It’s fall marathon season, which for many runners means it’s also shin splints season. Whether you’re a beginner or have several races under your belt, the injury can be debilitating.
Shin splints manifest as pain along the tibia or shin bone, and they are among the most common running injuries. Most people get them if they’re new to the sport or after ramping up their mileage. But you can also get shin splints if you incorporate hills or speed workouts without building up to them first, or by running on harder surfaces than you’re used to.
“Running is a pretty high-impact sport — it’s a lot of stress on the body,” said Dr. Michelle Kew, an orthopedic surgeon at the Hospital for Special Surgery in New York who was previously a physician for the New York Giants and the New York Red Bulls. If you plan to increase the amount you’re training, she says, it’s best to build up slowly and to follow the guidance of a running club, coach or training plan.
Fortunately, shin splints don’t always have to stop you from running for the season. Here’s what to know about treating them, returning to training safely and preventing new injuries.
What are shin splints?
Shin splints are an overuse injury. Many experts believe they are a result of inflammation in and around the muscles that pull on the tibia’s surface, or from damage to the bone. However, doctors don’t fully understand what causes them on a cellular level.
Pain from shin splints may be sharp or dull and it that may improve during a run at first, but it can linger as the injury worsens. “It’s like a toothache in your leg that doesn’t go away,” said Dr. Jordan Metzl, a sports medicine physician at the Hospital for Special Surgery. “The worse the ache, the more significant the problem.”
How can you tell if it’s shin splints or a more serious injury?
It can sometimes be difficult to distinguish between shin splints and a stress fracture — a small break in the bone — because both injuries can occur in similar places from overuse. Some experts even believe that shin splints are part of a spectrum of injuries that progresses in severity to stress fractures.
But shin splint pain generally occurs along a broad stretch of the shin, while stress fractures typically feel tender to the touch in one spot, usually toward the center of the tibia.
Colleen Brough, a physical therapist at NewYork-Presbyterian Hospital and director of Columbia University’s RunLab, recommends seeking medical attention if you experience pain with every step or pain that is localized. You should also see a doctor if your pain exceeds a 4 on a scale of 1 to 10 and affects how you walk, or if it lingers after 24 hours.
Those symptoms are “not a normal part of running,” Dr. Brough said. “That’s a yellow flag, that’s a pause, that’s a shot across the bow that says something is wrong.”
Dr. Kristin Whitney, a sports medicine physician at Boston Children’s Hospital and a co-medical director for the Boston Marathon, says that many people believe they have shin splints but are actually accumulating damage in the bone, which can lead to a stress fracture. To evaluate whether you have a stress fracture and need additional treatment, see a sports medicine doctor who can perform a physical exam and order X-rays or M.R.I.s.
How do you treat shin splints?
Ice and anti-inflammatory medications like ibuprofen can help reduce pain and swelling, but the best way to heal is usually a break from running. Ben Delaney, head of training programs and education for New York Road Runners, tells runners to take time to rest and see a doctor or physical therapist before the injury worsens.
But in some cases, you may not need to stop running entirely. If you have ruled out a stress fracture, Dr. Kew recommends cutting your mileage in half and incorporating low-impact cross-training like biking to maintain your cardio fitness.
Most people can typically return to their regular running routine in four to six weeks if symptoms improve, though some cases can last for months. A sports medicine doctor can help you develop an individualized plan.
Can you prevent shin splints?
Strengthening the muscles involved in running, from your feet to your core and glutes, can help keep your form stable and reduce the strain on your shins, Dr. Whitney said. Some people with shin pain — particularly if their feet pronate, or collapse inward, while running — may also benefit from supportive insoles. Experts also recommend that most runners change their shoes about every 250 miles to prevent injury.
Above all, experts agree you should build your mileage gradually. Mr. Delaney says training plans will vary, but an oft-cited rule of thumb is to increase your weekly mileage and long runs by 10 percent at most.
“We want to get to the start line in one piece, healthy and ready to run the best race that we’ve trained for,” Mr. Delaney said.
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