The term shin splints, also known as an anterior compartment syndrome, refers to pain along the shinbone (tibia), the large bone in the front of your lower leg.

Shin splints can be excruciatingly painful to the point that you may struggle to walk or run. They are typically caused by inflammation in the anterior muscle of the lower leg known as the anterior tibialis muscle.

This is the primary muscle needed to lift your foot. Shin splints are often considered an over use injury and unfortunately, are relatively common in runners.

Discover the common causes for shin splints and implement these strategies to prevent and self-treat shin splints.

How to Prevent and Self-Treat Shin Splints

Shin splints often occur as an individual suddenly increases his/her training volume by increasing the distance he/she is running. This condition may also occur when an individual isn’t appropriately trained for downhill running. Running downhill causes the anterior tibialis muscle to work very hard in an eccentric manner (meaning that the muscle is lengthening). This can very easily overwork a poorly trained muscle and may cause pain and inflammation.

Common Risk Factors for Shin Splints include:

1. Flat feet, which cause overpronation while running.
2. Poorly fitting or worn out shoes.
3. Tightness in the calf muscle or Achilles tendon.
4. Weak ankle muscles (particularly the anterior tibialis). Shin splints are also associated with weakness in the other muscles of the ankle and foot.
5. Weakness in the hip, pelvic, and/or core muscles can lead to faulty gait mechanics, leading to shin splints or other knee and lower extremity injuries.
6. A change in running surfaces or environments. This is most evident when transitioning from a softer running surface, such as dirt, to a concrete running track or running downhill.
7. Stress fractures in the shin (tibial bone) are another cause of pain and inflammation of the shin. Also, stress fractures in the foot can cause alterations in running form which may lead to shin splints.
8. Training overload. The muscles of the anterior shin (the anterior tibialis) are performing training intensities and volumes that they are incapable of doing. This causes inflammation, swelling, and pain.

How to Prevent and Self-Treat Shin Splints:

• Ice. Although shin splints can occur insidiously, they are often associated with a specific event which initiates an active inflammatory process. Apply the ice to the anterior tibialis muscle (the muscle right next to the shinbone). The rule for icing is to apply ice no more than twenty minutes per hour. Do not place the ice directly against the skin, especially if you are using a cold pack. A bag of frozen peas can be a cheap alternative. Individuals with poor circulation or impaired sensation should take particular care when icing.




• Rest. If you are experiencing an episode of shin splints, then you will need to rest. Avoid running downhill. Taper your training intensity and avoid exercises that place undue stress on the shins, particularly the anterior tibialis muscle. Utilize this time to incorporate cross training activities, such as yoga, to improve flexibility as shin splints can be linked to poor mobility.




• Warm up prior to exercise. I recommend that you increase your normal warm up time by at least 10 minutes in order to increase blood flow to the area. This allows for better mobility and also prepares the tissues for exercise. Consider using a self-massage tool to roll up and down the anterior tibialis as part of your warm up. My favorite self-massage tools for this area include the Thera-Band Standard Roller Massager and The Stick Self Roller Massager. I also recommend using the massager on your calf muscles. If you perform calf stretches, be mindful that prolonged static stretching before exercise may worsen performance.




• Cool down. After performing your exercises, take extra time to cool down and stretch. Focus on calf stretching as well as general lower extremity mobility stretches. Use the same self-massage tools as you did during your warm up. If you are prone to developing shin splints, I highly recommend regular massage and mobilization of the anterior tibialis muscle, as well as the calves. Tightness in the calves and Achilles tendon are a risk factor for developing shin splints. Be sure to emphasize stretching your calves. Hold each of the following stretches for at least 30 seconds, 3 times on each leg, 2-3 times a day. (These stretches shouldn’t cause more than a mild increase in pain or discomfort.)




• Self-mobilize the tissue. Be sure to mobilize the tissue of the anterior tibialis. For this particular area, you may want to use one of the self-massage tools referenced above. You could also use a tennis or lacrosse ball to aggressively work out the tissue along the shin. Remember that mobility issues and myofascial restrictions in the lower legs are highly correlated with the development of shin splints. Use the foam roller to address any lower leg tightness or restrictions. I tend to use the foam roller for the larger parts of the leg including the thigh, back of the leg, calves, and buttock muscles. Please refer to Lower Extremity Mobilizations Using a Foam Roll.pdf.




• Mobility bands, such as the Rogue Fitness VooDoo X Bands or EDGE Mobility Bands, are a novel way to self-mobilize the tissue of the calf and Achilles tendon. The use of mobility bands affects blood flow to the area and speeds up healing. Mobility bands also help reset some of the receptor cells in the muscle tissue that cause excessive muscle tightness. (If you suffer from any form of blood clotting disorder or are on blood thinning medications, I would advise against utilizing mobility bands for any type of deep compression.)




• Strengthen the stabilizing muscles of your hips and ankles. As part of a comprehensive rehabilitation protocol, I almost always have clients work on keeping the muscles of the pelvis, hips, and ankles strong. (Please refer to Ankle Resistance Exercises.pdf.) This will help to maintain normal gait mechanics during exercise and running. Not only will this help to prevent shin splints, it will help to prevent other orthopaedic issues such as plantar fasciitis, hip or knee pain. For my recommended hip and lumbar stabilization strengthening exercises, please refer to Exercises to Prevent Shin Splints in Runners.pdf.




• Improve your balance. Poor balance is often associated with muscle weakness in the foot and ankle as well as the knee and hip musculature. Weakness and balance deficits can lead to poor foot mechanics, which can lead to excessive strain on the plantar fascia. Improving your balance can help to reduce the risk of shin splints and is an important part of the rehabilitation. Stand near a counter top and work on standing on one foot. Hold for 30-60 seconds. To increase the difficulty, stand on a pillow.




• Change your shoes. Your shoes may be worn out and may be the cause of the pain. If you wear a shoe that helps to limit overpronation, remember that the inner cushion and structure of the shoe can wear out before its outer appearance. If this occurs, the shoe can no longer adequately control inappropriate foot and heel movements such as overpronation. Shoes typically only last 350-500 miles. If you are nearing those miles, then it may be time to change. If you’re unsure if your shoes are performing correctly, visit your local running shoe store. The trained staff can inspect your shoes for wear and tear. They may ask you to walk or run in order to watch your gait to fit you in the appropriate shoe. An over-the-counter orthotic, such as Superfeet insoles, is another option to help control overpronation. If the over-the-counter options aren’t helping you, please see a physical therapist or podiatrist for custom orthotics.




• If you change running surfaces, progress slowly. If you are used to running on softer surfaces, such as dirt or a running track, progress carefully and slowly when you run on a harder surface like concrete. Over all, softer running surfaces are better for your body.




• Train for running downhill. Running downhill forces the anterior tibialis muscle to work much harder than it would otherwise. Running downhill causes the anterior tibialis to perform more eccentric (when the muscle gets longer) loading and repetition. This can overload the muscle, particularly when running downhill very fast. Although running downhill may not be as aerobically taxing as running uphill, it’s actually physically much harder on your body. Performing the Ankle Resistance Exercises.pdf (particularly the dorsiflexion when your toes move up toward the shin) will also help to prepare the muscle for running downhill. Be sure to move slowly during the eccentric phase when the muscle is getting longer.




• Kinesiological taping. The purpose of the tape is to assist the anterior tibialis muscle with its contraction and to possibly help with swelling and nutrient exchange by assisting the lymphatic system. I have had luck using the KT TAPE and Mummy Tape brands. When treating shin splints, I recommend following these step by step instructions for Kinesiological Taping for Shin Splints.pdf. For application and removal tips, please refer to Skin Care with Taping.pdf.




• Use a compression sleeve or stocking. This condition is often associated with swelling and inflammation in the anterior compartment of the lower leg near the shinbone (tibia). The compression sleeve/stocking can help to limit the amount of swelling and promote blood flow back out of the lower leg. This insures better nutrient exchange, waste removal, and limits the swelling. I particularly recommend wearing a pair while you are in the rehabilitation phase or tapering back into full activity. There are many different styles of compression sleeves/stockings. I have had luck using the Vitalsox graduated compression socks. Always be sure to choose a pair that is at least knee high.




• Ask for help. If you’re still experiencing pain after implementing these self-treatment strategies, then it may be time to seek additional help. Your medical physician can help to determine if your pain is associated with a stress fracture. He/she could also prescribe a stronger anti-inflammatory medication if necessary. The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area. In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to seek your physician’s opinion as well).

If you experience pain to the point that you are having numbness in your leg, severe pain that is intolerable or loss of function in the lower leg, then this could be a sign of a medical emergency known as severe anterior compartment syndrome. It needs to be assessed by a physician immediately to prevent the possibility of permanent nerve and tissue damage. Although rare, severe anterior compartment syndrome can occur particularly after a trauma related event.

RETURN TO RUNNING

As you return to running and your normal training activities, insure the following:

• Your involved leg is as mobile and flexible as the other (particularly into dorsiflexion, which is flexing your ankle).
• Your involved leg is as strong as the other leg.
• Your ability to balance is equal in both legs.
• You can jog, run, sprint, and jump without pain.

If you are not progressing after 2-3 weeks of implementing these treatment options, speak to your medical professional so you don’t lose too much time with your training. As you taper back into your running program, follow these guidelines:

• Although you will need to progress and train on uneven ground and hills, initially start with level terrain only.
• Initially limit your running distance. I recommend starting with a distance approximately 50-75% of your pre-injury distance.
• Initially start with a slower pace. Don’t immediately progress back into very intense running activities, such as interval or hill training, until you have worked back up to your previous running distances and paces without pain.

Shin splints can range in intensity from mild to severe. The sooner you can initiate treatment for shin splints, the faster you will recover and be able to return to running without pain. Once resolved, I recommend implementing these strategies to not only prevent shin splints from re-occurring, but to help prevent other lower leg overuse injuries. For additional information on common running injuries and how to self-treat, please visit www.thePhysicalTherapyAdvisor.com.