How to Treat and Beat Shin Splints

It’s not uncommon to see an entire college or high school running squad wiped out by pain running up the front of their lower leg — the insidious shin splints.

“It’s one of the more common beginner running injuries,” says Jeff Gaudette, head coach at RunnersConnect. About 30-40 percent of the beginners he sees get shin splints.

The reason it’s so common among new runners has to do with what causes shin splints, also known as medial tibial stress syndrome. There’s not a consensus among doctors about the cause, but for a long time, it was thought to be a soft tissue injury — either small tears or inflammation of the muscles that attach near the shin or of the periosteum (a thin sheath of tissue around the shin bone). But, says Gaudette, studies have now found that the pain is actually a bone injury, not a soft tissue injury. In fact, if you ignore shin splints it’s possible for the pain to progress to a full-blown stress fracture of the bone.

It’s actually common for the term “shin splints” to cover a range of lower-leg injuries, says Marinus Winters, a physical therapist and PhD candidate at the University Medical Center Utrecht. On one end is the medial tibial stress syndrome—or what is most commonly referred to as shin splints — and on the other end is a stress fracture. To be sure you don’t misdiagnose yourself among this range of injuries, it can be a good idea to see a doctor, says Winters.

At a basic level, says Gaudette, what happens when we train and put stress on our bones is that the bones respond to that stress. In much the same way muscles rebuild from training, bones do too. When we run, the tibia or shin bone bends slightly from the impact. When we rest after our runs, it’s able to rebuild and get stronger.

“The shin bone starts to remodel and get stronger,” he says.

For that to happen, though, you have to give your body time to rebuild. So when new runners go out and run too much too quickly — without giving their bones (and muscles) time to recover — the shins become overstressed. Experienced runners are less likely to have this problem because they’ve slowly built their system up to handle the stress of running.

Upping your mileage or intensity too quickly can cause shin splints, but so can other things that overstress your lower legs. Poor running form, such as over-striding, can force the shin to absorb more shock, says Gaudette. And, weak calves or hips won’t do a good job of bracing the shin bone, putting more stress on it. A correlation between weak hip abductor and shin splints has been found in multiple studies.

The injury is also more common among women, who tend to have lower bone density, and among individuals with a higher body mass index.

While shin splints may simply seem annoying, once you feel pain on the outside of your shin, it’s important to treat it before it turns into a chronic injury.

“The onset of shin splints can be insidious,” says Winters. “You may experience once or twice a little pain along the shin bone, but it may not progress into a serious injury yet. However, when the frequency of experienced pain increases, it is not unlikely that you already have developed shin splints.”

If you can pull back on your training and address the root of the problem right away, then it may be possible to not miss too many days of running. But, if you run through extreme pain, then you risk a more serious injury. It’s hard to know exactly where that line is.

“It’s not an injury you just know you can run or you can’t run,” says Gaudette.

Generally, Winters tells his patients that the pain should never exceed a 4 on a 1-10 scale. It’s best to rest some and decrease running, then add it back in slowly once the pain is gone.

It’s likely if you ever had shin splints in high school or college, you were told to rest and ice. While icing can certainly help general recovery, there’s actually very little scientific evidence to support its effectiveness in curing shin splints, says Winters.

In addition to giving your body time to rebuild and recover from the stress you’ve been putting on it, what’s important is to address any additional reasons you may have been overstressing your shins, such as weak hip abductors leading to an unstable core. While people often want to do exercises to strengthen the shin muscles directly, that isn’t necessarily going to fix any form issues that were causing the problem.

“What you really need to work on is hip strength and calf strength,” says Gaudette. The calves and hips help to brace the shin and leg bones against the impacts of running. He puts his athletes suffering from shin splints on a regime of exercises like clamshells (laying on your side), donkey kicks (on all fours push one leg straight back), calf raises, and hip thrusts (one-legged bridges on your back).

He also recommends that they work on any running form issues, of which over-striding, he says, is “the most common flaw.” He advises his athletes to up their running cadence to at least 165 strides per minute, which can help bring your legs under them and prevent over-striding and overstressing the shin.