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MUSC Health Blog

Keyword: shin splints

Guest Post by:

Ryan Littlejohn,  ATC, SCAT
Athletic Trainer
MUSC Health Sports Medicine












Have you ever been running and noticed pain in your lower leg along your shinbone?  Medial tibial stress syndrome (shin splints) is a common problem among runners and athletes.  This condition can be extremely difficult to get under control if youre not sure how to treat it.  The most successful way to get rid of shin splints is to figure out what is causing the problem.  Here are 5 easy tips that can help get you back on the road to recovery.  

Tip 1:  Replacing old shoes is essential; go to your favorite running store and ask about getting the correct shoes for your feet.  Running shoes should be changed about every 500 miles as a general rule, as research suggests shoes begin to breaking down around that distance.  *For a specific calculation to when you need to change your shoes divide 75000/Body Weight.  This equals your shoe mileage!

Tip 2: Initially training should progress gradually and not too fast.  Muscles need to rest and overtraining is a common cause for shin pain.  Avoid doing too many hills when you initially start training; the body is not used to the extra stress that is put on your knees and legs.  There is nothing wrong with running hills but start gradually, this will help your body ease into the stress.   If you experience a little soreness, use ice AFTER activity on your shins to help control the pain. An excellent way use ice is to make an ice massage.  Put paper cups with water in the freezer.   After they are completely solid,  peel them off at the top and apply it up and down your shins for about 10 min with gentle pressure.

Tip 3:  Do you have flat feet or high arches? Your foot may be causing your shin pain but there is good news it can be corrected.   There are basically three different types of running shoes, cushion, neutral and motion control shoes.  Here is a quick assessment: standing barefoot with your shoes off wet the bottom of your feet and walk on a hardwood or solid surface.  If your feet are flat, the print will show your toes, middle of your foot and your heel on floor.   If your foot print appears to be partially touching, just toes and heals of your feet, then you might have a high arch or a neutral foot.   Why is this important?  When abnormal biomechanics  occur it causes the  body to compensate in various directions.   It can cause many overuse injuries in the knee, hip, shin and foot.  Buying the correct shoes should be the first place to start from the most reputable store.  They should be able to evaluate your  feet appropriately by telling you if you have a flat neutral or high arch.  This will be essential information to know before you purchase those new kicks. In addition, many running stores have over the counter orthotics they can recommend you to place in your shoes to help give you the proper support if needed.

Tip 4:  Exercises to help the problem (all of these exercises are fairly simple to do and can be done just about anywhere):

·         Resisted dorsiflexion using an elastic band, start in a seated position and place the band around the top of your foot and secure the other end.  Flex your foot towards you, keeping your knee straight.  Do 2 sets of 20 reps, 3-5 times per week.

·         Calf Raises stand with your feet slightly apart and push-up on your toes, then slowly return back down to the starting position.  Do 2 sets of 20 reps, 3-5 times per week.

·         Calf Stretch (Gastrocnemius) Put one foot in front of the other, with your front knee bent, lean into a wall, stretching your back leg (keep back knee straight) and hold for 30 seconds, repeat with other leg.  Complete daily, multiple times throughout the day.

·         Calf Stretch (Soleus) - Put one foot in front of the other, with your front knee bent, lean into a wall, stretching your back leg (bend back knee slightly) and hold for 30 seconds, repeat with other leg.  Complete daily, multiple times throughout the day.

·         Foam Roller – roll your calf daily with medium to light pressure, for 2-3 minutes, 1-2 times per day.

Tip 5: If you are not improving, head to your sports medicine specialist for further evaluation. Sometimes lingering leg pain maybe related to a stress fracture or other injuries, and additional testing maybe necessary. As a general rule, if your pain lasts for longer than 2 weeks and/or if you have tried to fix the problem by addressing your shoes, adding orthotics and completing a home rehab program, but the pain continues, then you need to take further action and go to the doctor.

Figuring out the problem is the first step, but we also want to fix the problem and not just treat symptoms. Hopefully these tips will get you back on the road to a full recovery.





Guest post by:
Emily A. Darr, M.D.
Assistant Professor of Physical Medicine and Rehabilitation
Department of Orthopaedic Surgery

Deanna Roberts, MS ATC
Department of Orthopaedic Surgery

So you've been training hard for an upcoming race and you're starting to feel an aching pain in your knee. Or maybe you're a new runner that's been increasing your mileage at the expense of a sharp pain in both your shins. Running injuries are a common part of the sport, and unfortunately, up to 82% of runners will experience one at some point in their training. Given this alarming rate of injuries, awareness of such injuries can be important in prevention, diagnosis, and treatment.

Bridge RunThe knee is arguably the most common site of injury with patellofemoral pain syndrome, AKA “runner’s knee”, affecting around 40% of runners. This is characterized by pain around and under the kneecap. Other common injuries include medial tibial stress syndrome, AKA “shin splints” which is an inflammation of the muscles and tendons of the lower leg characterized by a sharp pain, usually on the inside of the shins, Achilles tendonitis, plantar fasciitis, and IT band syndrome, which is pain on the outside of the knee that is caused by repetitive rubbing of the IT band against the outside of the knee.

Sometimes risk factors have a clear link with a particular injury, and sometimes there is a less clear link. Risk factors for which there is clear association with injury include:

  1. Increasing your mileage. Injury is more common when running over 20 and then 40 miles per week.
  2. Recent increase in training intensity
  3. Being new to running

Some risk factors which have a more loose association with injury may include:

  1. Changing your footwear or wearing improper footwear
  2. Running on harder surfaces
  3. Poor habits of warming up prior to running and stretching soft tissues
  4. Muscle imbalance and compensatory patterns

When dealing with an injury, it is best to listen to your body. Be sure to schedule rest days during your training, and take a few days off if your pain is worsening. If you are dealing with an injury that requires a few weeks of rest, pencil in some cross training days to maintain your cardiovascular conditioning. 

Pay attention to your training plan. If you notice a flare up in pain when running on the road, stick to a surface with more give like a turf field or soft track. Run on the side of the road that feels more comfortable and stick to flat courses if running up and down hills exacerbates your pain. When returning from a rest period, increase your training volume by 10% intervals to avoid overtraining and re-injury.

Can I run through an injury?

Dr. Bob Wilder’s Rules for Runners can quickly assess whether you should continue through pain.

  1. On a 10-point scale, pain during the run should be no greater than 0-3.
  2. Pain should not be severe to the point where you limp during or following the run.
  3. The long run should not be more than half the regular weekly volume.

Make sure to warm up before your run with dynamic stretching exercises that warm up your muscles and increase your heart rate. Include a cool down with gentle stretching exercises that focus on the main muscle groups worked during your run.

Running footwear has been a hot topic in recent years including minimalist shoes and barefoot running. Every foot is unique and every running style is different therefore a visit to a running store where a professional can assess your feet and help you decide on the best running shoe for you is well worth it.  Interestingly, studies have shown that when runners wear more expensive shoes promising more cushion or support, they suffer more injuries than runners who opt to wear cheaper footwear. There are no studies that show that running shoes actually prevent injury. Remember that the most important factor in finding a shoe that fits is to make sure it is comfortable when running, not just when placing it on your foot at the store.

If an injury continues to linger or worsen, see a sports medicine physician for further evaluation. He or she can provide you with a proper diagnosis and appropriate rehabilitation plan to get you back on the roads!

Running is a great form of exercise to engage in, whether it be in sport, with a running group, or participating in a color run with friends. These days, the possibilities are endless and so are the opportunities! With the proper training, equipment and rest, you too can have fun and be pain free during your run!


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