Shin Splints 101

This blog post is long overdue. I have had countless people – friends, family members, athletes, clients – all ask me about shin splints. What are they? How can I get rid of them? Can they be prevented? Despite being one of the most common athletic injuries, recreational or competitive, shin splints are easily treatable and very preventable. Too often sufferer’s deal with the pain and never fix the problem. My goal with this blog is to provide tips to fix the problem and resolve shin splint pain.

Shin splints, or Medial Tibial Stress Syndrome (MTSS), is a chronic injury typically described as dull-ache on the middle to inside portion of the lower leg. Pain is common during or after activity. In severe cases pain may last for several hours after activity and occasionally the individual will experience nighttime throbbing in the lower leg.

The pain from MTSS is attributed to irritation of the periosteum – a saran wrap like covering around bone – or a stress reaction to the underlying bone. Repetitive pounding or muscle pulling from these structures precipitates the injury. Popular belief is that shin splints are due to poor shoes, training intensity, and training surfaces. However, a critical review article written by Moen, Tol, et al., published in 2009 Sports Medicine found this was not the case. MTSS is often caused by poor joint movement and muscle imbalance.  These movement patterns and muscle imbalances are easily identifiable. The best part is that you can fix these problems at home by following a simple flexibility and strengthening program.

Blue lines illustrate normal hip-knee-ankle-foot alignment.
Red Lines illustrate femoral and tibial adduction and foot external rotation.
Green arrows show knees caving in and foot arch flattening.

First, let’s see if you have these movement dysfunctions. Observe yourself (in a mirror) walking or doing repeated squats. Do you see one or more of these four things: hips in, knees in, feet flatten, or toes point out? You may have one or all of these patterns; some may be extremely pronounced or could be very subtle. The image here shows a moderate to severe movement. If you observe this, even to the slightest degree, you are at risk for developing shin splints. Overtime these movement patterns create a muscle imbalance, where some muscles become overactive and some become underactive.

Using the above figure as an example, here are the typical overactive and underactive muscles we would see in a person with shin splints or with these movement patterns.

OVERACTIVE	UNDERACTIVE
Hip Flexors and Tensor Fascia Latae	Gluteal  Group (Maximus, Medius)
Lateral calf (lateral gastrocnemius / soleus)	Medial Gastrocnemius
Groin muscles (adductor complex)	Anterior and Posterior tibialis
Biceps Femoris	Medial Hamstrings

Our goal is simple, turn-off the overactive and turn-on the underactive; simple as that. Below is a basic 3-step program that can help correct this issue, step 1 -Turn-off, step 2 – elongate, and step 3 – turn-on. This program can be done daily and would take no longer than 30 minutes from start to finish. Here is what a basic program would look like.

Step 1: Turn-off the overactive using a foam roller.

• Gastrocnemius/Soleus
• Adductors
• TFL/IT-band

Foam roll each muscle for 90 seconds and hold tender areas for 20-30 seconds. A YouTube playlist created by friend and corrective exercise expert, Brent Brookbush, provides good examples and tips on how to perform these techniques.   

Step 2 – Elongate the overactive with static stretching

• Gastrocnemius/Soleus Static Stretch
• Kneeling Hip Flexor Static Stretch
• Adductor Static Stretch

Perform 1-2 sets of the stretch per muscle group and hold the stretch for a maximum of 30 seconds. Again, Brent has a good static stretching playlist that demonstrates these exercises.

Step 3 – Turn-on the underactive with focused strengthening

• Posterior Tibialis Strengthening
• Anterior Tibialis Strengthening
• Glute Medius Strengthening (Clams)
• Lateral tube walking
• Glute Maximus Strengthening (Ball Bridge)

Too often I see individuals with shin pain ceasing activity, buying new shoes, investing hundreds of dollars in custom orthotics, or giving themselves an ice bath. Shin splints do not have to be the end of training. Following a simple and structured program to correct of common movement dysfunction patterns you can eliminate shin splints and many other lower body injuries like Achilles pain, runner’s knee or hip pain.