Tibial Stress Syndrome For Runners | Stages, Treatment, Prevention

Updated: May 29



Whether you're new to running, have less than the ideal form, made a recent jump in overall mileage, or run in worn out or inappropriately sized footwear, chances are you have dealt with shin splints or tibial stress syndrome.


Understanding The Anatomy of Your Lower Leg


The two bones in the lower leg are the tibia and the fibula. These two bones are interconnected by a dense, fibrous connective tissue making a joint called a syndesmosis. This joint allows little movement to create a sturdy structure to support the lower leg muscles


Image by Medlineplus

U.S. National Library of Medicine


Tibia - commonly referred to as the shinbone and is the prominent weight-bearing bone of the lower leg. You can notably feel the front edge of the tibia by running your hand down the front of your lower leg.


Fibula - resting lateral to the tibia, is much smaller in size and bears minimal weight compared to the tibia.



The primary muscles involved in shin splints are the anterior tibialis and the posterior tibialis.

Anterior Tibialis - located along the lateral side of the tibia and inserts on top of the foot, the primary actions are to dorsiflex and invert the foot.


Posterior Tibialis - located along the medial side of the tibia and runs along the foot's arch to insert on the bottom of the foot with the primary actions are to plantarflex and invert the foot.


What are shin splints?


As you run, your lower leg absorbs a tremendous amount of shock as your foot strikes the ground. This repetitive movement, especially with unconditioned runners, causes the painful breakdown and damage to the muscle, tendons, and lower leg bones, leading to shin splints. Initially, runners may only notice pain when propelling forward with each step as they push off the ball of their foot. However, the injury can progress to constant ache or sharp pain at all levels and intensities of running.


How to treat?

For this article, we're going to grade shin splints into three stages.

Stage 1

  • Minimal discomfort to the touch of the lower leg

  • Running gait patterns is unchanged

  • No pain present at rest

  • Pain decreases during the run as you warm-up

The priority should be to back off training volume and intensity. Instead, substitute some of your running training with cross-training such as cycling or swimming. By cutting back on running, you decrease the repeated shock on the lower leg and allow time for the inflammation to subside and begin to begin. Self-care should include light rolling and stretching of the lower leg muscles. Professional treatment from a chiropractor, physical therapist, or athletic trainer may also be helpful to assist with treatment and aid in a gradual return to activity. With proper care, most runners can return to full training within 1-2 weeks. As the runner returns to full training, it is essential to incorporate specific exercises and pre-rehab into their daily workout to prevent the recurrence of shin splints.


Stage 2

  • Minor pain at rest possible

  • Minimal to moderate pain when running

  • Pain may subside after warm-up

  • Some changes notable to gait patterns when running, especially during initial warm-up

  • Tenderness to the touch of the lower leg

It's vital at this point to cut back running training and to seek treatment. If runners continue to stress the lower legs through running, shin splints can advance to stress fractures in the tibia. Again self-care should start with light rolling and stretching of the lower leg muscles. Runners can also opt for icing or topical ointments to temporarily relieve discomfort. Ice may be applied up to 3 times per day for 10-15 minutes. Professional medical diagnosis and treatment are vital at this stage to prevent the progression to a stress fracture. Once cleared, runners may gradually return to full training with assistance from their medical professional and coach.


Stage 3

  • Sharp/ shooting pain with each step

  • Running isn't possible without considerable pain

  • Pain is present at rest

Running is now non-negotiable due to the risk of fracture development. Seek medical diagnosis and treatment.

How to help prevent shin splints from occurring?

Biomechanically everyone is different, and there is no quick fix to prevent shin splints from occurring. However, here are some tips to decrease your risk of developing shin splints.

• Gradually increase weekly mileage by no more than 10%

By gradually increasing mileage, you allow time for the bones, muscles, and ligaments of your lower leg to make adaptations to the workload. Be mindful of your nutrition and hydration efforts to support maximum performance and aid in recovery.

• Get assessed for proper footwear

Whether you heel strike, overpronation, or stride like a gazelle, there's a shoe on the market for you. Start by visiting your local specialty running shoe store to explore options that support your mechanics and anatomy in the most effective way possible. And remember that just like the tires on your car, your shoes have a lifespan. If you start to notice usually aches or pains in your ankles, knees, or back or the tread is wearing, it may be time to shop for that next pair.

• Increase strength and mobility in your lower leg and ankle. Increase strength to hips and core.

Building strength and endurance through your lower leg muscles may help your ability to absorb shock when running. Additionally, strengthening through the hips and core may reduce the risk of injury as well. In contrast, the mobility improvements to your ankle can help maintain good mechanics throughout your run, even on different surfaces.


Complete a routine like the one below to help build stability and strength. The goal is for good form and control, not speed. Begin by completing sets of 10 repetitions or 20 seconds, progress to 20 repetitions or 45 seconds.


In Order:

  • Single leg stand with progression to standing on an uneven surface. Stability

  • Heel raises with ball between heels. Posterior Tibialis

  • Resistance band dorsiflexion

  • Resistance band inversion