Research Rundown

Shin splints aka Medial Tibial Stress Syndrome complete with runner’s knee in two categories. The first is “which name is more misused?” and the second is “which one is more common?”

The reasons are they both can result from overuse; doing too much training or intensity too early before the body is ready (aka too little regeneration time). They are both also garbage can terms for any pain in the specific area, however just because you have shin pain or knee pain does not mean you have shin splints or runner’s knee, which are both specific terms.

So, let’s take a deep dive today into what exactly shin splints are and what you need to know about them!

What Exactly are Shin Splints & Why do they Happen?

This injury is literally micro-fractures of your bone and is generally felt, you guessed it, on the shin. Typically midway-ish down the tibia between your ankle and knee with pain on palpitation over a length of at least 5cm. Discomfort timing can vary from getting better 10-20 minutes into a run after you’re warmed up or may go away or reduce upon cessation of running.

The progression happens where your tibia bone is healthy to where you’re starting to slightly overload it. As with many injuries, your training load starts to outpace the ability of your body to regenerate and keep up. If you continue to run through this slight shin discomfort you can eventually develop a full-blown stress fracture.

While running, your bones bend in just the tiniest amount like a beam on a bridge. In running who have healthy bones and who are training at an appropriate level, this is not a problem and could even strengthen the bones over time. However, if your training load is excessive or your bones are weak this repeated stress of compressive forces can result in injury.

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Shin Splints vs Compartment Syndrome

One very important distinction that must be made is the difference between two shin injuries, shin splints, and compartment syndrome.

We’ve touched base on and will talk more about shin splints in this article, but let’s very briefly talk about compartment syndrome, which is a muscle and fascia issue instead of the bone.

Compartment syndrome is when the tibialis anterior muscles up front on your lower leg become excessively tight from exercise. If your shin muscles are experiencing pain, cramping, numbness, and visible cramping or bulging, you may have this injury.

Preventing Shin Splints

I tell new clients that come to me for run coaching (kylekranz.com/pbrcoaching) that my job as their coach is to help them reach their goals without injury.

The two primary ways I manage this injury prevention are with strength work and managing their training load which often initially comes down to making sure their easy runs are truly easy and regenerative, which they often are not.

A review from a few years back looked at 165 papers and included 21 studies. The primary risk factors were a high body mass index, high amount of over-pronation (keep in mind that some pronation is normal and necessary), greater ankle plantar-flexion range of motion (pointing the toes down), and high hip external rotation where your hips and legs are turning outwards while running and not staying forward as much as they maybe should.

Specifically, one of the most curious ways to prevent shin splints is actually to “survive” the “I’m a new runner” period. A paper titled Contributing Factors to Medial Tibial Stress Syndrome: A Prospective Investigation found that those who had been running for fewer than 5 years where significantly more likely to develop shin splints. Just as when muscles are damaged, they adapt and strengthen – the same is true for bones! With a muscle, you may get a protective cramp (that’s what cramps often are) or if you keep going, a strain. With bones, you may get a stress fracture. Unfortunately, bones don’t have a way to cramp and almost “force” you to stop running before getting an actual injury so a lot of this comes down to being mindful of how your body feels.

There has certainly been research looking at how to prevent this injury that can account for as much as 50% of lower leg injuries. One review looked at insoles, foam heel pads, heel cord stretching, alternative footwear, as well as graduated running programs and found no great support for any of these interventions!

One of the studies mentioned above also found that orthotic use with a risk factor. In this case I wonder if they were wearing the orthotics due to high over-pronation, so in fact the navicular drop was the risk factor. In which case…the orthotics would be deemed a failure. To confuse us further, there has been other research suggesting that when controlling for orthotic use, only body mass index was an associated risk factor and that navicular drop (over-pronation) may not be an appropriate measure to actually identify people who are at a higher risk of shin splints before they get them and they found no significant difference between shin splints and pronation amount.

So to conclude with what we may know about preventing shin splints, the only concrete risk factor may be a high body mass index or weight. As it’s very much an over-use injury, aside from BMI training smartly is likely the best way to prevent this injury.

Healing From Medial Tibial Stress Syndrome

Multiple literature reviews simply suggested that rest is equal to or better than almost any other treatment option. So this clearly suggests that we really, really don’t want to get shin splints!

What’s curious is that when I asked on Twitter and Facebook many said that changing shoes, lacing patterns, KT tape, etc helped almost instantly. Yet this is curious because according to the literature….none of this really helps!

So what was going on here?

I can only speculate that perhaps these runners were simply misdiagnosing what they thought was shin splints with something completely different? I’m really not sure. I said early that the term “shin splints” is often mistakenly applied to general pain on the front/side of the lower leg, when in fact that could be any number of things and it’s indeed true that changing shoes, running form, lacing patterns, etc can help with injuries – I’m just not sure about medial tibial stress syndrome.

If you like what you just learned and want to get more info on my sometimes unconventional yet proven, down to earth, and simple tactics for helping my runners improve their running through sustainable training habits, nutritional guidance, developing great mindfulness practices, and incorporating easy to do running-specific strength work and having all of it come together with great accountability and motivation, download a guide at bit.ly/kyles4pillars where share with you how to implement some different parts of my own coaching into your own training.