If you are an athlete involved in strenuous sports such as tennis or football, you might have experienced a sharp pain in your lower leg around the shin area. This lower leg injury is commonly diagnosed as shin splints. Improperly treated shin splints, medically known as Medial Tibial Stress Syndrome (MTSS), can escalate into a serious injury, significantly affecting an athlete’s performance. Therefore, it is essential that you educate yourself on the preventative measures and treatments for shin splints.

What causes shin splints?

Shin Splints are essentially overuse injuries caused by a multitude of reasons. We can divide these causes into two categories: 

1. Internal factors: Pertaining to movement dysfunctions and anatomical factors such as hyperpronated feet or poor core stability

2. External factors: Including external variables such as improper footwear or unstable training surface

Are you at-risk of developing shin splints?

There is scientific evidence suggesting that the following population is at a higher risk of developing shin splints:

• Runners & dancers

• Trainees who suddenly increase the training intensity or drastically change the training program

• Trainees who do not warm up properly

• Trainees with hyperpronated or flat feet

• Individuals with higher body mass index, vitamin D deficiency, or osteoporosis

• Some studies also show that female athletes are more prone to shin splints

A common characteristic of this injury is recurrent pain which increases with more stress (running, jumping, etc.) and decreases with rest. 

How to prevent shin splints?

If you find yourself on the list of vulnerable populations above, consider implementing the following preventative measures:

• Warm-Up & Cooldown Routine

Incorporating proper warm-up and cooldown routine into your workout is critical to preventing injuries. Physiotherapist Daryl Stubbs observes that patients with Shin Splints often exhibit hyperactive muscles and concurrently, underactive ones. Following Daryl Stubbs’ recommendation, I urge you to integrate dynamic stretches or activation exercises for underactive muscles in your warm-up routine, and include static stretches and foam rolling for overactive muscles as part of your post-workout cooldown routine.

Here is a list of overactive and under-active muscles as suggested by Daryl Stubbs. Click to find activation/ static stretches for these muscles.

Under-active Muscles	Overactive Muscles
Medial Calf	Lateral Calf
Anterior Tibialis	Biceps Femoris
Posterior Tibialis	Groin Muscles
Medial Hamstrings	Hip Flexors/ TFL
(Gluteal Complex (Max & Medius)

• Footwear & Training Surface

Strong core and stabilizers will help you prevent dysfunctional movement patterns and other underlying causes for shin splints. Front Rack March, Ball Slams, Dead Bugs, High Plank Pull Through are great dynamic exercises for building core strength and stability. Pro tip: Program these in a fun HIIT circuit. Additionally, Stubbs suggests that proprioceptive training will enhance the function of postural stabilizing muscles in preventing imbalance and instability-related injuries. Standing on one leg or an unstable surface, such as a bosu ball, for up to a minute is an easy way to train your proprioceptors.

But what if you have already injured your shins? Now what?

Stop all training for at least 10 weeks!

Just kidding! In recent times, numerous healthcare professionals, including well-known physical therapist Aaron Horschig, recognizable from Squat University, have shifted their approach away from the ‘RICE’ acronym for recovery. Instead, they advocate in the favor of active recovery. In other words, modify your training to support recovery while maintaining your conditioning.

Here is a plan that you can implement if you have developed a minor shin splint injury:

1. Identify and cease the activity that potentially caused the injury. This could be soccer, running, or any other sport. You must refrain from participating until the shin pain has completely subsided. Since shin splints are an overuse injury, rest from the painful activity is necessary to recover. This can take a few weeks.

2. In this early stage of recovery, you can participate in low-impact cardio alternatives such as swimming, elliptical, and stationary bike to stay conditioned.

3. After a few days, you can experiment with resistance training. Based on my work with clients dealing with a minor shin splint injury, they typically manage weight training, including lower body exercises, without pain. This is perhaps because most weight room exercises involve stable feet placement on the ground. Nonetheless, try different exercises to determine your optimal choices.

4. As mentioned earlier, lack of an optimal warm-up and cool-down routine is one of the potential causes of shin splints. Therefore, your new and modified training program should include these routines. If any stretches trigger shin pain, remove them. Additionally, this is an ideal time to implement other preventative measures, such as investing in better footwear and working on core strength.

5. After a few weeks, once the pain has completely vanished, re-start the previously painful activity/ sport. The intensity and frequency, however, will be significantly less than before to allow time for your body to adapt to the stimulus. As adaptation occurs, you can gradually increase the stimulus and continually assess pain to prevent the overuse injury from returning. 

Here is one way to do so:

Step 1. Re-introduce the activity at 50% intensity, volume, and frequency in the first week after the pain is gone.

Step 2. Increase the volume and frequency by 10% percent each week till it is the same as before injury.

Step 3. Now, increase the intensity of your session by 10% till you reach the pre-injury levels.

Step 4. If you experience pain at any point, cut back to the intensity or volume/ frequency to the level you can do without pain. 

The recovery process might take some time, but you will return stronger than ever. If the pain persists for more than a few weeks even after stopping the painful activity or alternatively, if the pain is excruciating, please see a physiotherapist.

Returning to the weight room after an injury can be daunting. A personal trainer can provide guidance and motivation throughout the recovery journey!