Author: Daniel Burnett
Posted: 2/4/2022
Shin Splints! [Image]. Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/shin-splints
What Shin Splints Are
Many military members can relate to that creeping pain in the shin that starts as a dull ache, then overtime progresses to a nagging and sometimes halting pain in the lower leg. Shin splints affects many military members. Some studies report shin splints can affect up to 1/3 of military members at any given time. As an Army Ranger veteran, I can relate to the feeling of shin splints, and as a certified strength coach who focuses his business on military prep, I can confirm that there is a mass volume of people who reach out to me on a regular basis wanting to know how to deal with them. I remember my days in training, I dealt with that pesky shin pain as well. The first step towards beating shin splints is to understand them. My goal for this article is to elaborate on what shin splints are, what typically causes them, and tips to help people beat them.
Shin splints are formally referred to as medial tibial stress syndrome and have become a blanket term to refer to shin pain. The truth is that the term can relate to several issues of the lower leg. There are two major bones of the lower leg, the tibia, and the fibula. The tibia is the shin bone and is the main load-bearing bone. When referring to shin splints, the most common causes are stress fractures in the tibia or tendonitis in muscle tendons around the tibia. In rare cases, shin splints can be confused with compartment syndrome which is a more serious condition where the lower leg has internal bleeding and swelling of the tissues depriving the flow of blood and nutrients to muscles and nerves. This condition can be very serious and can require surgery. People should consult with their doctor if they are having intense pain, swelling, weakness, numbness, discoloration of the skin (paleness), and/or sensations of pins and needles in the lower leg.
No matter the root issue there is typically a common denominator: overuse relative to the body’s current conditioning. Shin splints typically occur in people who are newer to physical activity or people who ramp up their physical activity too quickly. Shin splints may also occur from overtraining the body with minimal recovery factors like proper nutrition, hydration, emotional stress management, time off, and/or sleep. Therefore, this condition is fairly common in military personnel. Understandably, the way the military applies training to its candidates is a blanket application. No matter if they show up as an athlete or couch potato, the training criteria is applied the same. Especially when it comes to a military selection, the focus isn’t to build any one up, it is to weed them out. They either show up and swim, or sink.
Many times, gradual training is not a tool used by the military and arguably, it does not have to be. It is up to the individual military member and leaders of members to prepare for the training and selections to be endured. As an Army Ranger veteran, I am no stranger to the overuse dilemma in the military. The Ranger mission revolves around impact type of activities, rucking, running, and a never quit mentality with minimal time for rest and recovery. In Ranger School alone, there were days on days where we would walk from dark to dark with over a hundred pounds on our shoulders while running on minimal sleep and nutrition. It’s all necessary training, but it does lead to the body’s breakdown. Some factors are out of our control, but what we can control is our preparation and rehab factors when available. That’s where these tips come in. The following are tips to prevent and rehab shin splints.
Tip 1: Train to be Stronger, More Flexible, and More Durable
When training is applied correctly, the constructive stress triggers the body to adapt with stronger muscles, bones, and connective tissue. This means that the body can handle more and more impact. However, when training and impact are applied too fast, people run into issues like injury to include stress fractures, tendonitis, or the overall blanket term: shin splints. Therefore, I promote that all military members and prospect military members to train and follow an educated training program. Obviously, shin splints are most common where there’s a lot of foot strike on the ground. If personnel have been preparing and training for a length of time to endure impact, they will have a much lower risk of developing shin splints. Flexibility is also paramount in that it improves range of motion and reduces resting tension in muscles and tendons. This will ensure prevention of shin splints as well as healthier posture, greater recovery rates, and overall greater health.
Note that there are specific exercises and stretches that are used in the prevention and recovery of shin splints that mainly involve stretching and strengthening of the calves (gastrocnemius and soleus), achilles tendon, and shin muscle (tibialis anterior). Again, training introduces constructive physical stress, stress triggers adaptation, adaptation triggers a stronger and more durable athlete. A stronger more durable athlete will mean far less risk of injury and an overall better performance. A more flexible athlete means greater recovery rates and less tension in the muscles and tendons. More flexibility will reduce the risk of overtraining and development of tendonitis.
Tip 2: Check Your Feet
Impact travels from the ground up. The way that feet strike the ground will create a chain reaction of how that force is applied throughout the body from the ground up. Those with foot posture problems can greatly influence the development of shin splints among other postural problems and injury. This is why flat feet is a screening in the military, it is known that those with flat feet (overpronation) have issues with injury and posture problems, to include development of issues like shin splints. People with high arches (excessive supination) can also have issues with shin splints. Personally, I am flat footed myself, so rest assured if someone has this issue, I can relate. When I would run or ruck march in things like blocky standard issue boots, many aches and pains would develop. Later in my military career, I learned of the importance of using things like arch support inserts. For a time, I used prescribed orthotic inserts for my flat feet which greatly decreased pain in my ankles, shins, hips, and back. That said, people with foot arch problems should look at using arch support inserts for their shoes and boots to ensure better foot posture and a better chain of force absorption from the ground up. Alongside inserts, people should also look into good boots within regulations and solid running shoes. I typically like to recommend the brands Asics and Brooks for running shoes, but there are many others that could work. Again, proper footwear and insoles are an important factor in force absorption from the ground up.
Alongside foot strike, military athletes should check their running form. There are multiple methods to running correctly but commonly, people who strike too heavy with their heels when running likely to develop shin splints. We like to refer people to a method of running known as the midfoot strike running form. This form of running is designed to displace the impact in a way that is typically considered the most safe and effective form of running that distributes impact most evenly. Also, when able, they should consider the surfaces they are running on. I am aware that most military personnel don’t get to pick where they are running or rucking in training; however, when running or rucking on their own time, they should consider running of softer surfaces like a track or grass and avoid hard surfaces like concrete.
Tip 3: Reduce Inflammation
Of course, before following any of this information consult with a medical professional doctor and take all directives from them, this is for educational purposes only. While there is debate on the RICE method versus other types of rehabs, I personally believe in its healing abilities. RICE is an acronym that stands for Rest, Ice, Compress, and Elevate. Resting can mean stopping or reducing impact to the injured area. Shin splints are an overtraining injury; therefore, we want to reduce impact and promote recovery. Unless shin splints are severe, athletes do not have to stop activity altogether. They can continue with low impact activities as long as they are pain free. Active recovery can have a lot of benefits in the healing process so switching to cardio like the elliptical, bicycle, or swimming will be good low impact ways to keep heart rates up and active while avoiding impact. The athlete should ice the area of about four times per day with each ice session being about 20 minutes in length. Ice will help reduce inflammation and encourage the healing process. Compress the area with a sleeve, ace wrap, or elastic bandage. When wrapping they want to wrap snugly but not too tight. Again, the name of the game is reducing inflammation. The range of how long the injured area can be compressed can vary, but I wouldn’t recommend compressing the area for more than 48 hours. Elevate the injured area above heart level when resting. This will help decrease blood flow to the injured area and further reduce inflammation. The RICE method may not always be applicable in the military. It is one of those things that can only be applied as able. However, when there is a window to apply it, take it.
Note, while the RICE method and is the best way that I have personally tested to rehab from my own injuries, there are debates on this method. Some say that inflammation is the body’s way of protection and providing blood flow and nutrients to an injured area. However, I would argue that the body tends to overreact in its natural healing responses. In some cases, over inflammation can do more harm than good and cause collateral damage or prolonged injury in the body. Therefore, reducing inflammation will ensure that the body can heal itself without over inflammation, further damage, and/or prolonged recovery. There are also other methods of inflammation reduction that may be considered like anti-inflammatory drugs, i.e. Ibuprofen (Advil, Motrin) or naproxen (Aleve). Also, eating a healthy diet and staying well hydrated promotes positive recovery rates and reduces inflammation in the body, so the coined term by military medics like “take this ibuprofen and drink water” does actually work to a degree. Be sure not to overuse anti-inflammatories because they can have their own negative side effects in excess.
Tip 4: Recovery Recognition and Length
Knowing when it is safe to increase impact is important. When pain and soreness are gone, the athlete can start increasing impact again but would want to be smart with it. It goes back to why the injury happened in the first place, this time we want to introduce impact gradually and keep it constructive while keeping a mix of low impact cardio until the military athlete feels ready to ramp it up. People will know when their shin splints have healed when flexibility and strength seem equal among both legs. Typically, there’s one leg that tends to be more injured than the other so feeling a near equal feel on both sides is a good sign. They should also be able to push on the areas that used to be painful with no pain. Then there is the obvious: They can run, jump, jog, and sprint with no pain. There isn’t a set length on how long it takes shin splints to heal. It really depends on what caused the injury, the severity of the injury, the individual’s bodily rate of healing, and the practices being implemented to promote healing. It is not uncommon for people to report three to six months to fully heal.
Summary and Additional Thoughts
You need to let the existing injury fully recover. Give your body adequate time to heal from the stress fracture before starting any strengthening exercises. This usually involves several weeks of rest and avoiding activities that put stress on the affected area. Mobility exercises are good to address existing stiffness like alphabet ankle exercises, calf stretches, and toe-tapping exercises are good options. Calf strengthening can help support the shin. Perform calf raises, both with straight legs and with bent knees, to strengthen the calf muscles. Start with bodyweight and gradually add resistance as you progress. Also, big one is strengthen the shin muscle (the tibialis anterior). The tibialis anterior muscle runs along the front of the shin and plays a crucial role in shin stability. To strengthen it, try dorsiflexion exercises, such as resistance band pulls, toe lifts, and ankle dorsiflexion exercises. If you can get your hands on some resistance bands, use them to add resistance to your dorsiflexion exercises. Sit on the floor with your legs extended and a resistance band wrapped around your feet, then pull your toes toward you against the resistance. Also, just work on ankle stability. Like balancing on one foot or performing exercises with a balance board or wobble board. These exercises can help strengthen the muscles that support the shin.
Conclusion
Shin splints are an overuse injury. The military is prone to application of high impact and blanket training concepts that promote overtraining and discourage recovery. Therefore, the military athlete should be well trained and prepared for impact prior to any military training, selection, or school. Smart, consistent, and gradual implementation of training to the point of great impact absorption efficiency is key! Having a stronger, healthier, flexible, and durable body will be able to handle great impact and physical stress, reducing injury and promoting better overall performance. Train, stretch, stay well hydrated, and eat a clean diet. Specifically strengthen areas in the ankle and lower leg with target muscles like the calves and shin muscle. If shin splints have developed, methods to reduce inflammation like the RICE method among others can be used. When pain has subsided and recovery has been attained, the athlete gradually returns to activity and prepare again to be a better and more durable military athlete. Military athletes should not be halted by shin pain, with this article I would encourage all military members to train, prepare, and recover. Turn that creeping pain into barreling success.
Watch Our Video on Shin Splints: https://youtu.be/e0tGUcHwte0
