Disclaimer – this article is for educational and information purposes only. The content contained within this article should not act as medical advice. If you are worried about any of the items discussed within the article, please seek advice from a suitably qualified professional.
Medial tibial stress syndrome (MTSS), commonly known as “shin splints”, is a common overuse injury of the lower extremity, particularly running.
Shin splints will usually present with pain that is worse with activity along the inside of the shin bone, the tibia.
The incidence of shin splints in runners has been reported as high as 20% in some studies, although a very recent systematic review reported the incidence to be just over 9%.
Statistically, novice/beginner runners are at an increased risk of injury compared to their more experienced peers.
Large increases in training load, volume, or high-impact exercise can lead to an increased risk of shin splints.
Other specific risk factors include; being female, having previously been diagnosed with shin splints, a high BMI, excessive foot pronation, excessive ankle range of motion, and excessive hip range of motion.
How do I know if I have shin splints?
Shin splints will usually present as a pain on the inside of the tibia (shin bone). This pain will usually be worse when running or exercising, specifically when performing impact exercises that involve running or jumping.
The pain will usually feel somewhat diffuse, and it may be difficult to pinpoint the exact location of the source of your pain.
An important factor to distinguish is the size of the painful area. If your pain is pinpointed there is a chance you have developed a stress response or even a stress fracture. If you get pain at night, or pain when resting, there is a potential that your injury is a stress response or fracture.
If you suspect this is the case, it is extremely important to seek professional help to help establish the extent of your injury as the management of shin splints differs dramatically from the management of a stress response or fracture.
Pain in this area of the lower extremity could have numerous other causes, so it is important that you seek medical advice if you are worried about your shin pain.
Managing Shin Splints
Several management strategies can be helpful for runners who experience splints, below are some of the most cost-effective strategies that could be trialed initially.
1) Load management & progression
As explained earlier, shin splints are often linked to an increase in volume or training load. Managing a runner’s load is often an effective strategy to reduce symptoms and manage the condition.
Importantly, load management does not necessarily require someone to stop running altogether. Usually, it is impact exercise that aggravates shin splints.
Therefore, an effective strategy to reducing a runner’s load may be to substitute one or two of their running sessions with a swimming session, or a session on the elliptical trainer.
The reduced load through the lower extremities during those two activities should be enough to not provoke a response of symptoms whilst also allowing the runner to still targeting their cardiovascular fitness.
2) A targeted, structured rehab program
Improving the tolerance of the muscles of the lower limb should help with the management of shin splints.
The exercises demonstrated in the videos below can help to increase the tissue tolerance of the muscles around the lower limb and foot.
We know that an increased BMI is a modifiable risk factor. Losing weight through a balanced diet and adequate exercise may be a way to manage your shin splint symptoms or reduce your risk of developing shin splints in the first place.
Esculier, J.F., Bouyer, L.J., Dubois, B., Fremont, P., Moore, L., McFadyen, B. and Roy, J.S., 2018. Is combining gait retraining or an exercise programme with education better than education alone in treating runners with patellofemoral pain? A randomised clinical trial. British journal of sports medicine, 52(10), pp.659-666.
Kakouris, N., Yener, N. and Fong, D.T., 2021. A systematic review of running-related musculoskeletal injuries in runners. Journal of sport and health science, 10(5), pp.513-522.
Linton, L. and Valentin, S., 2018. Running with injury: A study of UK novice and recreational runners and factors associated with running related injury. Journal of Science and Medicine in Sport, 21(12), pp.1221-1225.
Lohrer, H., Malliaropoulos, N., Korakakis, V. and Padhiar, N., 2019. Exercise-induced leg pain in athletes: diagnostic, assessment, and management strategies. The Physician and Sportsmedicine, 47(1), pp.47-59.