Shin splints is one of those injuries that feels minor until it isn’t. It starts as a dull ache along the inside or outside of the shin during or after a run. Then it starts showing up earlier in the run. Then it starts showing up on walks. The good news is that shin splints are very fixable, and in most cases, you don’t have to stop running to fix them.
What’s actually happening
The pain is coming from the tibialis anterior on the outside or the tibialis posterior on the inside. In both cases the underlying cause is the same: you’ve placed more load on the tissue than it can currently handle. For most runners with shin splints, the trigger is a training error: too much mileage too quickly, switching to minimalist shoes, running on harder surfaces, and/or returning from a break.
These things can often cause it to start, what is tricky about Shin Splints is that even though switching shoes may have contributed to it starting, switching back to the old shoes won’t make it go away. Once the tissue has been overloaded, there is a specific process you have to go through to increase the tissue’s load tolerance. And resting does the exact opposite (lowers the tissue’s load tolerance).
Why complete rest is usually the wrong answer
Rest reduces load and the pain goes away. But it doesn’t raise the tissue’s capacity. When you return to running, you hit the same ceiling though often, the ceiling is lower even than it was. In the same way that not using a muscle causes the muscle to lose it’s strength, removing load from tissue often reduces the tissue’s load tolerance. The better approach is to find the load level at which the shins are comfortable, train at that level, and gradually increase. You maintain fitness while the tissue adapts.
Foot mechanics and the pronation connection
For medial shin pain, foot mechanics almost always play a role. Excessive pronation loads the tibialis posterior more than it can handle. Footwear matters: a shoe with a narrow toe box prevents the toes from spreading and stabilizing the foot, increasing compensatory demand on the tibialis posterior. This isn’t the complete solution, but it is a necessary component to be aware of.
The strengthening program
Foot intrinsic strengthening through short foot exercises. Tibialis anterior loading through resisted ankle dorsiflexion. Single leg stability work that trains the foot to control pronation under load. The progression matters: start with low load work and progress to more dynamic movements as tolerance improves. However, don’t add strength to dysfunction. You don’t want to try and strengthen muscles that aren’t turning on. When this happens, the wrong muscles jump in to help and cause compensations and this often worsens the problem.
At Land and Sea PT in Oceanside, we work with runners through this process 1-on-1. If shin pain has been interrupting your training, come in and let us figure out what’s driving it.
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Dr. Jonny Blue is a Doctor of Physical Therapy and founder of Land and Sea Physical Therapy in Oceanside, CA. He specializes in orthopedic PT, root cause methodology, and helping active adults in North County San Diego get back to the activities they love without surgery or pain medication.