Cross Training for Shin Splints: Low-Impact Alternatives

Shin splints are a common issue among athletes, especially runners. A study published in the British Journal of Sports Medicine found that the incidence of MTSS among athletes was approximately 13.6% to 20.0%, with a higher prevalence among runners.[1]

The repetitive impact on the shins from running can take a toll over time, leading to inflammation and pain along the shinbone. While rest is often the first recommendation, incorporating cross-training can be highly beneficial for treating and preventing shin splints in runners and other athletes.

This article provides a comprehensive guide on cross-training and proper rehabilitation strategies to heal shin splints.

Understanding Shin Splints

Shin splints refer to pain and inflammation along the shinbone or tibia. The medical term is medial tibial stress syndrome (MTSS). This overuse injury often results from repetitive stress on the shin muscles and connective tissues.

Runners are especially prone to shin splints because of the repetitive impact on the shins with each footstrike. Any athlete involved in jumping sports like basketball can also develop shin splints over time. The continual shock forces from impact activities overload the shinbone and surrounding soft tissues.

Other contributing factors include:

• Inadequate arch support and foot biomechanics

• Sudden increases in activity or mileage

• Running on hard or uneven surfaces

• Excessive hill running or speedwork

• Poor conditioning of leg muscles

• Imbalances that affect running form and impact

Causes and Symptoms

Medial Tibial Stress Syndrome (MTSS), is characterized by pain along the inner edge of the shinbone (tibia) and is believed to be caused by a spectrum of stress injuries, including periostitis, tendinopathy, periosteal remodeling, and stress reaction of the tibia. Symptoms typically include sharp or dull pain along the inner part of the lower leg, which may become more severe during exercise.

Shin splints often begin as a vague soreness or tenderness along the inner, medial aspect of the tibia. This can progress to a defined pain toward the lower third of the leg with running. 

In severe cases, pain may persist even after activity. Shin splints focus on a specific spot, differentiating them from general soreness or stiffness.

Read More: Causes of shin splints

Diagnosis and Symptoms

It’s important to distinguish shin splints from other potential causes of lower leg pain. Stress fractures, for example, can mimic some shin splint symptoms. 

See a sports medicine doctor or physical therapist for an accurate diagnosis. Factors they will evaluate include:

• Specific location of pain - shin splints focus on the inside of the  tibia

• Pain history - Shin splints develop gradually and worsen with continued activity

• Physical exam for tenderness along the shin

• X-rays or MRI scans to rule out fractures or other issues

In addition to localized shin pain, common symptoms of shin splints include:

• Aching or soreness in the shins during and after running

• Pain that initially shows up toward the ends of runs

• Discomfort walking, especially barefoot

• Tenderness when pressed along the inner shin bone

• Pain when flexing the ankle upward

If you experience shin soreness when beginning a new training regimen, pay close attention. This could signal impending shin splints without proper rest and recovery. Catching shin pain early and modifying activities can often prevent full-blown shin splints.

Prevention Strategies

Treating existing shin splints focuses heavily on rest and recovery. However, prevention is ideal to keep shin splints from developing in the first place. Here are some key strategies you can use to prevent them.

Gradual Training Progression

Avoid increasing weekly running mileage or intensity by more than 10% at a time. This overload is a common cause of shin splints, as tissues cannot adapt quickly enough. Build slowly and include rest days to minimize risk.

Use Proper Footwear

Running shoes designed for your foot type and gait pattern can optimize biomechanics. Replace shoes every 300-500 miles as cushioning breaks down over time.

Run on Softer Surfaces

Run on tracks, trails, or treadmills instead of concrete to dampen the impact. Be cautious with crowned roads as the angled slope stresses the shins.

Strengthen Lower Leg Muscles

Strong calf, shin, and foot core muscles better stabilize the ankle and foot, reducing shin overload. Do strengthening exercises 2-3 times per week as prevention.

Attend to Other Leg Muscles and Movement Patterns

Weak hips, glutes, and core can affect form and exacerbate shin splints. Keep these areas strong, too. Consider gait analysis to identify problem areas.

Stretch and Warm-Up Properly

Tight calf muscles and limited ankle mobility put extra stress on the shins. Dynamic Warm-ups for shin splints prep the lower legs for activity, and running-specific stretches like alphabet writing keep calf muscles flexible.

Cross-Training as a Preventative and Rehabilitative Strategy

Cross-training refers to participating in complementary exercises and activities outside your regular training. For runners, it often means opting for low-impact activities like biking, swimming, or using the elliptical trainer. Cross-training has several benefits:

Maintains Cardio Fitness

Alternative aerobic activities keep cardiovascular fitness strong during shin splint recovery when running is removed.

Allows Continued Activity Without Overload

Non-impact exercises prevent further repetitive loading that would aggravate shin splints but keep you active.

Provides Active Recovery

Promotes blood flow to enhance healing without taxing the shins.

Strengthens Muscles in a Balanced Way

Full-body training strengthens complementary muscles compared to the imbalances caused by repetitive running. Prevents future shin splints.

Supports Biomechanics and Technique

Activities like swimming that engage the core and upper body help correct muscle imbalances and poor form tied to shin splints.

The two most beneficial cross-training choices are cycling and swimming since these modalities avoid stressing the shins and lower legs. Deep water running is also excellent. 

Options like rowing machines and stair climbing still load the shins significantly, so are less ideal for active shin splint recovery. Work with a physical therapist to design a tailored cross-training program.

Treatment of Shin Splints

If you develop shin splints, take a break from the aggravating activity. Try to catch it early when you first notice pain and soreness before it progresses. Include these treatment principles:

Rest  - Abstain from offending activities like running to allow the irritated tissue to heal. Cross-train to maintain fitness. Walking in a pool is one option.

Ice - Apply ice packs or do an ice massage along the shin for 15-20 minutes several times per day, especially after activity. Icing reduces pain and inflammation.

Compression - Wear compression socks or sleeves to provide muscle support and facilitate healing.

Elevation - Elevate your legs regularly above heart level to promote drainage and decrease swelling.

These steps follow the recognized POLICE and RICE principles for managing soft tissue injuries - protection, optimal loading, ice, compression, and elevation. Anti-inflammatory medication like ibuprofen can also relieve shin splint pain and swelling. Check with your doctor for appropriate use and dosage.

Rehabilitation Principles and Exercises for Shin Splints

Rehabbing from shin splints focuses on correcting the factors that caused them, gradually strengthening tissues, and restoring flexibility and mobility. General principles include:

Address Causative Factors

Consider arch support inserts or orthotics and proper footwear. Improve run form and training habits like surface and terrain. Build supportive and corrective exercise into routine.

Stretch and Mobilize

Tight calf muscles strongly relate to shin splints. Perform calf stretches like leaning against a wall in a lunge position. You can also foam roll and massage calf muscles. 

Rehabilitation Exercises

For rehabilitation, a multiphase treatment plan incorporating calf flexibility, hip, ankle, and foot core strengthening,  plyometrics, and conditioning exercises has shown effectiveness. [2] 

Pain-free flexibility and strength training in the early stages allow the body to better disperse forces away from the shins through the muscles to decrease the load on the shins. 

Plyometrics, introduced in the later phases of recovery, emphasize gradual eccentric stress loading to the musculoskeletal components of the lower leg, aiding in recovery and strengthening to prevent recurrence. 

Additionally, interventions such as shockwave therapy, compression sleeves, massages with a massage gun, and ice massage have been studied.  Though the most effective intervention remains unclear they have all been shown to decrease pain and help recover from shin splints. [3] 

Return to Activity After Shin Splints

Aim to gradually resume exercise and running without causing further shin irritation. Returning too quickly risks repeat injury. Follow these guidelines:

Wait Until Pain-Free

Only attempt running once you can walk pain-free for 30 minutes. Any lingering discomfort with daily activity means you still need more recovery.

Start Slowly With Low Mileage and Intensity

When cleared to run, ease back in with short, easy runs of 15-20 minutes, maximum 1-2x per week. Keep effort conversational pace.

Increase Weekly Mileage Cautiously

Add up to 10% more distance each week. Scale back if shin pain flares up. Better to take your time than have a setback.

Take At Least 1 Day Off Between Runs

Adequate rest allows tissues to adapt and prevents overloading early on. Consider cross-training on some off days.

Avoid Hills and Speedwork Initially

Stick to flat routes and avoid high-intensity intervals or tempo runs when first returning. Steer clear of crowned roads.

Wear Cushioned Running Shoes

Maximize shock absorption with appropriate, well-cushioned shoes, especially if foot pronation contributes to your shin splints. Replace shoes regularly.

Continue Strength and Mobility Exercises

Keep up with your rehab routine 1-2x per week as maintenance. These exercises promote proper mechanics and prevent future shin splints.

Modify Training if Pain Returns

If shin pain returns, take a few days off, cross-train, and evaluate why. Frequently, too much volume or intensity is too soon. Adjust your build-up.

Conclusion

Shin splints constitute a common but preventable overuse injury in runners. A gradual buildup of mileage and intensity gives tissues time to adapt. Proper footwear, soft running surfaces, and hip/core strengthening all contribute to preventing shin splint onset.

If shin pain does occur, rest and active recovery via cross-training are key to overcoming shin splints. A tailored rehabilitation program stretches tight calves, strengthens lower leg muscles, and corrects causative factors like weakness or poor biomechanics. Returning to running requires patience to prevent re-injury.

A commitment to smart training routines, cross-training, and lower leg strengthening will help runners remain active and pursue their goals pain-free. Use the comprehensive guidance in this article to either prevent shin splints from developing or properly rehab and recover if shin splints occur. With a careful, knowledgeable approach, shin splints can be conquered.