Shin Splints

Have you considered what a shin splint really is? I didn't until close to a decade into running.

When I first started running, I was always told that shin pain after a run was a shin splint. I was told that shin splints were little breaks in the shin bone (tibia) that happened from impact. And I always just went with it.

Turns out, what I was experiencing was something entirely different. A huge number of runners at any time have what they call "shin splints," but many of them do not have any sort of bone issue at all.

Something else is going on here. Most runners – particularly people who lift (more on that later) – do not have broken tibias this frequently. You may have never experienced those little breaks in the bone I was describing, even if you've had shin splints a hundred times.

So if it's not broken bones, what is it?

Much of the time, it's muscle soreness. We just haven't been taught as a society to recognize what certain types of muscle soreness feel like.

An ode to the tibialis anterior

Let's go into anatomy briefly to look at how the leg moves. The highlighted red in the below image is your tibialis anterior. Primarily, this muscle controls the dorsiflexion of your foot (a fancy word for pointing your foot up, and the opposite of plantarflexion, which is planting your foot down towards the ground).

Try pushing your foot up from the ankle only. If you do that, you'll feel your tibialis anterior muscle engage.

As it turns out, you are doing a lot of dorsiflexion whenever you run. And that dorsiflexion is being done with force. Think about your running form as you kick off from the ground (or break suddenly).

As with any muscle overuse, the tibialis anterior muscles are prone to get sore. And when they do, it often feels like it's the shin bone that's hurting. But oftentimes the shin bone is completely uncompromised, it's just the muscle soreness.

If we weren’t familiar with how sore biceps feel, we might assume our arm bones were hurting instead. By getting a feel for your own body, you can start to identify what muscles are sore and being used, and it's a remarkable thing.

This explains some common shin pain, but not all. You should be aware of the other types of shin pain as well:

Medial Tibial Stress Syndrome

This is often considered a "true" shin splint. Medial Tibial Stress Syndrome (MTSS) is inflammation around the tibia - but not breakage. It's that dull achey feeling around the shin bone you may feel after a run.

Stress Fractures

This is what I think most people think shin splints always are. It's what I had always been taught a shin splint was. But it's much rarer than run club conversation seems to suggest.

What's happening here is what it sounds like – a small hairline fracture in your tibia(s). Like soreness, this is primarily caused by overuse. But unlike muscle soreness, recovery times can be much longer. And while running through muscle soreness may be tolerable, but you should never run through stress fractures.

Tendonitis

We've discussed bone pain and muscle pain, but there is also tendon pain. Tibialis anterior tendonitis is when the connections between your muscle and the top of your ankle are inflamed.

In casual conversation, muscle soreness, MTSS, and tendonitis are all often lumped together as "shin splints." In clinical terms, only MTSS is typically considered a true shin splint.

This causes a lot of confusion! As with many things in the health and fitness world, I don't think there's much consensus on how we're labeling shin pain. If you'd like clarification on what type of shin pain you are experiencing, I recommend consulting with a medical professional.

Other shin pain

As a personal trainer, I'm less trained the on rarer shin pains. But there are two I'd like to highlight:

• Muscle cramps. Some people, especially long distance runners, may be prone to cramping in their tibialis anterior muscles. If you have this it will essentially feel like the front of your leg is "locked up." This is much more common in the calf muscles (specifically the gastrocnemius, or the big muscle of the calf). It can be quite painful, but often short-lived.
• Compartment syndrome. This is similar to a muscle cramp, but much more serious. If you experience severe pain, swelling, numbness, or tingling that doesn't improve with rest, seek medical help immediately. Here's an article from the UK's National Health Service on Compartment Syndrome for more information.

Strength Training Helps

Before I started strength training, I got shin splints after nearly every run. This is a story I hear quite often.

Although most muscles have a primary function (recall that the tibialis anterior primarily controls dorsiflexion), that doesn't mean that other muscles can't do the same thing, or aid in the process of a primary mover.

Strengthening your other leg muscles can help prevent shin splints long term. This works by ensuring no muscles are overactive or underworking, and are instead working in synchrony.

You can strengthen your tibialis anterior outside of running too if you'd like. Any exercise that requires your ankle to point upwards is going to engage the tibialis anterior.

It's all about squats

You can isolate muscles to try to get each one strengthened on its own. But in my opinion the best thing to do as a runner for strength training is squats. You'll essentially hit every major muscle involved in running in a single functional movement. And while squats aren't a panacea, they can help build strong and balanced legs.

However, even with the strongest legs in the world, shin pain from running can be caused by improper form as well.

Check Your Form

We often think of "good form" in the context of weight lifting. But it applies to running too.

If your feet are pronating (rolling inwards) or supinating (rolling outwards) as you run, you'll be causing undue stress on your shins. This itself can cause shin pain even if you don't have muscle imbalances.

Some runners choose to use stability shoes to help address pronation and supination. However, no one knows your own body better than yourself, and if you think stability shoes would help your running form, go for it.

I am a firm believer that stability running shoes hurt long-term. But you will be able to find evidence both for and against these types of shoes.

The latter study I've linked sums up the state of corrective/adaptive footwear for shin splint prevention well, saying:

The findings of this study suggest that our current approach of prescribing in-shoe pronation control systems on the basis of foot type is overly simplistic and potentially injurious.

Other ways people run

There is not a "wrong" way to run (despite what some on the internet may try to tell you), but there are a few other things to watch out for that could increase your risk of shin splints:

• Overstriding: Landing with your foot too far in front of your body increases impact forces.
• Heel striking: Excessive heel striking can stress your tibialis anterior muscles. This can cause and exacerbate plantar fasciitis too, but that's a story for another day.
• Foot placement: Aim for your foot to land under your center of mass, not ahead of it.
• General motion/stability: If you find yourself struggling to keep a center line while running, that may be the cause of issues on its own.

Altering your running form is outside the scope of practice for any ethical fitness professional, so I will not give advice here. But if you would like to change your running form, I recommend going to a physical therapist.

Speaking of shoes

While I don't recommend stability shoes for most people, I do recommend making sure your shoes fit and work for your feet. I'll have a different article on workout shoes later on. But one thing I'll say now is that while the right shoes aren't going to magically fix your shin splints, the wrong shoes may very well be a cause of your shin splints.

Will I never get shin splints again?

The human body is complex and even if you do everything right, you may not prevent shin splints entirely. The muscle soreness described at the top of this article can be particularly difficult to prevent. But knowing what is going on with injuries and what may be causing them is the first step in any good rehabilitation effort.

In my running journey, I've gone from getting shin splints nearly every time I run to getting them very rarely. If you get shin splints often right now, I hope your journey has a similar path.