Pain in the shin bone (tibia) region makes up 12-18% of all running injuries. So how do you know if you are running with shin splints — and if you do, what’s next? Certainly a common question we hear about this type of injury is “can I run with shin splints?“. Spoiler: running through shin splints usually doesn’t end well.
Technically shin splints is not a diagnosis but rather an umbrella term that includes a variety of problems that can strike the shin bone.
Podcast: Can You Run With Shin Splints?
Here’s what happens as you develop shin splints. First, the shin bone will progress from being normally loaded, to slightly overloaded, to very overloaded, to eventually fracturing. During the ‘overloading’ stages the bone becomes painful as the outside of the bone develops tiny microscopic fracture lines.
The very end of the spectrum, if you continue running with shin splints, is a tibial stress fracture. At this point, because the bone was repeatedly overloaded beyond its tolerance it fractures. A common culprit? The continued stress and loading that comes with with running.
Symptoms of Shin Splints
Pain on the inside border of the bottom one-third of the shin bone.
Initially, the shin will be sore to touch after running. If you continue to stress the bone, running with shin splints, the pain will start to appear at the start of your runs.
Eventually, if you don’t take care of it, the shin bone will be sore before, during and after running. When a stress fracture occurs, the runner will have difficulty hopping on a single leg because the pain will be too great.
How to Recover From Shin Splints
There are three key principles in recovery from shin splints:
- De-loading of the bone
- Addressing why the injury happened in the first place
- Returning to running with appropriate intensity
De-loading the bone
Because the shin bone is overloaded, the runner needs to quickly get off their legs. From personal and professional experience, this is difficult to do for the obsessive runner. We’d rather continue to run and will the shin bone to not be sore next time. But staying on your legs will only worsen the stress reaction and bring you closer to an eventual stress fracture.
In order to avoid the advancement of the condition, I recommend a minimum of two weeks off running, rather than running through shin splints. I inform the injured runner that they can cross-train (ride, swim, elliptical, aterG anti-gravity treadmill) during this time, but they cannot go for even a small ‘tester’ run, as even a small amount of running with shin splints can irritate their condition and set the recovery back.
After the initial two weeks of de-loading the shin bone, we will do a hop test and examine the shin bone for tenderness.
Typically the runner requires a second two weeks off, and in many cases up to a third two weeks off (total of six weeks off running). The hop test and examination are repeated at the end of four weeks, and then again if needed at the end of the six weeks.
Addressing why the injury happened
Runners who address the cause of shin splints have a much greater likelihood of making a smoother and more prompt return to injury-free running and normal training loads.
Typically, those that don’t address the underlying causative factors will return to running and suffer a recurrence of their shin pain.
The typical risk factors that contribute to the onset of shin pain are: training errors (a sudden spike in training load intensity, volume, or both; or failure to schedule appropriate rest between sessions), an over-striding gait (where the foot lands out in front of the runner’s body), a deficit in hip strength (collapsing at the hips), and inappropriate or worn out shoes.
For more detailed information on addressing these factors, I of course recommend picking up a copy of my book: You CAN Run Pain Free.
Returning to running with an appropriate intensity
If the injured runner has had the appropriate rest, then they are ready to make a progressive return to running.
It’s best for the runner to follow a prescribed return to run program. I give the runner a schedule every week and then fortnightly for the first four weeks of running — sometimes longer.
The time frames for my return to run programs are on a case-by-case basis, depending on the athlete’s goals, injury history, running volume and body condition. On a return-to-running program, it is critical that the runner perform self-checks on his or her shin for any tenderness to touch (just push the area), and occasionally do the hop test.
What about running through shin splints?
If pain returns, remember that running through shin splints is a bad idea. I will advise the runner to rest their shins from running for one week before retesting the hop test and the touch test. Listen to your body. Don’t do too much too soon, and don’t push through the pain.
All the best with your recovery from the pain of shin splints and your return to injury-free running!