Let’s Talk About: Shin Pain
Shin pain is often categorized as “shin splints” but doesn’t really tell us much about it. The majority of shin pain will occur on the medial side of the tibia (inside of the shin), usually in the bottom half. This pain can be very sharp and stabbing and is often associated with tenderness. This collection of symptoms is typically called medial tibial stress syndrome and collectively involves the bone, the tibial nerve, and three muscles and tendons.
The biggest risk with shin pain
Bone pain
First and foremost, if you have shin pain that is in the bone, there is a strong chance that you have a stress fracture or a stress reaction (inflammation of the bone that is the precursor to a stress fraction). There is no running through or rehabbing these injuries. The prescription is pure rest.
Additionally, an MRI is the only way to confirm a stress reaction. An X-ray will not detect early bone stress. A really good sports practitioner will be able to help you decide whether you need an MRI or not and whether it is safe to run through or not. You should not be your own doctor here! I am a doctor, and I go to a doctor in cases like these.
Other possible causes of shin pain
Tendon pain
So let’s say the bone is safe and healthy. Good news! Let’s talk tendons. Tendon and fascia pain/injuries are the most common type of running injury. They are also almost all a result of putting more stress on your body than it can tolerate during training. This is called overtraining. That’s just the facts. It’s not your shoes. It’s not your mechanics. It’s your training. You can’t will your tissues to strengthen and heal faster than it’s capable of.
Tibialis posterior tendon pain
Moving on! The number one culprit of shin pain is the tibialis posterior tendon. This tendon plays a big role in the push-off phase of your running stride. It also manages your arch control, meaning it’s working the whole time your foot is in contact with the ground, and is very susceptible to overuse.
Long toe flexor tendon pain
The second culprit of shin pain is the long toe flexor tendons. These start all the way at your toes and come up behind the calf muscles. These muscles flex your toes (obviously); however, they also often are overused for stability in people who don’t have great foot stability.
This is common in people who train too much in carbon shoes. The high heel-toe drop and carbon plate accelerates the heel-toe movement, and the brain can overcompensate. It does this by over-recruiting the toe flexors to slow things down and gain more stiffness and control in the foot (i.e. trying to gain stability).
Nerve Pain
Your nerves are a lot like your body’s banker. They keep track of your body’s credits and debits: credits being gained by rest and rehab and debits being taken out by pretty much everything that you do. They also keep track of your overdrafts – when you’ve taken out more than you’ve put in, it alerts you to your overdraft in the form of pain.
We see a lot of patients who don’t initially have an injury, but instead show the early warning signs of taking out more than you’re putting in (in terms of rest and recovery). These early warning signs can eventually turn into real problems and injuries. Patients who come in at this point are in a good spot to be listening to their bodies and taking some rest. But often, patients (and many providers) overlook the mobility and status of the nerve itself.
Nerve pain doesn’t actually usually feel like pins and needles or stabbing or burning. It can actually feel like a lot of things, which can make it very hard to diagnose. One good indicator? Asymmetrical tightness. For example, try a typical hamstring stretch on one side, then the other, with your foot flexed towards your knee. Is one side tighter than the other? If your tight side is also the side you have pain on, there’s a good chance that there’s a nerve there that needs some love.
Exercises to Prevent & Treat Shin Pain
Good news, there are a few easy ways to bulletproof your shins! But first:
The Disclaimer: Unless you’re actually seeing us as a patient, we are not your medical provider! All exercises here are meant to be jumping-off points for prehab/rehab – they are by no means an exhaustive list, nor at they an all-encompassing solution. If you believe you have an injury, always make an appointment with a medical provider to have yourself assessed. If you want to see us, click the “Book Appointment” button on the top right!
Toe Holds
Toe holds force you to place stress on the short and long toe flexors alike!
Keep in mind, these shouldn’t be painful!
Place all 10 toes onto a step. Your foot “knuckles” should be off the stair.
Using only your toes, hold your body weight for 10 seconds
Keep even pressure across your big toes → think “press down” not “squeeze and wrap your toes around a stick.”
Work up to 30 reps of 10-second holds over 2-4 weeks.
Progress to single-leg toe holds for 3-4 weeks.
Up-and-outs
Up-and-outs target the tibialis posterior muscle. It’s similar to a standard calf raise, with a twist - as you raise and lower, you’ll change your foot position to target this muscle more specifically.
Find a stair, ledge, or book.
Place your foot on the stair with your heel off the step.
Begin to raise your heel with even pressure across the ball of your foot. The most pressure should start behind the big toe.
As you raise your heel, roll your foot out so that the force of pressing ends up being placed mostly towards the 4th and 5th toes (the soles of your feet will begin to face each other).
Hold at the top and then slowly lower your foot over a four-count. As you lower, transition back to the medial foot towards the big toe and over-accentuate this force so that only the ball of the foot right behind the big toe is touching the stair.
Hold at the bottom and repeat.
Work up to 3 sets of 10 a day, and then increase to twice a day.
Progress to perform up-and-outs using only one leg.
Nerve Flossing
How do we treat nerves? We wiggle them! Nerves hate being left in a static stretched position; it strangles the blood flow to the area. So we use something called “nerve flossing” to wiggle those nerves back and forth to keep them happy.
Lay flat on your back. Loop a band (or rope or belt) around the sole of one foot.
Flex your foot toward your knee from the ankle. Rotate your ankle out so that your pinky is the closest to your knee.
Keeping your knee straight and maintaining this ankle position, raise your leg up until you feel a gentle stretch. (Most people feel the stretch in the calf or hamstring but a stretch anywhere is fine).
Once you find a stretch, pause. Hold your leg in the air using the tension of the band, rather than your hip flexor.
Point your toe like a ballerina. (Note that the stretching sensation is gone). Hold for 1 second
Re-flex your foot. Think about drawing your toes towards your shin, rotating so that your pinky toe feels like its being pulled towards your knee. You feel that stretching sensation re-engage. Hold for 1 second.
Repeat steps 9-10 for 30 reps.
Key Takeaways
Don’t mess with shin pain! Shin pain is highly associated with bone injuries. Don’t mess around here. It can become a very big problem very quickly.
Tendon issues need load and lots of it. These exercises are a starting point, not the solution. Find a healthcare provider who will help you progress.
No pain, period. Remember not to work through pain.