certainly in the interim it can provide temporary relief but these things do not address the root cause of the problem, which is the limited gas tank. How do you increase the periosteum’s gas tank? By running more frequently without depleting the gas tank! This strategy over several months will help these periosteal cells adapt to the body’s increasing demands to run more and run faster. This is also the basis for why training for a race usually takes several months; your body needs time to adapt for the task.

If you are starting to run, run at least 4-6 times a week with shorter distances 1-2 km without pain (0/10) and then gradually increase your distance slowly (this is not the 10% rule, the key is no pain for progression). Once your body has established a solid baseline you can then push your legs to cover more ground in a shorter time.

If you are currently experiencing MTSS or shin splints trying run/walk intervals is helpful strategy to stimulate your injured periosteal cells to heal without re-injuring them. For example repeats of 30s run and 30s walk for 5 reps for a week, and then progressing to 1-2 min intervals is an excellent long-term strategy for rehabilitation. 

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Strength training

Strength training may be helpful to increase capacity but there may be a risk of irritating the periosteum as the calf/shin exercises may increase traction forces on the irritated areas. Exercises such as heavy split-squats or single leg squats are metabolically helpful but are often inadequate to stimulate the bone compared to running even though it feels like much more work to squat than to run (squats are ~1.5x of your body weight unless around ~70% 1RM, while running is ~2.5-4x your body weight depending on speed). This may be due to the fact that the impact forces of running are directly absorbed from the heel, foot bones and shin compared to a squat or calf raise where the muscles may be the larger force absorber.

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My concluding advice is to listen to your body, run shorter distances more frequently when you are starting your training block to build adaptation through your body’s joints, bones, muscles, tendons and fascia. And to always seek a physiotherapist that runs when consulting a running-related injury!

Happy running and see you at YYCRunCrew =)

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About the author:

Waldo is a highly experienced physical therapist and clinical instructor for runners and rock climbers. With 7 years in the field, his approach focuses on bridging the gap between clinical science and functional movement. He holds two Master’s degrees from UBC (Rehabilitation Sciences 2017 and Physical Therapy 2019). His clinic, Stridewell Physiotherapy, is in Bridgeland, Calgary and is open to all runners.

Website: runrehab.pro

Instagram: @rehabinapinch

Learn more from Waldo Cheung at Stridewell Physiotherapy, HERE.