Why You’re Getting Shin Splints When Running

Posted 12 Sep

Whether you’re new to running, have made it a regular part of your routine, or are competing in marathons or running events, there’s one thing that can completely interrupt your running plans: shin splints. Today, our Brisbane podiatrists are sharing what shin splints really are (it’s not as straightforward as you may think!), why you’re likely getting them as a runner, and what you can do to help fix the problem for good.

Shin Splints During Running: An Overview

‘Shin splints’ is a painful and frustrating injury affecting approximately 70% of runners and one-third of active people at some point in their lives. Shin splints are well known as the pain that comes on at the front of the shins during physical activity. What many runners aren’t aware of, however, is that there’s much more beyond this. Unlike other medical diagnoses that are quite specific, such as plantar fasciitis heel pain, ‘shin splints’ is a broad term that can refer to one of three separate conditions:

1. A stress fracture to the tibia (shin bone)
   
2. Exertional compartment syndrome
   
3. Medial tibial stress syndrome (MTSS)
   

Tibial Stress Fractures During Running

Stress fractures are a common running injury, with the shin bone being the location of the fracture almost half of the time, according to research. Tibial stress fractures are caused by repeated mechanical loading, leading to bone strain that creates microcracks at a rate that accumulates beyond the bone's capacity for repair and remodelling. Tibial stress fractures are serious injuries with a standard recovery period of up to 8 weeks. Runners must be particularly careful with tibial stress fractures as they are five times more likely to experience another stress fracture after the initial injury episode compared to a non-runner.

Several factors can contribute to developing stress fractures alongside the repetitive and forceful nature of running, including the unique biomechanics of an individual’s feet and legs, muscle imbalances, and training errors. In the early stages, stress fractures are characterised by tiny cracks in the bone, often not visible on an x-ray, with minimal symptoms or pain. Without proper intervention, these can quickly develop into more severe and painful fractures, sidelining you from being able to run or stay comfortable on your feet.

Symptoms of a tibial stress fracture include pain and tenderness along the shin bone, which may be accompanied by swelling. The pain typically worsens with physical activity and lessens with rest. Early detection is crucial for a faster recovery, so it’s important to report and check any shin pain as soon as possible.

Exertional Compartment Syndrome

Your lower leg contains four distinct muscle compartments, each separated by fascia (connective tissue). These compartments only have a certain amount of space to house muscles, arteries, nerves, and other tissues. Think of it being similar to how a lunchbox is divided into sections, each holding a finite amount of food.

When the muscles in the lower leg's front (anterior) compartment become injured, they swell, as all muscles do. However, because these compartments have limited space, the swelling increases the pressure within the compartment. This pressure causes pain, discomfort, tightness, and sometimes visible swelling in the front of the lower leg. This is known as chronic exertional compartment syndrome, which is often labelled as “shin splints” due to the location of the pain at the front of the shins that is exacerbated by physical activity and eases with rest. As the anterior muscle compartment muscles are used heavily during running, this is the compartment that is most affected.

The good news is that with rest, the muscle swelling typically subsides, which should ease your symptoms. But this isn’t a cure; the next time you’re active, the pain often returns, and the injury can worsen. The increased pressure within the compartment can also lead to numbness or tingling in the foot due to nerve compression, and in severe cases, it can cause difficulty in moving the foot. Identifying and addressing the early signs of exertional compartment syndrome is crucial to prevent long-term damage and ensure a quicker recovery.

Exertional vs acute compartment syndrome

When discussing compartment syndrome, we must distinguish it from the other type of compartment syndrome you can come across: acute compartment syndrome. Unlike chronic exertional compartment syndrome, which subsides and gives you relief, acute compartment syndrome does not. This means the swelling continues, restricting blood flow to the area and putting your leg at a serious risk for permanent damage. As such, acute compartment syndrome is a medical emergency, and you should be seen at the emergency room as quickly as possible. Signs to look out for are severe pain in your lower leg, a pale skin tone at the leg, numbness (or tingling), a faint pulse and weakness when moving the affected leg. 

Medial Tibial Stress Syndrome

Medial tibial stress syndrome (MTSS) is the most common cause of shin pain among runners and will be the actual diagnosis when you’ve been told that you have shin splints. MTSS develops when there is too much stress or strain on the front and inside of the shin bone, typically affecting the ‘leading’ foot, which is the one that goes first when you start walking or running.

The stress that leads to MTSS is usually caused by overusing the muscles that attach to the shin bone or by placing excess stress on the lining of the bone itself, known as the periosteum. This results in irritation and degeneration of the tissues, leading to discomfort, pain, and sometimes swelling. These symptoms range from mild to severe enough to halt physical activity.

Several factors contribute to this medial tibial stress. These include training errors (including overtraining), biomechanical problems in the feet or legs (such as overpronation or excessively flat feet), muscle tightness (particularly in the calves), and a history of previous lower limb injuries. When combined with running or jumping activities, the strain on the shins significantly increases, pushing the muscles and bones beyond their normal repair threshold. Some researchers indicate that heavily cushioned footwear may actually contribute to shin splints and medial tibial stress. The engineering and design of these shoes allow athletes to land on their heels, placing excess force on the lower legs.

What Causes Shin Splints?

The most common contributing factors for shin splints that our podiatrists see include:

• Overuse and overtraining: running involves repetitive impact on the legs, which can strain the muscles, tendons, and bone tissue along the shin bone. Rapidly increasing the distance, speed, or frequency of runs can overload the shin muscles and bones, leading to inflammation and pain. This repetitive stress is a primary cause of shin splints, as it continually taxes the same areas without sufficient recovery time.
  

• Biomechanical issues: biomechanical problems, such as overpronation or flat feet, can significantly contribute to shin splints. Overpronation, where the foot rolls excessively inward, places additional stress on the shin bone as it compensates for the abnormal foot movement. Similarly, flat arches can lead to improper distribution of forces through the leg, increasing stress on the shin bone and surrounding tissues. These biomechanical issues alter the natural alignment and movement patterns, causing repetitive stress and injury to the shin area. Other gait abnormalities and alignment issues can also change the distribution of forces along the lower leg, leading to your lower leg muscles having to work harder to stabilise your feet and legs during movement, hence becoming overused.
  

• Improper footwear: wearing inappropriate footwear is another common cause of shin splints. Running shoes that lack proper rearfoot control, arch support, or cushioning features can fail to absorb shock, transferring more impact to the shins. Additionally, old or worn-out running shoes lose their cushioning and stability, increasing strain on the shins. Proper footwear is crucial in providing the necessary support and cushioning to mitigate the impact forces during running.
  

• Running surfaces: the surfaces on which runners train can also influence the development of shin splints. Running on hard surfaces like concrete or asphalt increases the impact forces transmitted through the legs, contributing to shin splints. Similarly, running on uneven or sloped surfaces can cause uneven distribution of forces, stressing the shin bone and surrounding tissues. Choosing softer, more forgiving surfaces may help reduce the risk of shin splints.
  

• Muscle imbalances and weakness: muscle imbalances and weaknesses play a significant role in causing shin splints. For instance, weakness in the calf muscles can lead to increased reliance on the muscles along the shin, causing overuse and strain. Tight calf muscles can limit ankle movement, altering running mechanics and increasing stress on the shins. Addressing these imbalances and strengthening the muscles can help prevent shin splints.
  

• Training errors: training errors, such as failing to properly warm up before running, can lead to sudden stress on the muscles and bones, increasing the risk of shin splints. Similarly, not allowing sufficient rest and recovery between runs can prevent the muscles and bones from repairing, leading to cumulative stress and injury. Proper training practices, including adequate warm-ups and recovery periods, are essential in preventing shin splints.
  

• Anatomical factors: anatomical factors, such as a history of lower limb injuries or structural abnormalities, can increase the risk of developing shin splints. Previous injuries can alter running mechanics, leading to uneven stress distribution and increased susceptibility to shin splints. Structural abnormalities, like variations in leg length, can also cause uneven stress, contributing to shin pain. 
  

• Poor running technique - poor running biomechanics, such as improper foot placement, stride length, or running form, can disrupt the natural distribution of impact forces during each stride. The repetitive nature of running magnifies the impact, causing irritation, microtrauma, and inflammation at and around the shins. Inadequate shock absorption and an inefficient transfer of forces through the lower limbs create a biomechanical environment that elevates the risk of developing shin splints.
  

Preventing Shin Splints In Runners

Ways that you can help reduce your likelihood of developing shin splints include:

• Gradually progressing your training: gradually increase your training intensity, duration, and frequency to allow your body to adapt and avoid overuse injuries. In running, this goes a long way in helping prevent the repetitive strain on the shinbone that leads to shin splints.
  

• Proper footwear: wear well-fitted running shoes with good arch support and shock absorption whenever you run. Good footwear minimises impact forces on the lower legs, reducing strain on the shinbone and surrounding tissues.
  

• Warm-up and stretching: incorporate dynamic stretches for the lower legs in your warm-up routine. A proper warm-up increases blood flow and flexibility, reducing tension and improving shock absorption, which helps prevent shin splints.
  

• Lower limb strength training: strengthen the calf muscles and those along the shin to improve their ability to absorb and distribute forces during running. Stronger muscles provide better support for the shinbone, reducing the risk of inflammation and injury.
  

• Cross-training: incorporate low-impact activities like swimming, cycling, or using an elliptical to give your shins a break from the repetitive stress of running. Cross-training helps maintain cardiovascular fitness while reducing the risk of overuse injuries.
  

• Adopt a solid running technique: focus on a midfoot strike, shorter strides, and an upright posture to evenly distribute impact forces throughout the legs. Proper running form minimises strain on the shinbone, reducing the risk of irritation and inflammation.
  

• Rest and recovery: ensure you have adequate rest and recovery between high-intensity workouts. Allowing time for your body to repair and adapt reduces cumulative strain on the shinbone and its surrounding tissues. Proper sleep, hydration, and nutrition are also crucial for recovery.
  

• Work with a podiatrist: podiatrists specialise in lower limb function and biomechanics, having a thorough understanding of how the feet and legs are loaded when you run and how you can modify those loads to reduce your injury risk, optimise your performance and support your foot health and mobility. Our podiatrists here at The Feet People work extensively with those with shin and leg pain (as well as a range of running injuries), helping you reach your fitness and recovery goals.
  

Podiatrist Treatment For Shin Splints

Treating shin splints with our podiatrists across our Brisbane CBD and Newmarket clinics starts with relieving your initial symptoms and creating a comprehensive treatment plan that addresses what has caused the shin splints in your specific circumstances. To do this, we may use one or a combination of:

• Custom-prescribed foot orthotics to modify the way your feet and legs are loaded, and hence the stress your shins are exposed to
  
• MLS laser to help with pain while reducing inflammation, promoting wound healing and supporting soft tissue repair
  
• Footwear changes to more stabilising and supportive shoes that match the needs of your feet
  
• A custom stretching and strengthening programme to address muscle imbalances, tightness or weakness. This is usually done in combination with foot mobilisation therapy (FMT)
  
• Shockwave therapy to accelerate the healing process
  
• Dry needling of surrounding soft tissue structures to release tension in the muscles.
  
• Gait retraining to help with specific biomechanical issues that could contribute to the injury.
  
• Changes to your gait or training program or schedule
  
• Strapping, splinting or bracing
  

Best Podiatrist For Shin Splints Brisbane

Our team is highly experienced in managing shin splints, and several of them participate in elite-level sports themselves.

Stephanie Bain (Newmarket)

Stephanie is a national running champion, with awards at 400m and 800m distances. Stephanie is currently injured but is an elite 5K, 10K and half marathon runner and specialises in running injuries. She specialises in running injuries, including shin splints, and runs a tailored “return to running program”. Stephanie has worked extensively with patients with recurrent ankle sprains and lateral ankle instability, sporting overuse injuries such as stress fractures, tendonitis and plantar fasciitis and acute injuries such as muscle strains and ankle fractures. Learn more about Stephanie here.

To book in directly with Stephanie at our Newmarket branch, click here.

Cristina Smundin (Brisbane CBD) 

Cristina was an elite national hurdler, competing at a national level, before sustaining her ACL injuries. Now, she uses her knowledge and first-hand experience to specialise in running injuries and tailored return to run programs. Cristina is proficient in leverage leading technologies in her treatment plans to help give her patients the best outcomes. This includes EXO braces, shockwave therapy, trigger point dry needling and custom foot orthotics. Learn more about Cristina here.

To book in directly with Cristina at our Brisbane CBD clinic, click here. 

If you’re unsure if shin splints are the cause of your leg pain or if it's something else, we can help. Book your appointment with our experienced Brisbane podiatrists here.