Does this sound familiar?
You've got your training plan ready to go.
Your favorite pair of running shoes.
And you have an AMAZING speed workout!
But the next morning you wake up, ready to go again...
and something doesn’t feel right.
You ignore it, push through it.
Maybe for weeks.
But this ache around your shins, on the inside of your calf, maybe almost up to your knee keeps lingering…
Until it's speed work day again, and...YOUCH!
As you come to max speed and start to decelerate, that aching pain in your shins is no longer vague.
It is full blown searing, stabbing, and at the same time, deep-dull-achey-painful.
The next day, it hurts to walk and you press on your shins…
and they are T E N D E R.
Those are shin splints, running fit fam.
And they're not always that dramatic.
But if you've been unfortunate enough to experience them, you want them gone.
NOW.
But did you notice this about our story-scenario?
Those lingering symptoms of shin splints were actually present for WEEKS until they really came to a head?
So as much as I wish I could give you 3 exercises and tell you "your shin splints will be gone in the morning"…that's unfortunately NOT the case.
Technically, WEEKS of inflammation and irritation have been building in the periosteum of your tibia bone (confused? Check out last week's blog HERE).
And a very wise, Irish nurse once told me: "it takes time for your body to get hurt to this point; it's going to take time for your body to heal from this point."
So since your shin splints can't get better overnight, let's do the next best thing.
Because, the next best thing WILL help your shin splints get better faster.
Let's dive in.
"I can self-treat" VS "It's time to go to PT"
Let me preface this with a couple guidelines.
In my personal, professional opinion, shin splints (or MTSS) is one of those cases that can be self-treated, but only up to a certain point!
Which one is appropriate?
Self-treatment: appropriate for symptoms at a 3/10, lasting LESS THAN 2 weeks
Physical Therapy time: when symptoms are 4+/10 and have been around GREATER THAN 2 weeks
I know, some runners will try to push through it longer, say "Oh I can fix myself…"
Please.
Don't.
You'll thank me later.
Or…if you don't want to wait that long, then by all means, make that PT appointment ASAP.
What You Might Have Heard…
There's a lot of speculation on how best to treat shin splints.
This is because the only thing the literature can say with certainty is that there's "limited research" on the topic.
Not very helpful.
Old school treatment methods not necessarily "bad", but possibly not as affective:
Rest, ice, elevation, compression, non-steroidal anti-inflammatories, massage therapy, dry needling, KT tape, splinting, bracing, crutches, shockwave, and physiotherapy with proprioceptive training.
Again, rest is VERY important. Please do that! If you find KT tape helps, than go ahead! I found other research papers saying it's unreliable, didn't do anything, etc, etc. But…this is your body. Do what works for you.
New school thoughts:
"Considering that foot pronation increases with the fatigue of foot intrinsic muscles, foot and arch exercises can improve the rigidity of the foot arch that helps to better control the foot pronation and tibial internal rotation, and therefore be useful in preventing and/or treating of MTSS."
I can say with confident, I have done exactly this in the clinic with great results. If you're looking for the exact series of exercises I use, you can find them HERE.
CAVEAT: depending on how flared up or painful your shins are, those exercises I linked above, ARE NOT be the best place to start.
WHY?
Because if you're still in the acute phase of your injury:
you're not ready to strengthen your feet.
You actually need to get OFF your feet.
You've probably developed shin splints due to overusing your feet because a muscle group (or 2) up above your feet isn't doing their job and they've dumped all their work into your shins and feet. (want more of a description? Check out this blog post)
If this is you, keep reading, I have exercises for you!
But, if you're looking to prevent shin splints:
Then YES! Check out my Blueprint for Runners to Stronger Feet Workshop.
But don't forget to add in the circuit below too…it'll help.
@Dr.Whitt.Fit Thoughts
Let's start from the top…
We've said above that shin splints seem to happen because we're over using our feet.
But how does that even happen?
A recent EMG study has suggested that an overactive soleus could be a culprit.
And with the soleus inserting (plugging into) your calcaneus, heel bone, it results in some goofy biomechanics with your foot, increased pronation which is likewise affected by increased muscular fatigue...
all of which can place additional stress on your tibia (shin) bone resulting in shin splints.
But what YOU know is:
You're in pain. Your shins hurt.
Maybe even your feet.
Running is painful and no longer fun.
And walking might hurt too.
Where to start: we need to give your body the opportunity to heal.
We need to give that inflammation and bone stress reaction a chance to calm down by creating a healing environment where all the supporting "teammate" muscle groups are doing the work they're designed to do.
How do we do that?
By removing your feet from the equation.
Use this exercise circuit as an experiment:
Try it standing.
Then try it the way it's intended to be done: on your knees.
2-3 rounds; 1x a day for 2 weeks max.
Tall kneeling halos
Clock Wise & Counter Clock Wise; x8-10 each direction
1/2 kneeling halo
Clock Wise & Counter Clock Wise; x8-10 each direction
Tall kneeling power chops/lift; x8-10 each side
What differences do you FEEL when you do these standing vs. on your knees?
While on your knees:
You had to work to keep your core straight; you might have noticed you wanted to bend sideways as you brought the weight around
Your glutes had to stay to strong and activate differently when you were on one knee compared to on both knees
Your core and glutes had to work hard together to create power and then control it with the power chops/lifts
And that's just the beginning…
What we're teaching your body here is how to use your glutes and core in a coordinated, dynamic way. We're asking your glutes and core to connect and stabilize while working on functional movement patterns called D1 and D2 NFP patterns (in other words, diagonals.) Because this diagonal, this contralateral (or opposite) glute and scapular connection is what makes running possible.
I know, we went hard-core neuro + sports physical therapy.
But I want you to have as much knowledge as possible on how your body works.
Because knowledge is power.
And this is integral for your healing.
Next Steps….
I suggest while your symptoms are at their most painful, you:
Be smart and think about whether this has been going on >2 weeks. If it has-go see a PT!!
If not, and you're determined to try things on your own, then tell your running coach what's going on (if you have one), adjust your training as necessary taking extra rest days, and use that circuit above religiously.
But please note, that circuit above won't fix everything. That's just the first step to re-educating your body, re-teaching it how to work together correctly.
I can help.
When I'm helping runners manage shin splints, I break it down into 2 phases:
Phase 1: NO FEET + core and glute coordination (the circuit above)
Phase 2: Minimal feet + core and glute coordination.
Phase 3: More Feet involvement + progressed core + glute coordination
I have a separate series of exercises for ALL THE PHASES which gradually progress into those foot exercises I told you about…
It sounds complicated, but it's not. Because I have a plan ready for YOU.
If you'd like someone to explain all of this,
Someone to guide you through these exercises, including the ones above,
Someone with a proven blueprint to help you feel confident managing shin splints,
Someone who can help you start preventing shin splints from every happening…
Then let's work together. Click HERE to get started.
Because I want you to know you're not alone.
And there are answers and resources because you're here, and part of the running fit fam.
And you know then, that over here, we Dare to Train Differently.
And that's the secret sauce.
I can't wait to hear from you and start working together,
Dr. Marie Whitt // @dr.whitt.fit
P.S. Yes, for real! Let's do some one-on-one work together and get you back to running, empower, resilient, and shin splint free!
References
Guo, S., Liu, P., Feng, B., Xu, Y., & Wang, Y. (2021). Efficacy of kinesiology taping on the management of shin splints: a systematic review. The Physician And Sportsmedicine, 1-9. doi: 10.1080/00913847.2021.1949253
Kashi, O., & Minoonejad, H. (2022). The Comparison of Anatomic Alignment of the Shin, Ankle, and Foot in Elite Runners with and without Medial Tibial Stress Syndrome. Journal Of Clinical Physiotherapy Research, 3(2), 89-94.
Menéndez, C., Batalla, L., Prieto, A., Rodríguez, M., Crespo, I., & Olmedillas, H. (2020). Medial Tibial Stress Syndrome in Novice and Recreational Runners: A Systematic Review. International Journal Of Environmental Research And Public Health, 17(20), 7457. doi: 10.3390/ijerph17207457
Naderi, A., Moen, M., & Degens, H. (2020). Is high soleus muscle activity during the stance phase of the running cycle a potential risk factor for the development of medial tibial stress syndrome? A prospective study. Journal Of Sports Sciences, 38(20), 2350-2358. doi: 10.1080/02640414.2020.1785186
Sievers, M., & Busch, A. (2021). Medial tibial stress syndrome: The relationship between gender and lower-extremity functional performance among collegiate track and field athletes. Internal Journal Of Sports Medicine And Rehabilitation, 4(16). doi: 10.28933/ijsmr-2020-12-0805
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