How to treat your shin pain

Running with Medial Tibial Stress Syndrome - Part 2:  treament Options for Shin Pain.

By Brace Hayden, DPT and Miya Ensley

If you are interested in learning more about the causal factors and differential
diagnostics for Medial Tibial Stress Syndrome (MTSS) or “Shin Splints” please read the first of this two part article “Running with Medial Tibial Stress Syndrome - What is Causing My Shin Pain?”

Treatment Options for Shin Splints

As this article was compiled by a PT, we can only stress the benefits of getting yourself in for a proper professional and structured PT assessment.  This will give you the most personalized treatment plan for optimal healing and expedited return-to-run results.

However, the DIY options include:

• Pausing high impact training (ie. running) or ramp down your training until MTSS symptoms improve.
• While taking a hiatus from run training or reducing your run volume, don’t throw out your metaphorical running baby with the bathwater and lose your fitness by stopping all physical activities. You can increase your odds of a faster healing process by diversifying your workouts and cross-training. Consider pool running, kick-boarding drills in the pool, biking on road/gravel/trails, or hiking/walking with ski/trek poles.
• Ice cup massage your shin(s) to reduce acute inflammation or hot pack them to improve blood flow. There is debate in the current sports medicine literature as to which is best, so a little self-experimentation is recommended to see what helps your system more.
• Always try to do a light warm-up jog for 5-10 minutes and then perform run-specific dynamic mobility exercises as a pre-run / cross-training workout to reduce future injuries. See these two prior RWM articles on some selected exercises and benefits of performing some pre-run stretches.
• Post-run sustained stretches (hold each for 5 to 30 seconds, back off/relax muscle, and repeat stretch 5 times). Like cooking, some people spend hours preparing a meal, others pop a frozen burrito in the microwave.  Customizing the duration of a recovery stretching routine is largely an individual’s preference based on time availability and what works best for their body.  Most importantly, just do it. Some people find adding tooled assistants (ie. foam-rolling or percussive massage guns) can add value to the routine. The bottom line is, performing a stretching routine after a run has a lot of supportive evidence on keeping muscles more flexible, less sore and reduce occurrence of injuries.
• “Toe-ga exercises” and more: Here are a few popular PT-recommended foot/ankle drills links to improve your leg strength, mobility, and MTSS-rehabilitating exercises. Dosing (repetitions, sets, times per day/week) of each can generally be started with 2-3 sets of 10-30 repetitions depending on respective fatigue and relative fitness. 
  • Ankle alphabets
  • Split lunge on BOSU
  • Eccentric tibialis ankle pull ups with loop band and weight
  • Heel-walking drill
• Wrapping and taping: Wrapping the shin musculature with a compression wrap prior to exercising can reduce some of the stress response and shin pain. There are a multitude of available taping techniques (Kinesio Tape, McConnell, etc) for supporting / binding the medial arch and lower leg musculature some athletes have found helpful.

Preventing Medial Tibial Stress Syndrome

• Make sure you wear the correct running shoes for your foot type. If you're unsure, visit a local running store that offers professional fitting and analysis.
• Have two pairs of (reasonably recently purchased) running shoes with good cushioning and alternate wearing them can vary the stresses on your feet / legs.
• If you enjoy running on roads or paved roadside paths that have a significant camber to aid rain run off, run out and back on the same side of the road (if traffic / safety allows). Similarly, consider alternating directions if you are doing long-distance track workouts.
• Strength train two to three times a week. Long-distance running requires a solid routine of weekly strength and conditioning workouts to maintain healthy joints and supportive musculature. Some runners can get away with just running, but the best evidence leans on a balanced (strength, cardio, stretching, sleep, nutrition, etc) routine. See the “Toe-ga exercises” section above for a few suggested starters.  Visit with a PT for a more personalized plan.
• Perform pre and post-run stretches. Especially if you are prone to developing sore shins, take the extra time to stretch the muscles of your calf and anterior shin once you’ve warmed up.
• When returning to your running routine, a good rule of healing is to gradually increase your mileage by no more than 10 percent of total distance / mileage each week.
• Choose your return-to-run surfaces and incline angles wisely. Hills and hard surfaces (ie. concrete) can increase impact loads on tendon bone connection causing the aforementioned increased potential for inflammation on the legs. Softer surfaces (ie. grass, trail, or the synthetic rubber track) and lower angle profile runs are recommended until MTSS pain has resolved. Reinstating hills and hard-pack surfaces gradually after injuries is helpful.
• Nutritional recommendations for reducing inflammation, healing and improving bone density are summarized nicely in these two articles on healing and bone health and healthy dietary tips on reducing inflammation.
• Improve your running stride and cadence. New evidence on shortening your stride and optimizing the rate your feet strike the ground each minute can reduce injury risk and improve gait efficiency. Getting an appointment with a PT trained in running assessment is one helpful route or measuring and progressing your cadence to 170-180 steps per minute has been deemed optimal. The benefits of shortening your running stride length and increasing the frequency are summarized nicely in this systematic review article.
• Orthotics and supportive insoles may be helpful for some foot types or people suffering from shin splints. People with particularly flattened arches or recurring MTSS issues, may find either off the shelf or custom fit corrective orthotics beneficial for reducing stresses on the lower leg. Supportive insoles may also improve alignment and stability of the legs and feet, thus improving the strain potentials of the musculature affecting shin splints.

References
Bhusari, N., & Deshmukh, M. (2023, January 18). Shin splint: a review. Cureus, 15(1). 10.7759/cureus.33905

Budde, K. B. (2018). Physical therapy guide to shin splints (medial tibial stress syndrome). Choose PT. https://www.choosept.com/guide/physical-therapy-guide-shin-splints-medial-tibial-stress-syndrome-

MacLean, K. (2023, November 16). 9 healthy eating tips that can help reduce inflammation. UC Davis Health. https://health.ucdavis.edu/blog/good-food/9-healthy-eating-tips-that-can-help-reduce-inflammation/2023/11

McCrann, P. (2018, September 1). Choosing the correct running cadence. Endurance Nation. https://www.endurancenation.us/run/choosing-the-correct-running-cadence/

McNamara, W., Longworth, T., Sunwoo, J. Y., Rizvi, S. M., Knee, C. J., & Cole, B. F. (2023). Treatment of medial tibial stress syndrome using an investigational lower leg brace. A pilot for a randomised controlled trial. BMJ. 10.1136/bmjinnov-2022-001054

Schubert, A. G., Kempf, J., & Heiderscheit, B. C. (2014). Influence of stride frequency and length on running mechanics: a systematic review. Sports Heatlh, 6(3), 210-217. 10.1177/1941738113508544

Shin splints | medial tibial stress syndrome (exercises, rehab, strengthening). (2021, October 3). YouTube. https://www.youtube.com/watch?v=_OyNx5VMzzc

Shin splints: symptoms, causes & treatments. (2023, June 14). Cleveland Clinic.
https://my.clevelandclinic.org/health/diseases/17467-shin-splints

Vasudevan, J. (n.d.). Shin Splints: Causes, Symptoms, Treatment and Prevention. Runner's World. Retrieved June 24, 2024, from https://www.runnersworld.com/health-injuries/a19595626/shin-splints/

Winters, M., Eskes, M., Weir, A., Moen, M. H., Backx, F. J., & Bakker, E. W. (2013). Treatment of medial tibial stress syndrome: a systematic review. sports medicine, 43(12), 1315-1333. 10.1007/s40279-013-0087-0