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Shin Splints: learn the signs, symptoms, and treatments for this common athlete injury.

Professionals in athletics sure love to debate definitions of words. And when it comes to "shin splints" its no different. Debated for nearly 40 years, the general definition of shin splints is roughly "any pain and discomfort in the leg/shin due to excessive and repetitive flexion of the foot."

Outside of being a very wordy, nondescript answer, "shin splints" have been long debated due to the fact primary causes vary between individual. As does the perceived pain.

Being as the definition clearly states "pain and discomfort" as conditional signs, there's no wonder why there's so much confusion on what it is, how to prevent it, and what to do if (and when) it happens to us. So to better understand what's going on let's start with something a bit more familiar.

crashing waves symbolizing the damage accumulated by repetitive trauma

Take a moment to image ocean waves on a beautiful beach. On a calm day the waves might look peaceful, gently crashing over the bank only to eventually wash softly against the sandy beach.

As this happens you may notice small shells, sand, and other ocean debris washing up on shore. For every deposit of something new, the ocean washes away something old - as is the circle of life. We replace what is old with what is new.

In this respect, the body is identical. And when we take care of it, allowing for adequate recovery time, the repetitive trauma from exercise is evenly matched by our rate of recovery. This natural processes of flushing out the old to replace it with younger, healthier tissues is part of healthy aging.

But not all days on the beach are so nice. To anyone who has spent time on, or near, a beach we know weather can change in a heartbeat. With that in mind, take a moment to imagine a storm setting in on the same beach as before.

The sky begins to darken, blotting out the sun. The wind picks up causing the waves to grow bigger and more violent with each consecutive tide. Every wave comes faster, bigger, and taller than before. Every wave crashing against the bank, washing more from the beach into the ocean.

After the storm, is there more or less debris washed on shore than before? Now, imagine if this were to last for weeks, maybe even months. What do you think would happen to the beach over time? To The sand? To the shore? Would it looks the same? Probably not.

When we abuse our bodies by pushing ourselves to the limit we inevitably build-in injury. This is why when injuries occur like this we call them "overuse injuries" because it was from doing too much that we created a build-up of trauma.

What causes shin splints?

The long and short of it all is repetitive trauma (of any kind) breaks down the body. Whether it be mental trauma or physical trauma, trauma is all the same. Repetitive trauma, in the case of shin splints, is primarily caused by running.

When this is combined with reduced recovery time the body's ability to heal is diminsihed. No longer are we able to remove damaged cells and replace them with new healthy cells, and we enter a state of inflammation.

What are the signs and symptoms of shin splints?

anatomical diagram of lower shin and ankle

Swelling, a type of inflammation, is a common sign and symptom of shin splints. Unlike bone aches (which can last for hours or days) and tendon/ligaments inflammation (which typically occurs around a joint) shin splints occur during activity and typically while running.

Other signs and symptoms include:

- aching pain down front of leg

- shins tender to touch

- pain worsens during exercises

- pain decreases with rest

Consider the following list of common activities which can lead to a shin splint injury:

1. over-pronation of foot / weak foot muscles

2. too much distance too soon

3. excessive weekly running distances

4. pre-injury (typically related to ankles, knees & hips)

Other factors which may increase the risk of sustaining a shin splint injury:

- inadequate or heavily worn shoes

- increased pronation of the foot (outward ankle/foot rotation)

- plantar muscle strength imbalance (overcompensation)

- heel striking while running/jumping (attention power-lifters)

- external femur rotation during hip extension

Other less-common but potential diagnoses for shin pain:

1. Stress fractures: Usually experienced as worsening pain during exercise which lingers when not exercising.

2. Vascular disease: Primarily assessed in older runners, this is related to a reduction in blood flow to the lower limbs and increased compartment pressure within the shin.

3. Spinal stenosis: Highly uncommon but could include a tumor, disc herniation, arthritis, or vertebral infections.

4. Deep Vein Thrombosis: Very unlikely to be experienced as shin splints, but can produce symptoms of leg swelling which can, and has been, misdiagnosed as shin splints.

How to treat a shin splint injury:

#RICE - Rest, Ice, Compress, Elevate

#POLICE - Protect, Optimally Load, Ice, Compress, Elevate

Both the RICE and POLICE methods are common ways of treating overuse and non-traumatic sports injuries. Both methods involve resting, icing, compressing, and elevating the injured area. We prefer the POLICE method as it adds an additional step - Optimally Load.

Optimal loading mean we use the injured area as much as possible without causing addition strain, pain, or injury. When working with performance athletes this often involves a trainer or partner to be able to externally identify what is too much as these types of athletes are notorious for pushing boundaries of pain tolerance.

Typically this portion takes 7-14 days before the body is ready to get back to regular training of these muscles. When that happens it is important to start small and build bigger as not to exacerbate the injury and repeat the process. The next section will go into detail on how to do this.

How to rehab a shin splint injury:

The key correlation we need to make about shin splints is that they are an overuse injury. Similar to any other overuse injury, the key to rehabilitation is to NOT DO the activity that led to the injury to begin with. Easier said than done, I know.

The following is a general 4-week rehabilitation protocol we've used to recover from shin splint injuries. Feel free to bookmark, screenshot, or copy down this information for future use. If you would like a downloadable PDF leave a comment at the bottom of this article.

Week 1 / reduce inflammation

Apply the RICE method of recovery everyday. For the first 3-4 days immediately following the onset of the injury focus on decreasing inflammation. NSAIDS (non-steroidal anti-inflammatory drugs) like Ibuprofen are fine to take during this time. Avoid drugs like Tylenol that mask the pain.

Week 2 / regain mobility

Week 3 / introduce recovery exercises

Week 4 / reintroduce normal exercise

Back to the basics.

When initiating exercise post-rehab it's important we remember there is a higher likelihood of sustaining this type of injury, and that if we're don't take care, it could happen again.

This doesn't mean we baby ourselves or limit the exercises we do. It means we act smart and build the necessary strength so things like this are less likely to happen ever again.

The best way to start training is to take the previous load/intensity before injury, and divide it by 4. We then spread out the rebuilding into 4 weeks, increasing frequency and duraiton each week.

For example, let's say we were previously running a total of 4 miles, 4 times per week. Post-rehab we would start with runs for the distance of 1 mile, 1 time per week. Each subsequent week we can increase our millage, duration, and frequency by 25%.

Continuing our example for week 2, we would complete a 2 mile run for a total of 2 runs in the week. Week 3 would be 3 mile runs for a total of 3 week. At this point it clear where we're going with it and how close we are to pre-injury performance.

The most important thing in week 3 is not to push too hard. That means don't try to make week 3 a PR week. Don't try to surpass any goals we had before injury. Keep with where we're at, and maybe take a little longer.

At this point the hardest part is over and were on the home stretch. Take it easy and allow for constant progress over time.

At this point you should feel pretty knowledgeable about what's going on inside our bodies. If you enjoyed this article and learned something new, please leave a positive review and a comment with what you found most helpful.

This article is dedicated to Myriam. Good luck and speedy recovery. We got your back when it comes to health and wellness, just let us how more we can help.


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