Medial Tibial Stress Syndrome (MTSS), commonly known as shin splints, is a frequent overuse injury experienced by athletes, particularly runners. This condition involves pain along the inner edge of the shinbone (tibia). The question of whether to continue running through this pain is serious, as the wrong decision can significantly extend recovery time. Understanding the nature of this injury is the first step in making an informed choice about your training.
Understanding Medial Tibial Stress Syndrome
Shin splints are characterized by exercise-induced pain along the length of the tibia, typically in the lower third of the leg. The condition is a tibial bony overload injury, where micro-trauma occurs when the rate of bone breakdown from repetitive impact exceeds the body’s ability to repair it during rest.
Primary causes often relate to training errors, such as a sudden or rapid increase in running mileage, intensity, or frequency. Changing to a new or harder running surface, like concrete or uneven terrain, can also contribute. Biomechanical factors, such as flat feet, high arches, or muscle imbalances, may lead to poor force absorption during impact. Running in worn-out or unsupportive shoes also places greater strain on the lower leg.
The Immediate Decision: Running Through the Pain
The direct answer to running with shin splints is no, as pushing through the pain carries a significant risk of worsening the injury. Continuing to place repetitive stress on an already inflamed tibia can escalate the condition into a more serious bone stress reaction. If microdamage accumulates without adequate healing time, it can lead to a full tibial stress fracture.
A stress fracture is a small crack in the bone that requires a longer recovery period. While MTSS may resolve with a few weeks of rest, a stress fracture often necessitates eight or more weeks away from running and may require the use of crutches or a walking boot. The pain from MTSS is typically diffuse along the shin, but if the pain becomes localized to a single, pinpoint spot, or if it persists during rest, a medical evaluation is required immediately to rule out a fracture.
Immediate Care and Recovery Protocols
Once the decision to cease running is made, the initial focus must shift to reducing inflammation and promoting the acute healing phase. The standard protocol for immediate care involves the application of Rest, Ice, Compression, and Elevation (R.I.C.E.).
- Rest: Avoid all activities that reproduce shin pain to allow the bone to repair.
- Ice: Apply ice to the painful area for 10 to 20 minutes several times a day to reduce swelling and ease discomfort.
- Compression: Apply an elastic bandage snugly to limit swelling, ensuring it does not cause numbness or tingling.
- Elevation: Elevate the injured leg above the level of the heart to assist in draining excess fluid.
While resting the tibia from high-impact activity, maintaining cardiovascular fitness is possible through non-impact cross-training. Activities like swimming, deep-water running, or cycling allow the body to remain active without the repetitive loading that irritates the shin. Gentle stretching of the calf and Achilles tendon is useful to relieve tension in the muscles that attach to the injured area.
Strategies for Safe Return and Long-Term Prevention
Returning to running must be a gradual process to prevent the recurrence of MTSS. A widely accepted guideline for safely increasing running volume is the “10% rule,” which advises against increasing weekly mileage by more than 10% from the previous week. This slow progression allows the bones, muscles, and connective tissues to adapt to the increasing load.
Addressing muscular imbalances through specific strengthening exercises is a proactive measure for long-term prevention. Exercises such as calf raises help strengthen the posterior lower leg muscles, which can reduce the bending force on the tibia during running. Toe taps, where you lift the toes while keeping the heel planted, specifically target the tibialis anterior muscle, which is crucial for absorbing impact.
Proper footwear is another component of prevention, as running shoes lose their shock-absorbing capacity over time. It is recommended to replace running shoes every 300 to 500 miles, as worn-out materials offer less protection against ground reaction forces. Considering a shorter stride with a slightly higher cadence, aiming for 170 to 180 steps per minute, can also lessen the impact forces on the lower leg. For persistent issues, a professional gait analysis can identify mechanical flaws, such as excessive foot pronation or supination, allowing for targeted correction through custom orthotics or specific training drills.