What Is It?
Medial Tibial Stress Syndrome (MTSS) is a common injury, referred to in common vernacular as “shin splints”. This condition is characterized by pain in the front of the lower leg, which can run from below the kneecap all the way down to the ankle. It accounts for 10-15% of all running injures, and up to 60% of the conditions that cause pain in the lower leg. The lower leg is the initial shock absorber during impact exercise – if this shock-absorption system begins to fail, you may experience a sore, tingling sensation that can be mild to debilitating. Typically, one leg is involved and it is almost always the runner's dominant one. If you are right-handed, you are usually right-footed as well, and that's the leg that's going to hurt.
Treating Shin Splints
When shin splints strike you should stop running completely or decrease your training depending on the extent and duration of pain. Then, as a first step, ice your shin to reduce inflammation. If pain is severe, a medical specialist should be consulted first to rule out a stress fracture, or an exercise-induced compartment syndrome. Both of these are very serious injuries that require immediate medical attention. Generally speaking, the more severe the pain, the greater the chance that it is something more serious. For that reason, the crucial first step in treating shin splints is identifying the root cause of the problem. There are many possibilities including sudden changes to your training, poor ankle flexibility, poor muscle tone in front lower leg muscles, training mistakes, and structural problems like overpronation or flat feet. But don’t fret – there are many possible strategies for preventing or overcoming shin splints.
1. Increase distance slowly! This is a concept in exercise physiology called gradual progression. Four words can usually be applied to the reason an individual develops shin splints: too much, too soon. Even though sunlight is streaming down through the trees and the air is heavy with the sweet smell of spring, do not throw caution to the wind and add an hour and a half onto your run that day! In all likelihood, your lower leg muscles will rebel, which might lead to dreaded time off. There is no magic rule for adding time onto a run – many avid trail runners find trails more forgiving on their bodies than the road, and may add 30 minutes onto each long run. It pays to be more prudent with road running, increasing long road runs by no more than fifteen minutes at a time. In general, the longer you have been running, the more accustomed your body will be to the sport and any progressions you incorporate.
2. Stretch your calves. If your calf muscles are flexible your ankle will have more mobility, which makes for a more efficient shock absorption system. Make sure to stretch both your gastrocnemious and your soleus, by letting your heel drop off a step (sticking your butt will give you a better stretch). Start with a straight leg, then bend your knee to feel a deeper stretch closer to your Achilles tendon. The added bonus of stretching your calves off a step is that you stretch the plantar fascia on the bottom of the foot as well. This will reduce the risk of developing achilles tendonosis - another common, yet extremely painful, running injury.
3. Strengthen the front of the lower leg. This is very simple – just lean back again a wall and lift your toes up toward the ceiling, then lower slowly. This can be done with or without weights – lighter individuals may want to hold dumbbells to add some resistance. Build up to 20 reps. The speed of the reps can be varied to train for both strength and endurance. (Executing quick reps with heavy weights is not recommended.) Only train for endurance once all pain has disappeared and a base of strength has been developed.
4. Take care when changing your training environment. If you hit the trails during the warm weather and switch to road running for the winter, make the transition a gradual one. Exchange one trail run with flat road for several weeks, then two runs, and so forth. Once you are road running exclusively, once again use gradual progression to build up your time. The same rule applies if spring has sprung and the forest once again beckons.
5. Evaluate your running technique. Working with a personal trainer or a running clinic coach will give you information on how you might improve your running technique. I have found watching elite runners on UTube to be a very effective strategy for evaluating and alterning my own running gait. I have particularly found the Ethiopian runners, especially Tirunesh Dibaba, exceeding beautiful to watch - and even though I look nothing like her when I run, I have been able to transpose aspects of her technique to my own.
6. Don’t disregard possible structural issues. People with flat feet or fallen arches are especially prone to shin splints. If this sounds like you, taking great care to choose the right shoes, as well as considering custom made orthodics, can correct issues that cannot be addressed by exercise programming alone. Some research suggests that store-bought orthodics can work just as well as custom-make ones, at a fraction of the cost. Visit a specialized running store where the staff can observe your running gait and recommend appropriate footware to meet your needs.