Are shin splints stopping you from running?
Shin splints or Medial Tibial Stress Syndrome (MTSS) is a condition that is extremely debilitating for those unfortunate enough to have suffered with or are currently suffering with. It always seems to plague you just when you start to get back into running or activities such as football, soccer, basketball or any other activity that requires a lot of running. It is a highly prevalent injury to the running/sporting population, where studies have estimated its prevalence to be 9.1%, whilst its peak incidence to be 9.4% (Kakouris et al, 2021).
So, what are shin splints?
Shin splints are an overload injury where repetitive stress is placed on the shin bone (tibia) and the connective tissues attaching the muscles to the bone. Shin splints can be defined as, “exercise induced pain along the postero-medial tibial border and recognisable pain is provoked on palpation (touch) of the border over a length of ≥ 5 consecutive centimetres.” (Yates & White, 2004)
Every tissue in the body is adaptable to load (stress). The key is finding the right amount of load at the given time of the tissue’s current capabilities. In other words, if you do too much too soon, stress will result, and the tissue will react from the overload. If this overload is sustained and repeated, it does not give the tissue the appropriate time to adapt, leading it to a negative cycle and eventually pain and injury occur.
The evidence for risk factors in developing shin splints include biomechanical factors and external factors such as shoe support and running surface. However, the most important factor is the training load! Backing up what was previously discussed, if you do too much too soon then a training load error will occur and result in injury. Increasing the intensity of running plays a significant role in increasing stress on the shins and working muscles. Intensity should always be built up slowly over time once a good training volume and capacity has been established. Biomechanical factors that play a part include those runners who have an increased hip adduction in combination with increased hip internal rotation and rear foot eversion (leading to a poorly controlled pronation or rolling in of the foot). The increase in Ground Reaction Forces (GRF) certainly is important. Overstriding, reduced cadence (steps per minute) and increased vertical oscillation (how high you leave the ground when running) are all modifiable factors that increase GRF. The increase in GRF increases the torsion and stress on the shins and connective tissues, which increases the chance of injury. Although biomechanical technique certainly plays an important part, training load is the key!
When it comes to running surfaces, studies have shown that surfaces at which the runner is not accustomed to will lead to a higher chance of injury. So, train slowly and build up running volume on that surface; our bodies are amazing at adapting for the better. There is some evidence that wearing insoles can help reduce risk of shin splints, however it is of low quality. My advice would be to find a shoe that feels comfortable for you and train appropriately in them to build up a capacity.
What can we do for shin splints then?
Increasing the cadence is one of the easiest things you can do to minimise GRF and stress to the shins. Studies have shown that slightly increasing the cadence by as little as one step per minute was associated with a 5% decreased risk of developing a bone stress injury (Kliethermes et al, 2021). Other studies have found that increasing cadence also reduced the risk factor of increased hip adduction angle (Yong et al, 2018). A tip to increase cadence is to be more of a forefoot striker (land more on the balls of your feet). It has been shown that this is one way to reduce joint impact to the knee, shins and hips. Further studies have shown that those who suffer with shin splints have muscle strength and endurance deficits. These muscles include the powerful soleus muscle which lacked size, strength, and endurance. Furthermore, it was found that the tibialis anterior, peroneals and flexor hallucis longus muscle were all weaker in those individuals who had shin splints (Mattock et al, 2021).
Concluding thoughts
It must be said, the evidence for shin splints is not of the highest quality. However, it does give us great insight into how we can mange the injury with training load and rehabilitation. I myself have tried doing too much too soon in the hope to get back into football and have got shin splints. Stay tuned for videos on my Instagram page @thereformlab.osteopahy that highlight the rehabilitation for shin splints and my own return to running journey.
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