Basic Guidelines for Shin Splints
By the Orthopedic Physicians of Alaska Athletic Training Team
What Are Shin Splints?
Shin splints (medial tibial stress syndrome) happen when muscles, tendons, and bones are overloaded (overworked/overused) and cause chronic inflammation. It is typically felt on the inside of your shin bone (tibia), but can also develop in other areas of your lower leg.
What Are Some Common Causes of Shin Splints?
- Flat/High Arches: Arch problems are probably one of the most common causes of shin splints. The arch of the footshould have a slight curve to it to help take some of the force in during physical activity. When arches are too flat or too high, it can cause overloading of structures (muscles, bones, tendons) in your foot/lower leg, which can lead to shin splints. Not everyone with flat feet or high arches will get shin splints, it is typically a combination of issues. Consult a running shoe expert to find the right arch support for you.
- Running on a Poor Surfaces (Gravel/Pavement/Crowned Roads): Running on poor surfaces like gravel, pavement, or crowned roads can cause excessive forces to run through the lower leg and over time can cause stress to the shins. Changing running surfaces, like going from turf to concrete or vice versa can also cause shin splints.To avoid this problem, avoid changing running surfaces frequently and aim to run on softer surfaces.
- Overuse (running in the same direction/too much): It is very common to develop shin splints with overuse, because your muscles are constantly being overloaded without adequate rest. This is more probable to happen if you suddenly increase the duration or intensity of your workouts/runs. Therefore,it is important to begin training for a sport season long before the first day of season!Other ways to avoid overuse injuries is to run your route backwards, change up your route often, or cross train (bike/swim).
- Old/Flexible Shoes: Solid, supportive shoes are critical to help avoid shin splints. If your shoes are old or too flexible, they do not support the arches in your feet, which cause an uneven distribution of forces through your muscles/bones and can result in shin splints. It is important to replace your running shoes every 6 months if running or exercising in them frequently. Consult a running shoe expert to find a supportive shoe for your specific activity.
- Weak Hip/AnkleMuscles: Sometimes athletes simply have weak hips and ankles. This means the muscles surrounding the hip, lower leg, calf and/or feet are not strong enough to handle the amount of force/activity that is occurring which will make them tired and can lead to chronic inflammation, and leading to other structures (tendons/bones/ligaments) picking up the slack. This can be evaluated/fixed preventatively in the off season, but consult your Athletic Trainer for full evaluation and a specific rehabilitation plan.
- Poor Range of Motion: When your muscles are tight, your ankle cannot absorb the shock of the foot striking the ground as it normally wouldleading to over compensation by other lower leg structures. See Range of Motion exercises to help improve this problem.
General Guidelines:
Goals:The goal of this shin splint rehab is to control pain and swelling caused by MTSS and fix the underlying cause of shin splints. It is important to identify the underlying causes of shin splints because over time shin splints can progress to more serious injuries like stress fractures. Please consult your Athletic Trainer for full evaluation.
Rest:Minimize activity for a few days and then slowly progress back to normal exercise. Rest does not necessarily mean do nothing, it could simply mean doing a non-pounding activity like biking or swimming. This may vary based on where an athlete is in season and rest will be determined by your Athletic Trainer.
Ice: Icing 20 minutes on and 90 minutes off, several times per day will help reduce inflammation, swelling, and pain. Using an ice cup (fill a small paper cup with water and freeze it) to massage and ice your shins for 10 minutes each day may be more effective for some than just an ice bag. Be sure to ice after activity to decrease inflammation (ice bag, ice cup, ice bath).
Heat/Massage: Applying heat for 15-20 minutes to the shins and surrounding muscles can help increase Range of Motion prior to activity. An alternative to heat can include foam rolling or massage. Heat or massage should typically be used prior to activity, see your Athletic Trainer for more specific treatment suggestions.
Footwear Changes:
- New shoes with a firm base of support
- Rigid arch supports (not the gel based ones)
- Arch Taping if unable to do the first two
Range of Motion (ROM):Maintaining good ROM in the lower extremity is vital to the recovery process and returning to activity. Consult your Athletic Trainer for full evaluation, treatment, and rehab plan if you currently are experiencing shin splints. If you know you are predisposed to shin splints,try some of these exercises preventatively a few weeks prior to activity.
ABC’s: Write your ABCs during the school day to help increase range of motion of the ankle and simultaneously increase foot awareness and strengthen muscles.
Marble Pick Ups: If possible, get some marbles and place them on the ground. Using only your toes, pick up each marble ONE AT A TIME and drop it into the cup. You have completed one set when they are all in the cup.
Stretching Exercises:Keeping your flexibility is important to maintaining range of motion and should be completed with minimal to no pain.
Achilles/Calf Stretch: There are a few ways to stretch your achilles. The first is to get in the push up position and put all your weight onto one foot. Bend your knee to stretch more at your achilles tendon than your calf. The other way is by putting your toes up against a wall and pulling your body toward that wall. Again, bend your knee to focus the stretch in the achilles tendon.
Tibialis Anterior Stretch (Active):Find the spot on the front of your shin that hurts the most, then press into it with your fingers and hold that spot. Use your other hand to cover the first and apply more pressure. Then slowly move your foot up and down as far as you can 5x and on the 5th one hold for 5 seconds (the hand is still pressing into that spot). Repeat this at all the sore spots on your shin.
Strength Exercises: These will help maintain and increase your foot and ankle muscle strength. Completing these exercises as listed is important to ensuring you return to play strong and will help reduce risk of injury.
Heel Walks, In/Out:Walk on your heels pulling your toes up as far as possible. After 7-10m turn toes outward, after 7-10m turn toes inward. Try not to let the toes go down in during this exercise.
Toe Walks, In/Out:Go up on your toes, similar to a calf raise, walk 7-10 m, turn toes outward, walk 7-10, and turn toes inward, walk 7-10m
Single Leg Calf Raises 2 x 20: While standing on one foot, slowly push through your toes until you are as high as you can go with your heel off the ground. Raise up on the toes quickly and then slowly lowering the heel to the ground in a controlled manner.
Heel Drops 2 x 20:While standing on the edge of a stair (or something similar), raise yourself up onto your toes and slowly drop your heel down as far as it will go until you feel a stretch in your calf.
See your Athletic Trainer for more advanced ankle and all hip strengthening exercises!