Shin Splints


Experience From - Johnathan Webber, Dave Hurd, Jim Stephenson, Dan Baglione, Dick Vincent , Katie Fernan , Sean Greenhill , Ron Christiansen , Jeff , Mike Palmer , Jay Hodde #1, Seka Hunt , Corrie Dawn , Matt Kavanaugh , Rocke McClung , Jay Hodde #2 ,

Jonathan Webber

If there is anyone out there not at Squaw today in anticipation of tomorrow's excitement, I have a problem that I believe is shin splints.

I went out for a run 3 hrs on Saturday. A little while into it, I don't remember exactly when, I felt a little tweak in my right leg midway up the shin. I didn't think much of it and finished the run.

The next day, I went out for an hour. It was a little more sore the next day and bothered me most of the way, kind of a nagging pain, nothing to slow me down though.

I took Monday off and Tuesday at work, I found I could barely walk without excruciating pain. It is centered about midway up the leg, outside of the tibia or behind it, I'm not exactly sure. I can walk for about 50 yards before the stabbing knife carves out my leg. There is no touch tenderness in the area and pushing on the face of the tibia causes no problems, but just try and walk a few feet!

Does this sound like normal shin splint activity? How long before I can run again?

I am using the RICE therapy and when quiet there is no discomfort. I had to drop out of VT for heart problems so that is not a concern, but I am still hoping for Wasatch. Is this unrealistic?

Dave Hurd

Jonathan Webber wrote:

"I have a problem that I believe is shin splints..."
I don't have a comprehensive reply. I do know that one can stave off shin splint problems by sitting on a countertop, legs dangling, and dorsiflex the feet (raising the toes toward the ceiling), say 25 times. Once one can do this, begin to add weight. How? Use one gallon paint cans, EMPTY-, two of them, one for each foot. Wrap the handles with clothes line. Dorsiflex 25 times. Stop momentarily at the top each time, and at the bottom each time. Once one can do this, begin to fill the cans with sand. On reaching full cans, one has strengthened the attachment of the muscle to the shin enough that many people will not have shin splints. Clearly, one can not begin this preventive treatment while in pain. I saw this years ago in a column by George Sheehan, and it sure works for me. Now I do once per week.

Jim Stephenson

Jonathan Webber asked about shin splints. One thing that can give rise to these symptoms is a stress fracture. The posterior tibular tendon can become tough enough to crack the tibia, I think particularly if one increases mileage a bit too fast.

A bone scan would be in order. One should rule out frontal compartment and claudication as well. At any rate, "discomfort" (we hate to call it pain) in this area needs attention. For various reasons one can run through the pain, but something like Wasatch could really take you out of the game.

I've trained with four stress fractures at the same time, but I don't recommend it. You finally just have to slow down and heal. It seems particularly unwise to get into a major event without knowing what is going on.

Dan Baglione

Another way to accomplish the same thing that Dave Hurd mentioned is to use an old bicycle tire innertube. Wrap it around something solid and stable. Lie or sit on the floor. Place the two loop ends over your foot and dorsiflex as with the paint can. Since an innertube occupies very little space, this method facilitates continuation of the exercise while travelling.

Dick Vincent

Jennifer wrote:

"Shin splints" as is obvious from the wide variety of experiences are caused by a wide variety of things. I suspect that biomechanics is a major culprit no matter what and accidentally discovered a remedy for them. you'll need to find something else, unless you have one of course. We have a marvelously heavy oak dining room table. Its four legs are attached to a lower platform that sits about two toe widths above the floor. When I feel shin splints coming on, I do foot lifts by sliding my feet underneath the platform and then trying to lift the table with my feet. A few reps each morning while eating breakfast also seem to keep them away, if I remember to do them on a regular basis. This really exercises the muscles on the front of my lower legs and seems to do help each time for the shin splint pain goes away."

I had luck with a similar exercise. I cut off a pair of Cross country skis just behind the binding and left about 2 feet in front of the binding. Then I taped a huge rock on the front portion of the ski. I would just sit around and tap my foot and low and behold the pain subsided with in a few days. That was after having the problem linger on for weeks..... I am on your side with this remedy. Now to decide which is more practical, cutting up a pair of cross country skis or buying a dining room table.

Katie Fernan

This one worked for me and doesn't require any additional equipment: Walk on your heels. Don't let the front of your sole touch the floor and just hobble around like that for a few minutes a day. You'll feel burning in your tibialis anterior muscle after a short bit. I did it while I brushed my teeth (morning and night), and that was enough for me.

Sean Greenhill

I do toe lifts myself, when at the desk at work, in university lectures, on the PC etc. A similar effect on the shin muscles is acheived on the upstroke whilst cycling (yes, I mean cycling with shoes clipped to the pedal or, like me, with toe clips, because no company in the world makes cycling shoes in your size). This works the muscle, and for extra effect, lift your toes on the upstroke. When I go up hills commuting to and from work, I deliberately raise the toes and by the end of the climb the shin muscles are burning just as bad as the quadriceps.

It's not just quad strength that the bike builds.

Ron Christiansen

I've always had luck getting rid of shin splints by standing on the edge of a step or some type of ledge and doing "toe-ups"--the opposite of the excercises (cut off skis and dining room table) described by others. I wonder why both work? A question: I've always associated shin splints with pain on the inside of the shins but how about pain on the other side of the shin (the front of the leg)? Is this shin splints? Can the same type of excercises help out this pain?


Andrea wrote:

"I was intrigued to read about the correlation (as least in a few of ya'll's experiences) between the relief of shin and achilles problems and flexible soled shoes.

Here's my possible problem: what about those of us who have recurring shin (mostly) and achilles (sometimes) problems but also have runner's knee (all the time), requiring somewhat of a stiff, motion control shoe? Is the solution in using "stable" rather than outright MC shoes, and focusing on the muscle imbalances and physical things?

Specifically the two problems of shin splints and runner's knee interest me, as they are both often linked to overpronation, which is why one ends up with inflexible shoes.

I have also started using Superfeet in some of my street shoes, which I have taken a big liking to. I realize that the most benefit would be gained by having a pair in EVERY set of shoes I wear, unfortunately, the shoes I wear the most are Tevas. Anyone care to comment on their viability as compared to "real" orthotics?

A different product note: my current favorite running shoes are Brooks Addiction IIs, which I picked up two pair of for $22 each(!). They make my knee feel happy. :-) And I keep beating myself in the noggin for not buying 20 pairs of Asics Gel Moros when I had the chance...for trails I always seem to come back to wearing those."

Shin splints are often caused by calf muscles that are powerful and "snap"your foot via the achilles tendon. The poor anterior muscles try to hold on as best they can during the "snap," they hold on so fiercely they begin to pull off the bone and or develop micro-tears.

The only long term solution I know of is building up the strength of your anterior leg muscles so they can slow down the "snap" to a smooth transition from foot landing to push off. Earlier threads discussed a wide range of exercises that will help. My favorite consists of sitting, heel on the ground, raising my foot up and rotating slowly from side to side. You should feel the anterior muscles bunch up as you move your foot up and down and side to side. Use the principal of isometrics - tighten up, hold, loosen, tighten up, hold and so on. Repeat as many times as you want.

Perhaps the achilles problems are related to the imbalance causing your shin splints. With luck you might fix both injuries by strengthening the anterior muscles.

Mike Palmer

A good exercise for the anterior tibialis was described in Owen Anderson's "Running Research News" a couple of years ago. Simply stand against a wall and extend your feet out at about a 20 degree angle (more or less). Dorsiflex both feet rapidly (move your feet up while your heel remains on the floor) about 12 times. Imagine that the floor is an eggshell that you're trying not to break--you'll get the right speed for the exercise. Then do one foot at a time by bending the leg you aren't working at the knee and resting your foot against the wall. Work up to 3 x 15 with both feet and then one foot at a time.

You'll feel "the burn" in the anterior tibialis. You may not be able to do 12 or 15 reps at first. If you do this exercise about three times a week, you'll significantly strengthen you're lower legs.

Walking barefoot is also a good lower leg strengthener. The Kenyans, who tend to run barefoot as soon as they're able to run, have fewer lower leg injuries than people who have worn shoes most of their lives.

You should be able to find which edition this article was in by doing a search on Owen Anderson's webpage.

Jay Hodde #1

Dan wrote:

"I agree with Jeff Bristow and others. The most common cause of shin-splints is anterior leg muscles being overpowered by strong calf muscles."
Let me disagree a bit. It's more complicated than that, and while you are right that an "imbalance" in strength between the calf muscles and the anterior tibialis is a major cause of ANTERIOR or ANTEROLATERAL shin splint pain, there are other locations of shin splint pain that appear to have different causes.

Pain anywhere is the shin has commonly be called a "shin splint". This term is a vague description of a SYMPTOM of a more specific medical condition, or medical conditions. For this post, I'll go along with the common usage. Just understand that a variety of musculoskeletal conditions in the lower leg can cause shin pain.

The "shin splint" can occur in all three compartments of the leg: the medial, the lateral (often referred to as "anterior"), and the posterior. The most common site of "shin splint" pain is in the medial compartment.

As others have mentioned, ANTERIOR shin splint pain occurs on the lateral (outside) of the leg, usually where the anterior tibialis muscle (the most prominent one on the lateral leg) attaches to the tibia. The most common causes of pain in this area are: excessive downhill running or participating in sports that require repetitive starts and stops. This pain is often caused (as has been mentioned by Dan and others) by the calf muscles (gastrocnemius and soleus) overpowering the anterior leg muscles (primarily anterior tibialis, but the peroneus longus and brevis can also be involved).

No one has mentioned (I don't recall) POSTERIOR or MEDIAL shin splint pain.

POSTERIOR shin splints occur on the back of the calf muscles and are usually caused by poor biomechanics. Overpronation of the foot stresses the muscular attachment to the tibia, resulting in pain and inflammation. The problem can be aggravated by flat arches and/or tight calf muscles and a tight tight Achilles Tendon.

MEDIAL shin splints are the most common type of shin splint pain. The pain occurs along the medial border of the tibia and is often caused by damage to the interosseus membrane (the connective tissue that lies between the two leg bones, the tibia and fibula). There is some disagreement as to the biomechanical reason for this pain, but it is commonly associated with excessive pronation (in the clinic, we tape the arch for support to decrease the severity of pain). I personally disagree that "muscle imbalance" is a cause of this pain, thus the reason for my disagreement to start my post. Not everyone will agree with me.

COMMONLY, shin splints are cuased by overtraining, or training excessively on hard unforgiving surfaces. I personally start to get pain if I have to run a lot on the treadmill (due to poor road or weather conditions -- common this time of year). Cases such as this are more often due to repetitive shock / gravity than they are to any sort of muscle fatigue (though, admittedly, not always).

If you experience pain during an ultra, the pain is likely to occur later in the event when you get tired and your muscles start to fatigue. When this happens, shin splint pain is often due to tibialis anterior fatigue and may be associated with anterior tibialis tendinitis.

Andrea asked about how all this relates to her knee pain and her need for stiffer shoes. I'll just state that leg strengthening exercises (described by others) will likely help all her conditions -- her shin splint pain, her "runner's knee", and her anterior muscle fatigue.

Seka Hunt

I am an athletic trainer and have found that many people do not really understand the importance of treating shin splints correctly.

Shin splints are generally chronic in nature along the anterior portion of the shin. It is caused from irritation to the anterior tibialis muscle which in turn irritates the nerve located in that area. RICE is a good start, but avoid the compression. That is the problem to begin with. There is only so much room in that compartment. I would recommend Ice Massage for 6-12 minutes or until numb. ( take a paper cup, fill about 1/2 way with water and freeze. Tear cup down to ice and apply in small circular motions over the surface of the shin). I would also work on Proprioception. This helps with your anti-gravity muscles including your Anterior Tib. Standing on one foot and balancing. To increase difficulty, perform in sand or on a trampoline. If you have access to a theraband or a large "rubber band" like tube, tie one end to a table leg. Then sit on the floor, leg straight, opposite tied end and hook the other looped side over your foot. Work on dorsiflexion, pulling the toes towards you, while the leg is straight. 3 sets of 15. If numbness in toes is present, see a physicians. Or if the condition remains the same or worsens. Shin splints take a long time to heal!! However, they can lead to stress fractures. Take this very seriously!

Corrie Dawn

Dear Shin Splint Sufferers

I am in desperate need of your advice. I am suffering from shin splints and I need to know your opinions on when I can run. Let's just say for argument sake that I do not have a stress fracture. I am, however, in pain, especially in the morning and after running. There is one localized spot on the bone, where if pushed, it makes me a little queasy. It has been a week since I have run and I only ran once the week before...

The books I am reading give all types of reasons why I may have shin splints and suggestions for correcting them, but can you start running when you think you have figured out the cause..or do you have to wait until you are completely pain free? I suspect my problem was caused by the wrong shoes, so now that I have new shoes, can I commence to run? The books almost sound like they are saying to go ahead and run with your new corrective situation, or is this wishful thinking?

Any suggestions are greatly appreciated...

Matt Kavanaugh

Regarding "desperately seeking shin splint advice" I went through exactly the same thing last summer. I was training hard for a marathon, including lots of downhills while on vacation in the Sierras. During a 21 mile run at the end of July I got hit with pain in my left shin about half way through, and I struggled through to finish (should have quit). It was too painful to run on after that, so I hit the books to read up on my injury. I concluded that I had shin splints or a stress fracture, and that treatment was to be rest and non-weight bearing exercise. Conventional wisdom is that if the shin hurts, don't run on it. Only return to dry land running when pain is gone and you remain pain-free during your workout.

I bought an Aqua Jogger for pool running and moved my workouts into the pool. After about a week or so the pain was gone, so I attempted a dry land run. Pain returned after just a few minutes of running, so it was back into the pool. I did pool running workouts for about a month, then eased back into dry land running, starting out about every other day, alternating with the pool running. Also, I bought more cushioned running shoes, stopped running hills, and trained exclusively on treadmills, dirt paths and tartan tracks. I believe the shin splints I incurred were a consequence of the marathon training program I undertook, most of it running on asphalt, quite a bit downhill, and without adequate cushioned shoes (I preferred light weight trainers at the time).

I was able to build back up to my full marathon training level, having lost about 2 months training time to the shin splints (but I did retain most of my fitness and leg speed through the pool running). In hindsight, I realize I did not have a stress fracture; it responded too quickly to the rest I think. From what I read, a stress fracture will often not be detectable by x-ray, and a bone scan won't detect it for a couple of weeks (and in the meantime you rest it and do non-weight bearing workouts). There are some very good resources on the internet and Noakes' book on running has some (not a lot) of info as well.

Pool running can be deathly boring, but I found that doing laps in the deep end, with a Sony radio headset, made it tolerable. I read that some runners will transition back into "real" running from pool running by pool running in shallower water (i.e., move from the deep end towards the shallow end, making the workout partially weight bearing). ... Good luck.

Rocke McClung

As one shinsplint sufferer to another I get shinsplints anytime I come back from a layoff or increase my mileage (I tend to get gung-ho and do too much too soon). This has been a problem for years and I have just recently figured out what works for me.

  1. Stand on a curb or other step and drop your heel off the edge stretching the calf muscle. I do this with the leg straight and with the knee bent--the different angles stretch different parts of the lower leg. Sometimes I'll slowly and gently rock between the two stretches.

  2. Drop to your knees, point your toes backwards so the top of your instep is on the ground, gently ease back until you are sitting on your heels. Try to feel the stretch in the front of the ankle. My ankles pop when I do this one.

  3. Once or twice a day hold your foot in both hands and work it through its full range of motion. The idea here isn't to really stretch anything, more to keep things loose and moving easily.

  4. Feel around in your lower leg with your thumbs. If you find a knotted area, it needs to be loosened up. Apparently, sometimes a small part of an apparently long and flexible muscle can spasm and cause problems. Massage the knot forcefully with your thumbs (I have even used a cut off mop handle). Sometimes it helps to use a little lubricant on the skin while your are doing this. This can be pretty painful while you are doing it but the relief I feel afterwards in almost miraculous.

  5. Strengthen the lower leg. Walking on your heels is a good exercise for the area. Also, you might try leaning with your back against a wall with your feet about 6 inches away from the wall. Raise your toes up so you are standing on your heels. Repeat 20 or 30 times.This will give the front of your legs a great workout. Also do calf raises for the larger calf muscle.

  6. Wrap your lower leg with an Ace bandage for your runs. This has helped more than anything else I have done and I put in a lot of painful miles before I discovered it, duh! I wrap the lower part of the shin very tightly so that the painful area gets maximum support and wrap the calf muscle a bit more moderately. Just make sure you don't wrap so tightly that you cut off circulation.

  7. After running I repeat the stretches and ice the area if there is any tenderness.

I have been able to go from painfully hobbling around while walking to running pain free in less than a week by doing this.

Of course, I'm just a runnin' redneck from Mississippi and have no formal education in these matters, but it worked for me.

Jay Hodde wrote:

Let's just say for argument sake that I do not have a stress fracture. I am, however, in pain, especially in the morning and after running. There is one localized spot on the bone, where if pushed, it makes me a little queasy. It has been a week since I have run and I only ran once the week before...
Based on this very little bit of information, I would advocate a visit to a sports medicine physician. As a general rule, shin splint pain is more likely to be spread out over the shin (i.e., a broad area). A stress fracture tends to exhibit "point tenderness".

Because the information you have given us indicates to me that you may be suffering from a stress fracture and not shin splints, I think stress fracture advice is more appropriate until you can rule it out.

Assuming a stress fracture, you should stop running completely for 4-6 weeks, limit all weight bearing activities, and see a physician for complete diagnosis and treatment.

I'm sorry if this response sounds harsh, but ignoring potential problems is just asking for longer recovery times and could make the problem worse.