Shin splints: prevention, treatment, and recovery

To many runners, shin splints are the bell toll of death for their training plans. This is partly because full-blown shin splints can be pretty fucking painful during both exercise and rest and because a firm diagnosis often goes hand in hand with prescribed rest–the last thing a runner wants to hear.

I’ve been lucky enough to experience shin splints not once but three times. For this most recent doozy, I combed the available research out there and did my best to treat them without having to seek medical attention–just so I could write this post! Not really. Before I list out all of my attempts (some pathetic) at thwarting and subduing my shin splints, let’s talk for a second about what they are.

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My extensive medical knowledge, earned from a steady diet of “House” and “E.R.”, combined with my ability to read Wikipedia articles tell me that shin splints, or medial tibial stress syndrome as we TV-doctors call it, is a common overuse injury among runners that is characterized by pain along the shin bone. There is more than one type of shin splints, depending on where the pain is focused, according to this, but essentially it boils down to this: as your shin and calf muscles become fatigued during a run, they are less able to absorb the shock of each step, leading the connective tissues between the one of the shin muscles and tibia (one of the lower leg bones) to become damaged and the periosteum (the membrane that surrounds the shin bone) to become inflamed. Muscle tightness in the calf can also contribute to the condition. I personally have been battling posterior shin splints and have never experienced its anterior counterpart, although I imagine the strategies for dealing with either would be similar…

Shin splints have many, many possible causes or sources but are ultimately, as I said, an overuse injury. In layman’s terms this translates to “too much, too soon.” Let’s talk about some other things that can lead to shin splints!

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  • Shitty shoes: Traditional running shoes are often heavier in the heel, which can cause the wearer to run with a heel-strike stride, where their heel hits the ground first and then the foot rolls forward to push off with the toes. This form contributes to shin splints because the foot/leg does not absorb the shock of impact as well.
  • Shitty form: If you suffer from excessive pronation, an inward roll of the foot during walking or running (the leftmost example in the diagram, which I got here), have flat feet, run with your toes pointed outward, or lean too far forward or backward while running, you might be susceptible to shin splints.
  • Shitty running surfaces: A few years ago, an article in the New York Times seemingly debunked the myth that running exclusively on soft surfaces will prevent or minimize the risk of injuries like shin splints. There was a lot of backlash against this theory but the consensus was that it’s best to run on varied surfaces/terrain during race training, including the types of surfaces/terrain you’ll be running on during the race.

Now that I have got you thoroughly freaked out, let’s talk prevention. I’d like to make a key distinction here that prevention is NOT treatment, so although some of the strategies for prevention might still work for shin splints in-the-making, if you feel like you might already have shin splints, skip on ahead.

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Stage 0: Prevention

  1. Build up your shin muscles: If shin splints can be caused by fatigue, stave off fatigue by making you muscles stronger. Try to build your shin and calf muscles up evenly to prevent weird muscle imbalances from creating other problems.
    • For shins, try: toe taps (like you’re impatient), tracing the alphabet with your toe, heel walking (#9), and the exercise with the light dumbbell shown here
    • For calf muscles: while standing bend down and touch your toes (this is a calf and hamstring stretch), standing calf raises with or without weight, running on sand
  2. Check your form:
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    Supination!
    • Make sure your feet aren’t rolling inward as you run and that your toes are not pointed out. If possible, try running on a treadmill that faces a mirror or arrange to have yourself filmed or photographed while you run. That sounds totally ridiculous but it wasn’t until I saw the hi-res photos of the first race I did that I realized I actually supinate or roll my feet outward a little. I blame marching band.
    • Since heel-strikers are more prone to this injury, may I suggest barefoot-style running? It’s certainly different and might take a little getting used to, but I credit a large part of my commitment to continue running to this minimus toe-strike form.
  3. Check your shoes:
    • This is a traditional, knee-jerk piece of advice from doctors and running enthusiasts alike. Running is unique to many sports in that it requires little equipment–but the most important piece of running equipment to invest in is the shoes. But don’t just go out and buy the most expensive pair you can find. Some stores specialize in fitting shoes to a runner’s feet and running style, and are certainly worth checking out if you aren’t sure what shoe is “you”.
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    • Running shoes wear out, sometimes after a couple hundred miles and sometimes after more. I’ve put probably about 200 miles on my shoes, running on a variety of surfaces, and the tread wear is beginning to show. Granted, this is likely because these shoes are trail running shoes and are not meant to stand up to the wear and tear of pavement.
  4. Try compression equipment, like compression or recovery socks. Both work by lending some additional support to the shin and calf muscles so that less stress is placed on the shin’s connective tissues.
  5. Check yourself before you wreck yourself
    • It’s perfectly acceptable, in my opinion, to start slow. Many running apps these days have plans that take “from the couch” to the distance of your choice over a few months. Building up your distance gradually will help avoid overuse injuries like shin splints.
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High-tech!
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Low-tech…

Stage 1: So You Think You Might Have Shin Splints

  1. Do everything I just said in the prevention stage.
  2. Ice: If your shin bones are throbbing a bit after a run, ice is your new best friend. I recommend icing for 20 minutes on and 20 minutes off, repeating for about 2 hours total if possible. Complete this process after your run and keep your feet elevated. I just discovered these wraps, which I haven’t tried but look amazing. They’re filled with gel which can be frozen (a step up from my gel ice packs or Ziploc bags of dishsoap that I usually use) or heated for heat therapy treatments.  I recommend icing even on days that you don’t run if your shins are still inflamed. Once the inflammation is gone, usually after about 48-72 hours of icing, switch to heat and apply a heating pad to the injured area.
  3. Use a foam roller or your two hands to massage the bejeezus out of your calf and shin muscles.
  4. Anti-inflammatories
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    • For occasional use, try an NSAID like ibuprofen. Beware, though, you can’t be popping NSAIDs like they’re candy or you’ll risk liver damage. Also, if you have a predisposition toward nausea while exercising like moi, then you probably want to avoid medications such as these, which claim nausea as a side effect.
    • My mom bought me an anti-inflammatory topical cream called Topricin to use on my shins, which you’re meant to apply 3-4 times a day. I wasn’t too good about keeping up with it, so I’m not sure if its ineffectiveness was just the product’s fault or my own.
    • Not all anti-inflammatories have medicinal sources. Try adding foodslike blueberries, salmon and other fish, green tea, leafy greens, nuts, sweet potatoes, papaya, olive oil, and kelp and herbs and spices like tumeric, cinnamon and ginger to your diet, which are natural anti-inflammatories.

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      KT tape: the two pieces running perpendicular to your shin should be about 6 inches apart. Try to “frame the pain” with these pieces.
  5. Kinesiology therapeutic (KT) tape can help reduce pain from shin splints by taking some of the pressure off of the shin bone. Put one piece of tape vertically along the shin bone of the affected leg and then put one horizontal piece each above and below where the pain is located along the shin. I’ve taped a few times, and would recommend that you make sure that your legs are clean and dry to prevent the tape from falling off during the run. Also, in my picture, the horizontal pieces are probably a bit far apart, but I reasoned that my entire shin hurt, so why not frame the entire shin? During the three or four runs I did with tape, I had mixed results, mostly because the tape kept falling off. I had one “successful” run where the pain was practically unnoticeable, but it returned instantly after removing the tape afterward.

Stage 2: So Your Shins Hurt a Lot and You’re Kind of Starting to Freak Out

If your shins hurt even while you’re not running or the bones themselves feel tender to the touch, GO SEE A DOCTOR.

I probably should have taken my own advice when I reached this point a few months ago, but I already knew from a previous check-up that my doctor didn’t know anything about sports injuries (her running knowledge had a very 1970’s flair to it, and she didn’t know anything about forefoot-strike running styles) and I was too scared to be told to stop running because I’d had a race coming up that I couldn’t afford to not train for. The biggest reason why shin splints spell utter doom for runners is that really the only cure for shin splints is REST.

If you don’t rest, you risk your shin splints, a temporary injury, developing into stress fractures, which can be a permanent injury. Stress fractures are exactly what they sound like: microscopic fractures in your shin bone due to repeated stress or impact. Often the pain is localized, rather than a dull throbbing, and persists long after the activity is over. My shins used to hurt even when lying on my side in bed if one leg was putting weight on the other.

There is not a very sophisticated way to diagnose stress fractures. You can either:

  1. Go to the doctor for an X-ray, rest for about 6 weeks, and then return for a follow-up X-ray. If your shins show signs of healing, you probably had stress fractures. I opted out of this because I feel like it’s a throwback to the 17th century witch trials where you throw a woman in the water and if she sinks, she isn’t a witch. Great, and now she’s dead. Say I didn’t have stress fractures and I just rested six weeks for no reason? Well, at least you’d also get rid of your shin splints too…
  2. Get a bone scan: You’ll be injected with a radioactive tracer that will light up on the scan to highlight areas where your body is making repairs to the bone. Unfortunately, this test is very expensive, and isn’t very good at distinguishing between stress fractures and other types of soft tissue injuries.
  3. Get an MRI: the magnets and radio waves of a magnetic resonance imaging machine will produce images of internal structures. Again, it’s pretty expensive, but is better at diagnosing stress fractures even in their early stages.

Resting from shin splints might be torturous and you might feel restless and antsy, but it’s better to stay off your legs (or crosstrain) for a few weeks rather than not being able to run ever again.

Stage X: Recovery

I’m starting my recovery phase now. I’ve rested for about five weeks since the half marathon in early October, only doing short (1-2 mi) jogs to assess how things are going and crosstraining to keep up my aerobic-ness. I waited until I didn’t feel any unusual shin pain during the shorter runs before attempting longer ones last week, starting with a few 3 milers. They were okay, but I feel like I’ve reset myself by about three months, which is a little discouraging.

I’m sticking with it, though. Yesterday I did 5 miles, but definitely starting feeling some twinges near the end. Forcing myself to go shorter and slower than I know I’m capable of will be challenging, but my fear of my shin splints returning trumps almost everything else!

If I could’ve done anything differently during my rest period, it would have been to maintain my good stretching habits. I tended to do some long stretches after my runs that kept me loose, but those sort of fell by the wayside once I stopped running.

In summation, shin splints really suck, so you should do everything you can to avoid them. If you’ve already got them, there are some ways to treat them, but rest is the only surefire cure. They’re not just going to spontaneously go away, unfortunately.

For even more reading on shin spints, here are some additional resources:

Shin Splint Treatment: How Improving Your Calf Strength Can Fix Your Shin Splints

Suffering from Shin Splints? Try This

WikiHow: How to Get Rid of Shin Splints

Foods that Reduce Inflammation

Five Foods that Reduce Inflammation

Nutrition for Shin Splints

 


 

 

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