Everything You Need to Know About Shin Splints

Every Runner Knows The Battle

Ahh the good ole' shin splints, every runner dreads them. And too many know the feeling of the shooting pain in your shin with every step of a run. The internal battle of whether I should let them rest or push through the pain? Then after finally giving in and resting for a week getting back to running, only to have them flare up after two runs.

With my writing, I want to answer some questions about shin splints you may have.

• What exactly are shin splints?
• How do they happen?
• Which type of shin splints do you have?
• How can they be treated?

The Definition of Shin Splints

Shin splints, or in the medical world, "medial tibia stress syndrome," is an injury resulting in pain that occurs in the shin.

The mighty google defines it as:

"pain in the shin and lower leg caused by prolonged running, typically on hard surfaces."

Good but pretty simple definition...

Just to make sure were all on the same page here, the shin is the bone that connects your ankle to your knee. If we're getting scientifically correct, the tibia. It is the tibia that becomes damaged with shin splints.

Now the medical definition:

"Medial tibial stress syndrome (MTSS) is an overuse injury characterized by diffuse tibial anteromedial or posteromedial surface subcutaneous periostitis, usually in conjunction with underlying cortical bone microtrauma." [Franklyn M, Oakes B.]

Whoah, that's a mouthful. Let me break it down for you. Basically, pain in the front or the middle of the shin causes by bone irritation from repetitive trauma of running.

Now that we have that down let's dive a little deeper.

Types of Shin Splints - Anterior Shin Splints vs Posterior Shin Splints

Believe it or not, there are two different types of shin splints.

1. Anterior shin splints
2. Posterior shin splints

Both are equally common in runners.

And as you may know, both types typically get grouped together, classified as simply "shin splints."

Unfortunately, this gives a sense that every case of shin splints is the same.

The broad grouping of "shin splints" makes shin splints tricky to resolve. To get your injury to go away, you need to know what is causing it. It is imperative you know which type of shin splints you are dealing with.

Where Does Shin Splints Hurt?

The first and most apparent difference between anterior and posterior shin splints is the location of the pain in the shin.

Anterior Shin Splints Pain:

• Located on the front lower third of the shin bone.

Posterior Shin Splints Pain:

• Located on the inside of the shin bone just before the calf muscle.

The different pain locations are what first tipped off researchers "shin splints" could be broken down into two categories.

Causes of Shin Splints

It would make sense with the pain being in different locations, the causes of the injury would be other. In 2012, researchers Franklyn and Oakes set out to research what causes each type of shin splints and came up with some pretty medical heavy definitions. I will try to explain them more straightforwardly so you can understand.

Anterior Shin Splints:

"Tibial flexion from contraction of the two heads of the Gastrocnemius and the Soleus muscle causes tibial bending moments during the push-off phase of running." [Franklyn M, Oakes B.]

When you run, your calf muscle pushes off the ground propelling you forward. Because of how your calf muscle attaches, the contraction of your calf muscles causes a micro bending moment of your tibia. Think of it as a bow.

This repetitive micro bending can cause trauma to the shin bone, leading to what's called a stress reaction. The stress reaction will show up on MRI and bone scans.

Posterior Shin Splints:

"Tension in the tibial attachment of the deep fascia in conjunction with the origins of the powerful action of the soleus and gastrocnemius muscles proximally." [Franklyn M, Oakes B.]

Your muscles are attached to the bone via fascia. In a healthy body, when the muscle contracts it pulls the bone. In posterior shin splints, muscle contraction creates tension on this fascia, pulling it away from the bone.

The tension creates a stress reaction on the inside of the shin bone, where the calf muscle attaches to the shin bone.

Shin Splints Commonalities

So now that you know the differences, let's talk about a critical commonality between the two.

They are both classified as overuse or chronic injuries in the medical world.

In other words, the injury didn't happen from a particular moment, like when you roll your ankle. Instead, an overuse injury occurs gradually over time. Usually, you don't even remember exactly when it started, but it progressively becomes more debilitating.

Runners are no strangers to overuse injuries. Unfortunately, 90% of all running injuries are overuse. This shouldn't come as a surprise. Every mile you run takes, on average, 2,500 steps, and with every step, force must be dispersed throughout the body. If joints aren't lining up correctly, or your body does not have the strength to absorb this force, it will lead to injury.

How to Treat Shin Splints (general guidelines)

Now that you hopefully have a better understanding of the shin splints you are dealing with, you can help treat them.

1. Manage your running distance or volume: Due to the overuse nature of shin splints, they are not something you can ignore and keep training through. You need to try and control how much running you do. I tell runners to try and stay at the same volume for a couple of weeks. If it is not improving, you will have to go cross-training.
2. Cross training: Building up the resilience of your body's tissues in the weight room. Just like muscles can get stronger, so can bone. When you place your bone under increased demand, it grows back stronger. This is why it is recommended little old ladies start to lift weights for their osteoporosis. Stronger bones can withstand more of the repetitive microtrauma of running demands.
3. Strengthen muscles that absorb force: Running is repetative meaning a lot of force goes through your body. You need this force to be absorbed through your muscles versus your bones. A lot of shin splint suffers have poor shock absorbing ability. 
4. Address your running form and make modifications: As I've said you run, you need to be able to absorb force appropriately. A quick couple of tips would be running with a midfoot pattern and landing with a slightly flexed knee. I have had success watching runners and helping break down their form.

So there you have it. Hopefully, this wasn't too wordy, and hopefully, you were able to get some good stuff out of it. The more you know about an injury, the more you can prevent and treat it.