Shin splints, shin pain, medial tibial stress syndrome. Ouch.

June 8, 2020 Office Manager

Post by Sam Donaldson, APA Sports & Exercise Physiotherapist

Shin pain while running can be a tiresome and frustrating issue for all runners, from the causal runner, to the elite. Exercises for shin pain can be effective in reducing the symptoms and even improving your running efficiency and pace.

But what causes this shin pain?

First, it’s important to distinguish between “medial” shin pain and “anterior” shin pain. Tenderness of the bone at the area that is most towards the front can be a sign of a bone stress injury that should be addressed with a sports physician. If you’re not sure – ask!

It usually occurs as a result of working more than it is ready to cope with. This might be a result of not running for a period of time, then re-starting; or, rapidly increasing the amount of running; or, even a change in shoes or surface that you are training on.

Medial shin pain is discomfort on the inner side of that shin bone and can often still feel like it is at the front. It relates to the attachment of muscle and tendon to bone, which hides just behind that shin bone.

The interaction between the musculotendinous insertion to that area of the bone, in a leg that is otherwise not coping with how much work you are doing on it, will result in bone stress or an inflammation of the outer surface of the bone (periostitis).

If left untreated, this otherwise low risk injury can progress to something worse. It is therefore important to touch base with your Physiotherapist or health professional to ensure you’re on the right track with it!

 

Common findings in people with shin splints

Muscle weakness or reduced flexibility around the ankle are major features. These muscles include the Soleus and Gastrocnemius (calf muscles), in particular. But, for those who are familiar with the RHP difference, it is never as simple as one specific region. The body is not just separate limbs, but rather one system with parts that must work together for the common goal (in this case – running).

So, when we look above the shin, hip and pelvis muscle weakness is also very common and may in fact be on the opposite side to the painful side.

What do I do for sore shins while running?

“Rest” is typically the answer, but that doesn’t mean lay up in bed. Rest might, in severe cases, mean no more running for a period, but you shouldn’t stop all together. Bicycling or other forms of cross training, strength training and some stretching will be great ways to keep you moving forwards – not backwards!

You will also need to work with your Physiotherapist or trainer on an optimized routine, so that you can run within your tolerance levels, but allow enough time for the shin to recover between sessions. Bone is very unpredictable between people with how it responds to training, so a structured return to run program is important.

 

Are orthotics useful for shin pain?

According to research, the jury is still out on this one. In certain people, orthotics will be very helpful, but this is not everyone. One way I like to test this is with strapping tape to briefly replicate what a foot orthosis might do, with a positive outcome suggestive that a trip to the Podiatrist is a good idea.

Exercises for shin pain in runners

The best way to address this is an individualized approach. So see your physiotherapist as well. A general guide will include strength exercises for muscles including:

  • Gluteus maximus (buttock)
  • Gluteus medius/ minimus (side of hip)
  • Gastrocnemius (calf, done with straighter knee)
  • Soleus (calf, done with bent knee)
  • Trunk/ abdominals

When performing strength exercises, they should be done a minimum of twice per week with at least two sets with good form, to a number of repetitions that you would rate as quite difficult (not necessarily maximum effort, but close!)