Sara recently decided she wants to get back in shape and manage her stress levels, so she started running again. For the first week, she was loving it - every run made her feel energized and happy. Then she gets into her second week, and suddenly every step hurts her legs. All the enjoyment she got out of the first week was gone, but she’s still pushing through, thinking that this is just normal pain related to getting back in shape. Her third week starts, and she’s even feeling that leg pain just walking around doing her regular daily activities. “Shoot, is this shin splints?” she thinks. “What do I do now?”

Sound familiar?

Shin splints are a common problem, affecting up to 35% of active individuals, especially those who run and jump.

Despite being common, shin splints can be difficult to manage. Today, we’re discussing what shin splints are and the best ways to manage the issue.

What ARE shin splints?

These microtraumas are normal and essential for your body to adapt and grow stronger. Without microtrauma, your muscles wouldn’t get the same stimulus to grow and strengthen, your bones wouldn’t get harder and denser, and your tendons and ligaments wouldn’t get thicker and tougher - all things that are major benefits of exercise. However, your body needs time to adapt and repair itself from these microtraumas. Many injuries (shin splints included) come from overtraining and not giving your body enough time to rest and recover.

With shin splints, these microtraumas cause damage to the outside layer of your tibia, creating inflammation and pain on the surface of the bone. Typically, this pain occurs along the inside (or medial) edge of your leg where your calf muscles attach.

Risk factors for shin splints can include:

• Having a higher body weight - Carrying more weight results in your body exerting more force with each step or jump. (This does not necessarily mean that you need to or should lose weight to deal with shin splints, particularly if you’re at a healthy weight or don’t have significant amounts of fat mass).

• Being female - The female body has some biomechanical differences compared to males, which may contribute to increased load on the tibia and higher risk of shin splints.

• Running on hard surfaces like concrete - Softer surfaces, like grass and turf, absorb more force from our steps than harder surfaces like pavement do.

• Having weak or tight calf muscles - Your calf muscles are a key component in absorbing forces coming in from the ground. If these muscles don’t have a full range of motion or are too weak to absorb these forces, your tibia may have to pick up the slack and absorb more force.

• Having more foot pronation and less hip external rotation - These factors change how your body moves, potentially requiring your tibia to absorb more force than it would otherwise have to.

How do I know if it’s shin splints or something else?

Symptoms of shin splints can include:

• Diffuse pain along the inner lower leg

• Sharp or dull pain

• Pain during and/or after physical activity

• Tenderness when touching the inner lower leg

• Mild swelling of the lower leg

If you’re thinking that the symptoms sound somewhat vague, you’re not alone. The symptoms of shin splints can vary from person to person, depending on their current and past activity level, training volume, and other biomechanical factors like leg strength and type of shoe. As a general rule, shin splints progress along a spectrum. The symptoms typically start showing up gradually; at first, symptoms will show up only after an activity like running, but over time the symptoms will show up during activity. If left unaddressed and unmanaged, the symptoms can progress to being present all the time, which is not ideal.

Another problem with figuring out if you have shin splints is that shin splints can look like a couple other conditions. These include stress fractures and chronic exertional compartment syndrome.

Stress fractures are a word most athletes know. They’re typically a result of overtraining, putting your body through too much before it has the chance to adapt and recover. Tibial stress fractures are common in runners who ramp up their mileage too fast. There’s no perfect way to differentiate shin splints and stress fractures. A general rule of thumb, is that if you can pinpoint your shin pain (point to it with one finger), you’re likely dealing with a stress fracture. (As stated earlier, shin splint pain is more diffuse, or covers a larger area). Stress fracture pain also tends to worsen throughout a workout and with each passing workout, while shin splints may not progress quite as quickly or as noticeably. All that said, the only definitive way to diagnose a stress fracture is with an MRI, which can be expensive.

Chronic exertional compartment syndrome is a much less common condition, where fluid builds up in and around your muscles during exercise. This fluid buildup can impinge your nerves and blood vessels. This causes numb, tingling, pale, and/or cold feet, along with aching or burning pain in the calves during exercise. If you are experiencing numbness, tingling, or a change in color or temperature of your feet during exercise, you need to see a professional sooner rather than later. Typically, chronic exertional compartment syndrome isn’t a huge danger and won’t create long-term problems, but it certainly can. Getting it under control sooner rather than later is important to maintain your performance and peace of mind.

Managing Shin Splints

“So I have shin splints. Now what do I do?”

The thing with shin splints is that they can be a challenge to treat.

The best treatment for shin splints is to rest, reducing or stopping weight-bearing activity until the pain goes away. This is not an ideal solution for any athlete or active individual, but it is the best way to stop the microtrauma causing the pain and inflammation in the shin. Notice that it says WEIGHT-BEARING activity. You can still do activities like swimming, biking, some resistance training, and some yoga or pilates moves. Stopping all activity and sitting on the couch until you feel better may be counter-productive, as blood flow is a key factor in healing and recovery.

As with most conditions, the actual best treatment is prevention. If your tibia never accumulates enough damage to cause pain, you don’t have to deal with the pain now and you’re less likely to experience it again in the future.

Here are some other things to consider for both prevention and treatment of shin splints and medial tibial stress syndrome:

• Change your footwear - If your shoes don’t have enough cushion, your legs may be struggling to deal with impact forces from the ground. If your shoes have too much cushion, you may be heel-striking or doing something else creating biomechanical issues in your body. You could even try barefoot running (stay on a soft surface like grass). If you’re not sure if this is the issue, a visit to a professional like a chiropractor or a specialty shoe store can help guide you.

• Change your gait - How you’re “supposed” to run is a hot topic in the running world. Certain aspects of running form, including cadence and heel-strike may create issues.

• Change the surface - Harder surfaces, like concrete, exert a higher force on your body than softer surfaces like grass and turf. Switching up your routine to include more exercise on a softer surface can help reduce pain while keeping you active. Exercising in your yard, in a park, or on a football/soccer field are all good options.

• Stretch and strengthen - Your feet, calves, glutes, hips, and core all play major roles in managing incoming forces. If these muscles are tight and weak, there might be more pressure on your bones during impact activities like running. Five to ten minutes of barefoot running and band exercises at the end of each workout can be an easy starting point. A chiropractor or physical therapist can help guide you if you’re not totally sure where to start.

• Work on your balance - Balance exercise strengthens your feet and ankles, while also improving your motor control: all good things for shin splints. Here’s an easy program: In bare feet, stand on one leg for 30 seconds. Repeat on the other leg. Slowly build up to one minute on each leg. Once you can do one minute on each leg, add another set on each leg with your eyes closed for as long as you can. Repeat twice per day. (Hint: do this while brushing your teeth!)

• See a chiropractor - Restrictions in how your joints move can create biomechanical issues all over your body. In particular, how your feet, ankles, and hips move are often related to shin pain. A treatment plan for shin splints might include adjusting your feet, ankles, hips, and spine, as well as soft tissue work on tight or overactive muscles, exercises to stretch and strengthen muscles, and recommendations for footwear.

If you’re dealing with diffuse pain in your shins or lower legs after physical activity, you could be dealing with shin splints. It’s important to remember you will typically recover easier and faster if you address these issues sooner rather than later. Taking some time to try a different activity, working on the strength of your leg muscles, and visiting a professional like a chiropractor can all be good steps to getting back to full, pain-free function.

If you have questions or concerns about your health or performance, please reach out to us.

You can call or text us with questions or to schedule an appointment at 763-373-9710. You can also schedule online here!

Wishing you the best,
Dr. Nicholas Carlson
Northbound Chiropractic
Serving Delano, MN, Maple Plain, and the rest of Wright and West Hennepin Counties