The fall sports season is underway for many collegiate athletes across America, which means training camp is in full gear. Sports coaches everywhere are scrambling to get under-trained athletes in shape as quickly as possible, which means thousands of athletes are running til they puke. And then running some more.
Throw an out-of-shape athlete into two-a-days or three-a-days with high-frequency, high-intensity conditioning on top of sports practices with less-than-adequate nutrition and recovery, and the chances for injury increase dramatically. Even the athletes who come into camp fully prepared after a good strength and conditioning regimen get dragged along for the ride.
So it came as no surprise when several of the field hockey players I train approached me about “shin splints.” This is a common complaint from athletes across the board and can be an indicator of many dysfunctions that can lead to further injury. It needs to be addressed and corrected quickly so the athlete can get back to playing at 100 percent.
In this post, I’ll show you a few simple exercises you can do to ward off shin splints. Nothing revolutionary here – consider it a compilation of drills borrowed from other awesome coaches that are really useful in this situation.
But before we can fix shin splints, we have to understand them.
What are shin splints?
So what exactly are shin splints? The term gets thrown around so much that we (e.g. athletes, coaches, doctors, etc.) use “shin splints” as a blanket term for most any pain involving the anterior (front) part of the shin, specifically the tibia and its surrounding structures.
Shin splints can be as simple as inflammation or as serious as a stress fracture. That’s why it’s dangerous to use the term so loosely without really understanding what’s going on.
The Mayo Clinic website gives the following definition for shin splints:
The term “shin splints” refers to pain along or just behind the shinbone (tibia) — the large bone in the front of your lower leg. Medically known as medial tibial stress syndrome, shin splints occur during physical activity and result from too much force being placed on your shinbone and connective tissues that attach your muscles to the bone. Shin splints are common in runners and in those who participate in activities with sudden stops and starts, such as basketball, soccer or tennis.
I put part of that definition in bold because it’s extremely important for the prevention and treatment of shin splints. The field hockey players who came to me complaining about shin splints all received similar advice from the athletic training staff, which involved the standard recommendations of R.I.C.E. (Rest, Ice, Compression, Elevation) and strengthening the anterior tibialis (the muscle on the front of the shin responsible for dorsiflexion of the foot, e.g. pointing the foot upward).
This is good general advice, especially the “rest” component. But it’s incomplete advice. It’s a band-aid that doesn’t fix the root of the problem.
Let’s look back at that bold print above, and then make a list of the causes of shin splints.
What Causes Shin Splints?
Most of the literature points to four main causes:
- Improper footwear
- Overpronation of the feet
- Weak anterior tibialis muscles
There’s a connection here. Consider an athlete who suddenly increases training volume and intensity (perhaps after a summer of sleeping til noon and crushing a few too many Four Locos) while wearing crappy running shoes or cross trainers. This alters running form, causing the feet to strike the ground incorrectly. The calves become tight/facilitated and the anterior tibialis becomes weak/inhibited – a case similar to lower crossed syndrome. Now we have overcompensation upon dysfunction – a deadly combo that inevitably leads to injury.
A Quick Word on Orthotics
Before we go any further, let me point out that orthotics are the standard intervention for both prevention and treatment of shin splints, and they do work. They’re the only effective shin splint intervention backed by research. But that’s not the point of this post.
A physical therapist or podiatrist can provide custom orthotics that fix abnormal foot mechanics. This is indisputable and probably a good course of action for many athletes, but it’s not the direction I would want to go with all my athletes. I’d rather get to the root cause and take the time to fix the hips and ankles. More on this later.
Ankle as the Foundation
Overcompensation is the key here. If we use Mike Boyle’s joint-by-joint approach, we can see that if we’re experiencing problems at the foot and the tibia, we should probably be looking right in between the affected areas. That leads us to the ankle.
The ankle is the main joint that connects us to the ground. After the many small joints of the feet, the ankle supports the rest of the body’s mass and is highly reactive, changing orientation during running, jumping, landing and lifting. Technically it only has two movements (dorsiflexion and plantarflexion), both in the sagittal plane, but when you combine it with movements of the foot, knee and hip, you’re talking serious influence on the entire body.
If the ankles don’t move properly, the feet, knees, hips and pertinent muscles and connective tissues can take a beating. Here’s a prime example. Watch someone with poor ankle mobility try to do a deep squat. The torso will bend too far forward and the heels will want to jump off the floor. Before the lifter even descends to parallel, the pelvis will go into posterior tilt and the lumbar spine (lower back) will lose its tight arch, greatly reducing stability. This is a recipe for disaster, and shows you just how far the effects of faulty ankles can reach. Not by coincidence, several of my athletes who complained of shin splints struggle to squat without their heels popping up.
How Do We Prevent It?
To prevent shin splints, we have to do several things:
- Mobilize the ankles
- Lengthen tight calf muscles
- Strengthen the anterior tibialis
- Remove the negative stimulus
We mobilize the ankles with dynamic dorsiflexion drills, lengthen the calf muscles with static stretching and eccentric exercises, strengthen the muscles on the front of the shin with resistance training, and remove the negative stimulus by discontinuing the activity that triggers shin splints.
Just like I said in 10 Tips for Cranky Elbows, Part 1 and Part 2, I’m not a doctor. If you have shin splints, go see a physician, physical therapist or athletic trainer. They’re the only ones qualified to diagnose and treat this stuff.
For the purpose of this post, we’ll focus on mobilizing the ankle. Below is a simple daily routine that you can do to help prevent the onset of shin splints or possibly supplement current rehab efforts (with permission from a qualified professional).
Wall Ankle Mobilizations
I’m borrowing this one from Eric Cressey, and it did wonders for fixing my ankles and in turn fixing the ass-wink during my squat. You can easily integrate this movement into a warmup that includes other wall-based exercises like forearm wall slides, back-to-wall shoulder flexion or wall hip flexor mobs.
Stand facing a wall in a split stance, with the front foot close to or touching the wall. Break at the knee, push the front knee over the middle of the front foot and touch the knee to the wall while keeping the front heel down. This should give a good stretch in the Achilles tendon of the front leg. Do a few reps, then gradually move the front foot away from the wall until you find a distance where it’s tough to touch the knee to the wall but you can still keep the heel on the floor. Do 10-12 reps per side during your warm up, or multiple sets of higher reps as a separate session.
Knee-Break Ankle Mobilizations with Toes Elevated
With the toes elevated on a couple of 5-pound plates (or the edge of an Olympic platform like the one in the above video by Mike Boyle), simply bend the knees, pushing them straight over the toes without letting the knees crash in or out. Many people will feel a tightness in the front of the ankle, which is common. When done properly, this exercise tends to have a very small range of motion, but a few sets of 10-12 reps per day can improve dorsiflexion dramatically.
Eccentric Calf Raises
I was a toe-walker when I was a kid. This gave me all kinds of problems with my Achilles tendons during youth football but led to some sexy calf development in the process (no pain, no gain, eh?). Anyways, my physical therapist made me do about a 1,000 of these a day when I was a wee lad to stretch out my tight calves.
Focusing on the eccentric phase builds strength in the plantar flexors (muscles that point the foot down) in a lengthened state, which can help alleviate tightness AND help the calves “re-learn” how to absorb force while running or landing from a jump. This takes the stress off the front of the shin and shifts the bulk of the work to the bigger, stronger calf muscles.
It’s a pretty simple exercise. Stand on the edge of the stairs and do a normal calf raise, then lower down slowly to a fully stretched position, keeping tension on the calves the whole time. You can do these one foot or two feet at a time for 15 reps per set.
You could also integrate calf stretching into a full body warmup exercise like the inchworm variation seen below. This way you hit multiple body parts at once and don’t have to justify spending lots of valuable training time on just your calves.
Bulgarian Split Squats
Ah, the dreaded Bulgarian split squat. This is arguably the gnarliest single leg exercise known to man. It’s hard as hell, but it’s one of the best “bang for your buck” movements because it improves just about everything we all suck at. It hammers the quads AND the posterior chain, serves as a loaded stretch for the hips/groin, and works dorsiflexion of both ankles simultaneously.
Split squats also hammer the glutes, which help control hip internal rotation and in turn control overpronation at the ankle. Think about someone landing from a jump with knocked knees (something we see all too often, from female athletes especially because of wider hips and sharper angles of the femur). The weight naturally shifts to the insides of the feet (pronation). A strong set of glutes can help with deceleration during landing not just from a jump, but from each stride while running.
A few big coaching cues here are to keep the front heel down while trying to keep a vertical shin with the front knee over the midline of the front foot (without letting the knee go way over the toes), and to keep the “laces down” with the back foot instead of popping up onto the toes. This forces the back ankle into dorsiflexion at the bottom of the movement. It’s a 2-for-1 deal.
Remove the Negative Stimulus
We can do all the mobilizing and strengthening in the world, but before we fix the problem, we have to stop doing what’s causing the problem. Like Eric Cressey so wisely said, you can’t just keep adding. A few sets of weighted anterior tibialis exercises ain’t gonna cut it here. We have to remove the negative stimulus, which in the majority of cases is excessive running.
This goes for any kind of repeated, high stress ground-based movement. The REAL problem is when sport coaches use running as punishment and pile countless laps and suicides on top of all the running done during practices and games. But that’s a topic for another day.
Anyone who knows me knows I hate distance running and think it’s pretty useless for most team sport athletes. I prefer sprints over distance running for conditioning nine times out of 10. So maybe I’m a little biased (but I’m not alone) in thinking that most athletes should cut back on their long, slow jogs.
There are some biomechanical reasons that distance running can cause shin splints and exacerbate an existing case.
First off, distance running is done in a mostly upright position, which encourages heel striking. When the foot lands heel-first, it places a large stress on the anterior tibialis because the ankle lands in dorsiflexion (toe pointed up). Over time, this can cause inflammation, pain and eventually stress fractures.
When we sprint, everything changes.
Sprinting puts the athletes in a more forward posture, resulting in less dorsiflexion of the ankle and a forefoot strike rather than a heel strike. This takes pressure off the tibia and the anterior tibialis and moves it to the bigger, stronger calf muscles.
Now don’t get me wrong – sprinting can be just a dangerous. It’s extremely high-impact, with ground reaction forces reaching up to six times the athlete’s body weight. It involves a greater range of motion than distance running, with significantly greater hip flexion (think quad or groin strains) and hip extension (think pulled hamstrings). And coaches often have their athletes do lots and lots of sprints in a fatigued state, so technique goes out the window.
But sprinting can be incredibly self-limiting. It tends to decrease the overall volume, because we can’t sprint as far and as long as we can jog at a halfassed pace. And when pain sets in, we’re less likely to push through a dozen 40-yard repeats than we are to grind out a 5k.
While sprinting with shin splints is a bad idea, doing more sprints and less distance running is a great idea for a healthy athlete from both a conditioning and structural standpoint.
To be fair, the negative stimulus doesn’t have to be running. It could be too many plyometrics which place a great deal of stress on the anterior tibialis with each landing. Fancy (but mostly useless) drills like agility ladders for high volume could be an offender. Or too many explosive jumping drills like broad jumps or depth jumps could fry the front of the shins. The key is monitoring the total volume and reducing the amount of ground contacts (or taking a break from the exercise altogether) until the shin splints subside. A good general rule is to keep plyo volume low when running volume is high and vice versa. As Jim Wendler always says, you can’t serve two masters.
More on Orthotics
It would be unfair to write an article about shin splits without talking about orthotics. That’s because, as I mentioned before, the only intervention for preventing shin splints that’s backed by research is the use of orthotics.
I’m gonna come out right away and say it – I don’t know anything about orthotics because I’m not a physical therapist or podiatrist. All I know about them I learned from this journal article that Fred Dimenna so kindly showed me. It reviews all the relevant research regarding shin splint prevention and concludes that the only prevention method of statistical significance is the use of orthotics. In a 1990 study that followed 1,338 male military recruits through nine weeks of basic training, Schwellnus et al. found significantly fewer incidences of shin splints among recruits who wore neoprene insoles (2.8 cases for every 1,000) than the control group that didn’t wear inserts (6.8 cases per 1,000).
The research on other methods of prevention (strength training, stretching, graduated running protocols, etc.) is limited and inconclusive. But in my (limited) experience, improving ankle mobility along with strengthening the anterior core and entire posterior chain does well to correct many lower body dysfunctions – shin splints included.
Dimenna, ever the skeptic and wizard of all things fitness, was kind enough to read an earlier draft of this post and noted that not mentioning orthotics would be a disservice to my readers. He’s right, because we can’t ignore the research, especially if it’s as cut and dry as the review I linked to previously. But I truly believe that simply wearing custom insoles without working on gaining the necessary mobility, flexibility and stability is akin to treating the symptom and not the disease.
Eric Cressey said something at the 2012 NSCA National Conference that really stuck with me. He said sometimes you have to go with what you know will work and wait for research to catch up. More research needs to be done involving other methods of shin splint prevention.
To wrap things up, improving ankle mobility is one way to avoid lower leg injuries such as shin splints, especially when training volume is high like it is during preseason training camps. You can easily implement these exercises into a warmup routine, or do them daily as a separate prehab workout. They can also drastically improve your squat and deadlift technique, especially if you currently lack the ankle mobility to squat deep or deadlift from the floor with a neutral spine.