Management of Shin Splints

Understanding Shin Splints and Evidence-Based Management

• The American College of Sports Medicine suggests that tibial bone stress injuries are among the most common overuse injuries in runners, with an annual incidence as high as 21.1% in track and field athletes 4
• The American College of Sports Medicine also notes that bone stress injuries have one of the highest recurrence rates of all running-related injuries, with prior bone stress injury increasing recurrence sixfold in females and sevenfold in males 4

Biomechanical Factors and Rehabilitation

• The American College of Sports Medicine recommends running gait analysis and retraining as they address the root causes of shin splints 1, 5, 3
• Reducing stride length or increasing cadence is recommended by the American College of Sports Medicine to reduce tibial stress 5, 3
• Addressing excessive hip adduction during running gait is a predictor of tibial bone stress injuries in female runners, according to the American College of Sports Medicine 5, 6

Evidence on Taping for Shin Splints

• The American College of Sports Medicine states that there is insufficient evidence to recommend taping over more evidence-based approaches addressing the underlying biomechanical issues 1, 5, 3

Recommended Approach to Shin Splints Management

1. Strength Training and Biomechanical Correction

• The American College of Sports Medicine suggests addressing reduced lower extremity muscle size and strength, which are associated with higher risk of bone stress injuries 5, 3
• Implementing resistance training has shown positive effects on increasing bone strength, particularly in female runners, according to the American College of Sports Medicine 5, 3
• Focusing on core and proximal strength to optimize lower extremity biomechanics is recommended by the American College of Sports Medicine 5, 6

2. Running Surface Considerations

• The American College of Sports Medicine notes that evidence regarding running surface is conflicting and unclear 1, 2, 7
• While some studies recommend starting on a treadmill due to reduced peak tibial acceleration, others show no clear benefit of softer surfaces, according to the American College of Sports Medicine 2, 7, 3

3. Training Progression

• The American College of Sports Medicine recommends individualizing the rate of progression based on risk and grade of the tibial bone stress injury 7, 8
• High-risk tibial bone stress injuries require slower progression and delayed integration of speedwork, according to the American College of Sports Medicine 2, 7
• In the initial stages post-injury, avoiding hills is recommended by the American College of Sports Medicine 2, 7

Common Pitfalls to Avoid

• Relying solely on external supports, such as taping or bracing, without addressing underlying biomechanical issues will likely lead to recurrence, according to the American College of Sports Medicine 1, 5, 3
• Ignoring sex-specific considerations, such as females benefiting from a slower progression due to higher tibial bone stresses across running speeds, is not recommended by the American College of Sports Medicine 7, 8
• Returning to running too quickly contributes to the high recurrence rate of tibial bone stress injuries, according to the American College of Sports Medicine 7, 8
• Overlooking plyometric training, which may be beneficial during advanced rehabilitation, is not recommended by the American College of Sports Medicine 5, 6