A deep dive on shin splints
Track, club volleyball, AAU basketball… ’tis the season for shin splints!
Today, I want to talk more about that annoying pain on the inside of the shin that gets worse with running and jumping, really sucks the day after running and jumping, then feels better with rest.
What’s going on in there?
The fancy research folk refer to shin splints as “medial tibial stress syndrome.”
In medicine, giving something the title of “syndrome” essentially means “we don’t really know what’s going on here.”
Isn’t that wild? Shin splints are about as common as seeing a teenage girl with a Starbucks drink, yet we still don’t know exactly what’s going on in there.
There are two prevailing theories.
1) Bone damage
One theory is that there is microdamage to the bone itself.
When you sprint and jump, your calf muscles contract violently. Those calf muscles produce a moment that bends the shinbone (tibia) backwards.
It doesn’t actually bend it. The muscle contraction provides stress in that direction. It’s like if you tried to break a really thick tree branch. You probably won’t be able to bend the branch, but you might put some cracks in the bark.
Similarly, those violent muscle contractions provide a bending stress that could cause microdamage to the bone surface.
2) Fascial/tendon damage
Another theory is that the bone itself is not the issue, but instead the place where the muscle inserts into the bone is the problem.
Overusing the calf (and other lower leg) muscles can lead to the tendon and facial connections to get damaged and irritated.
In reality, both issues are probably in play to some degree.
“Okay, but what can we do about it?”
Regardless of the anatomical problem, the root cause is the same. Your athlete has a mismatch between the amount of work their shins are doing and the amount of work their shins are capable of handling.
We call these load management issues. Load management issues lead to overuse injuries.
With an ankle sprain, you might just take one weird step and then you’re hurt. Shin splints aren’t like that. This injury builds up overtime.
As a load management issue, shin splints have two sides of the equation that we can manipulate in our favor: 1)the amount of work the shins do and 2) how much work the shins are capable of handling.
Manipulating workload
The initial phase is all about giving the shins the opportunity to calm down. They’ve been beat up. They’re inflamed and irritated.
We have to find a window of opportunity to give them some R and R.
Continuing to push through the pain isn’t going to solve the problem. It’s only going to continue to escalate it.
During this down time, we can use some modalities (like ice, ice scraping, heat, etc.) to help manage the pain. None of those will heal the damaged tissue, but it can provide temporary relief from pain.
From there, we move into the single most important element of this whole process: a gradual ramp in workload.
If your athlete goes from complete shut down to full workload, they’ll be right back where they started.
A rough rule of thumb is to start at 50-60% of the workload that they’re trying to get to, then increase workload by 10% each week.
In reality, their starting workload might be more or less than that. A good evaluation will discover where their current capacity is, then build up from there.
Outside of global workload, we can manipulate the amount of stress that that the shin itself undergoes:
- Jumping and running on soft surfaces is easier on the shins. Get them off of the hardwood and start jumping on some cushiony turf.
- Cushioned insoles can help mimic a soft surface and take some stress off their shins.
- See if there’s something about their running or jumping mechanics that we can alter to take some stress off the shins.
Increasing capacity
To manipulate the other side of the equation, we can increase the capacity of work that the shins can handle.
Muscles can act as buffers and protect the surrounding bones/joints. Aiming to get all of their lower leg muscles (gastrocnemius, soleus, tibialis posterior, tibialis anterior, intrinsic foot muscles, etc.) stronger can increase the workload that they can handle.
If they don’t have enough ankle dorsiflexion range of motion, then they’re not going to be able to absorb force smoothly. Adding more ankle dorsiflexion can help increase the amount of work that their shins can handle.
The most important factor to increase capacity, though, is gradual exposure. As we push the threshold of how much stress their shins can handle, but don’t cross it, their body will adapt and increase it’s capacity to handle that load.
​A quick thought on separating yourself from the pack
The barrier to standing out and getting ahead is exceptionally low. Doing “the basics” well is uncommon. I’m reminded of this every time I go to hire.
- Write with correct spelling, grammar, punctuation, and semi-formal language. (Not “aye how much that pay?”)
- Show up on time.
- Take ownership of your schedule. (Don’t no-show a shift or cancel last minute because you forgot you had another obligation.)
- Be consistent in who you are, even on bad days. (As Seth Godin says, consistency > authenticity.)
Separating yourself from the pack is easier now than ever.
More from me…
- 2024 is geared toward pumping out more educational content on social media. Follow me on Instagram ​@gtperformance_​ to learn all about athlete development.
- If you think this newsletter doesn’t suck (or maybe you even enjoy reading it), I would really appreciate you sharing it with some other parents that might benefit from reading it. You can just send them to ​gtperformance.co​ and they can subscribe there!
- Everything in these newsletters and on our website is for educational purposes only and should not be taken as medical advice for you or you athlete. Consult directly with a healthcare professional.
Thanks so much for your help in spreading the word about athlete development!
Be >,
Zach
Dr. Zach Guiser, PT, DPT, CSCS