So what should you actually do to lower your risk of MTSS? Well, simply
utilize our shin-splint-preventing exercises, outlined below:
1. Wall Shin Raises.
Simply stand with your back to a wall, with your heels about the length
of your feet away from the wall. Then, lean back until your buttocks and
shoulders rest against the wall. Dorsiflex both ankles simultaneously,
while your heels remain in contact with the ground. Bring your toes as far
toward your shins as you can, and then lower your feet back toward the
ground, but do not allow your forefeet to contact the ground before
beginning the next repeat. Simply lower them until they are close to the
ground, and then begin another repetition. Complete about 12 to 15 reps.
Once you have finished the reps, maintain your basic position with your
back against the wall, dorsiflex your ankles to close to their fullest
extent, and then quickly dorsiflex and plantar flex your ankles 15 times
over a very small range of motion (smaller than the nearly full range you
use for the basic reps; the emphasis here is on quickness). These short,
quick ankle movements are called pulses.
As you gain strength over time, make the wall shin raises progressively
more difficult by advancing from one set of 15 reps to two and then three
sets of 15 (for the basic raises and the pulses). It's OK to walk around
for 15 to 30 seconds between sets.
Now the single-leg raise
Once you can quite comfortably complete 3 x 15 of the double-leg raises
(both basic and quick), progress to the single-leg wall shin raise. The
basic position for this exercise is as before, except that you begin with
only one foot in contact with the ground; the other foot rests lightly on
the wall behind you. Now, full body weight is on one foot - as it is
during running - as you carry out the overall routine, and the exercises
are considerably more difficult. Begin with 12 to 15 reps per foot (both
for the basic exercise and pulses), and progress to 3 x 15 (basic and
pulse) on each foot as your strength increases. There's no need to rest
between sets; simply carry out 15 reps on one foot plus the pulses, shift
over to the other for 15 repetitions and pulses, return to the original
foot, and so on until you have completed three sets with each foot.
2. Heel Step-Downs
These are simple but devastatingly effective exercises for preventing
MTSS. Begin with a natural, erect body position, with your feet about
shoulder-width apart, and then step forward with one foot. The length of
the step should be moderate - as though you were walking in your normal
manner. When your heel makes contact with the ground, stop the foot from
fully plantar flexing, ie, use your shin muscles to keep the sole of the
foot from making contact with the ground. After heel contact, the ball of
your foot should descend no more than an inch toward the floor or ground;
your foot is held in check by the eccentric contractions of your
dorsiflexors (shin muscles). Return your foot to the starting position
(back by the other foot), and repeat this basic stepping action a total of
15 times. Then, shift over to the other foot and complete 15 steps. As
with the wall shin raises, progress to three sets of 15 reps over time.
Now with longer steps
Once you have mastered the basic heel step-downs, perform the same
exercise - but with dramatically longer steps. Using lengthier steps will
increase the accelerating forces placed on the dorsiflexors and force them
to work more forcefully and quickly, as they must do during running. Start
with one set of 15 reps of long steps per foot, and progress to 3 x 15 on
each foot over time.
Finally, you will be ready to carry out the heel step-downs from a high
step, which will increase the forces on your shin muscles to the greatest
extent - and build the greatest amount of strength. Use a bench or
exercise platform which is about four inches off the ground to carry out
your stepping. Aside from beginning each step from a bench, your movements
are the same as they are in the basic step-downs; the idea is to land on
the heel of the forward foot and then to use the shin muscles to prevent
the sole of the foot from making contact with the ground (again, don't let
the ball of the foot move downward by more than an inch). The actual
length of the step is moderate at first (you can progress to long steps
later). As before, begin with 15 reps per foot, and progress to three sets
of 15 reps as you gain strength and coordination.
Both the wall shin raises and heel step-downs can be carried out three to
four times a week, along with your other strength-building exercises (you
can complete them more often if you've had lots of problems with MTSS in
the past; don't do them to the point of pain, however).
Warm up to stronger shins
The following portion of the shin-splints-preventing routine can be
completed during the warm-ups preceding your regular workouts. The
prescribed exercises develop shin strength and resiliency, as well as
overall ankle coordination, and thus are great antidotes for your ankles'
desires to begin hurting during strenuous training. It's also a good idea
to include the exercises in your warm-ups; doing so transforms the warm-up
from humdrum routine into an important strength and coordination session.
Here's what to do:
1. Walk on your toes with your toes pointed straight ahead for
about 20 metres, getting as high up on your toes as you possibly can. Your
legs should be relatively straight as you do this, and you should - at
least initially - take fairly small steps.
Then, cover 20 metres high up on your toes, but with your toes pointed
outward. Your legs should rotate outward from the hips when you perform
this movement; don't merely turn each foot at the ankle - the whole leg is
Finally, walk 20 metres high on your toes, but with your toes pointed
inward. As you do so, rotate the entire leg in from the hip, not just the
ankle. Repeat each of these activities (toes pointed ahead, toes pointed
out, toes pointed in) at least one more time before going on to the second
2. Walk on your heels with your toes pointed straight ahead for
about 20 metres, getting as high up on your heels as you possibly can.
Your legs should be relatively straight as you do this, and you should -
at least initially - take fairly small steps.
Then, simply proceed as you did with the toe walks, walking 20 metres on
your heels with toes pointed outward and then 20 metres on heels with toes
pointed inward. Repeat each of the heel walks (toes straight ahead, toes
pointed outward, toes in) at least one more time.
As the toe and heel walks become easy for you, graduate to doing the three
variations of each exercise while jogging lightly, instead of walking! At
least at first, you should make certain you are on a padded or grassy
surface when you jog on toes and heels.
3. Skip for 20 metres, landing in the mid-foot area with each
contact with the ground, and with toes pointed straight ahead. Then, do
the same, but with toes pointed out for 20 metres, and then with toes
pointed in for 20 metres. Repeat the sequence at least one more time.
4. Then, get well up on your toes and skip for 20 metres with toes
straight ahead, pointed out, and pointed in.
Now skip on your heels
Once the skipping exercises are comfortable, try some light skipping on
your heels. Gradually build up your ability to heel-skip with toes
straight ahead, pointed out, and pointed in for 20 metres at a time. Heel
skipping is a great way to build dorsiflexor strength, but carry it out
only on a padded or grassy surface to avoid impact injury to your heels.
5. Once you've completed your walking, jogging, and skipping routines,
it's time for rhythm bounding. This isn't the kind of bounding you're
probably envisioning - we don't mean progressing forward with extra-long
strides, at least not at first. Rather, you should jog along with very
springy, short steps, landing on the mid-foot area with each contact and
springing upward after impact. As you rhythm bound, your ankles should act
like coiled springs, compressing slightly as you make your mid-foot
landing and then recoiling quickly - causing you to bound upward and
forward. Move along for 20 metres or so with these quick, little,
spring-like strides, alternating right and left feet as you would during
running. After 10 to 20 metres of regular jogging, rhythm bound for 20
more metres, alternating three consecutive spring-like contacts with the
right foot with three with the left. After 10 to 20 more metres of regular
jogging, close the set by bounding along for the full 20 metres on your
right foot only, followed by 20 metres on the left (making certain that
you land on the mid-foot area with each ground contact and that your ankle
area, not your knee or hip, is doing most of the work). Make sure (at
least at first) that all of this is done on a padded surface or soft
grass. As you become stronger and more skilled, you can increase the
length and amplitude (vertical height) of each bound and include
additional sets of bounds (work your way up to four sets).
6. Complete some 'dorsiflexion bounces'. To do these, simply begin jumping
vertically and repetitively at close to maximal height, landing in the
mid-foot area with both feet and then springing upward quickly after each
contact with the ground. The interesting part of this exercise is that you
should dorsiflex your ankles - pulling the tops of your feet toward your
shins - on each ascent, before plummeting back toward earth and plantar
flexing your ankles just before making contact with the ground. Do 10
dorsiflexion bounces, rest for 10 seconds or so, and then repeat. Over
time, you can add additional sets and increase the number of reps to 30.
When you are really strong and skilled, perform this exercise on just one
foot at a time, but only on a low-impact surface.
7. Finally, carry out rhythm bouncing. Rhythm bouncing is actually just
jumping around, but what jumping! You should start with 10 jumps in place,
moderately fast, with medium height, and with maximal motion at the ankles
- but little flexion and extension at the knees and hips (over time, you
can work up to 30 jumps). Then, after resting for a few seconds, change
the amplitude (height) of your jumps to less than an inch, and complete 20
jumps as fast as you possibly can (pretend that your feet are hitting a
hot stove - so that you must minimize your impact time with the ground).
Again, almost all of the action should take place at your ankles, not at
your knees and hips. As you become more skilled, work up to 40 quicksilver
After resting for a few seconds, complete five 'high-impact' jumps,
increasing the amplitude (vertical height) of your jumping as much as
possible. Over time, progress to 30 of these maxi-jumps.
So far, all of the rhythm bounces have been carried out in place, so make
things interesting by jumping forward and then backward as quickly as
possible. After you have made 20 'contacts' (each time your feet strike
the ground is one contact), rest for a few seconds and then jump from side
to side for 20 contacts. Rest again, and then jump in a direction which is
about 45 degrees from straight ahead, alternating directions (first
towards the right, then towards the left) for 20 contacts as you move
ahead in a zig-zag manner. Remember to use your ankle muscles to propel
you, not the big muscles at the knees and hips.
As you gain skill and strength, you can increase the number of sets of
each type of rhythm bouncing from one to three, and then - the fun part -
carry out each type of bouncing on one foot only. Moving in different
directions as you bounce increases the ability of your shin muscles to
handle all of the forces created during running - the side-to-side and
rotational stresses, in addition to the less-overlooked front and back
Of course, carrying out these exercises doesn't mean that your risk of
MTSS is zero. If you suddenly change your weekly volume of running from 25
to 75 miles because you've been bitten by the marathon bug, for example,
something will have to give, and it might well be your shin muscles and
tendons. So, be certain to avoid dramatic changes in the frequency,
volume, or intensity of your training; always gradually progress to more
difficult levels of work.
Sports-medicine experts often recommend stretching the ankle area by
slowly moving the ankle to 'each' end of its range of motion in the
straight-back and straight-ahead plane, eg, to the fully dorsiflexed and
then completely plantar-flexed positions, holding each position for
anywhere from five to 60 seconds. The problem with that, of course, is
that you are only stretching your muscles in one plane of motion and thus
not adequately mimicking the stretching which takes place during running.
At the very least, in addition to carrying out the plantar-flexed and
dorsiflexed stretches, you should also stretch each ankle by fully
rotating it outward and inward - and by plantar flexing and dorsiflexing
the ankle while the foot is pointed both outward and inward to various
degrees - not just straight ahead.
The experts also recommend strengthening the ankle area by adding
resistance to the above stretching movements with the use of surgical
tubing or elastic bands. That is indeed a way to increase general strength
of the ankle, and it will certainly make you stronger when you carry out
surgical-tubing exercises in the future. The problem, of course, is that
you run with your feet on the ground - not poised in the air in the
clutches of elastic bands. So, to fully prepare your ankles and shins for
the rigours of running, you're better off focussing on the specific
exercises we are recommending.
Does stretching actually help to prevent MTSS? No scientific evidence
indicates that it does, but the idea that stretching might be protective
is a logical one (overly taut muscles seem more likely to be damaged by
pulling forces, compared to relaxed fibres). Don't stretch your ankle area
until after your muscles are warm, however; a good time would be after a
warm-up and/or at the end of your training session.
Other lower-leg injuries
Of course, all problems in the lower part of the leg are not necessarily
examples of MTSS. In particular, two conditions - compartment syndromes
and tibial stress fractures - can sometimes be confused with shin splints.
Compartment syndromes owe their name and origin to the fact that the leg
muscles are not simply loose straps which run from bone to bone. In
reality, the muscles are often grouped together into little sections of
the leg which are enclosed by a tough wrapper of connective tissue. Such
an arrangement of muscles tucked into a wrapper is called a 'compartment'.
During the act of running, excess fluid can build up within one of these
compartments, putting pressure on muscle fibres, nerve cells, and blood
vessels - and also causing a great deal of pain. Frequently, the pain will
be so severe that a runner must curtail a workout or come to a standstill
during a race. And the pain will usually be accompanied by the two
telltale symptoms of a compartment syndrome - numbness and weakness.
Numbness occurs because the excess pressure within a compartment hampers
the activity of sensory nerves carrying messages to the brain. As a
result, the runner with compartment syndrome may lose feeling in the 'web'
of the foot - between the first and second toes, or the insensitivity may
extend up the foot toward the ankle. Weakness is experienced because motor
nerves carrying impulses towards the muscles are also damaged by the high
pressures within the compartment. If a compartment in the front of the leg
is involved, a runner may have trouble dorsiflexing the ankle, and the
foot may seem to flop loosely. In a posterior-compartment problem
involving muscles in the back of the leg, there is often weakness when an
individual tries to 'toe off'.
If you truly have a compartment syndrome, you will usually observe
swelling in your lower leg which tends to subside when your leg is
elevated. A doctor can tell for sure if you have this troubling problem by
placing a catheter into one of your compartments and measuring pressure
before, during, and after running (you will usually have to run long
enough to produce pain during this test).
What about stress fractures?
Stress fractures are small breakdowns in bony tissue, and tibial stress
fractures, which are sometimes confused with MTSS, are the most common of
all stress fractures in athletes, accounting for about 50 per cent of the
total. In addition to producing a lot of pain, stress fractures can
actually progress into dislocation fractures, in which two parts of the
bone actually separate. Stress fractures also may be 'warning signals' for
an underlying nutritional or hormonal problem.
Unfortunately, traditional X-rays often fail to detect stress fractures,
so a more costly procedure called a bone scan must frequently be performed
to confirm the diagnosis. In a bone scan, radioactive material is actually
injected into the blood. Bony tissue which is remodelling and rebuilding
itself at the site of a stress fracture will accumulate more of this
infused radioisotope, causing the affected bony area to show up as a dark
splotch on a 'scintigram'. While it's often said that stress fractures
take two to three months to heal, up to six months may be required to
restore the bone to normal and remove most traces of pain, and a few
athletes need more than a year to fully recover.
Sometimes called 'crescendo pain,' the agony associated with stress
fractures tends to build up steadily during running, beginning as an
annoying irritation and becoming a throbbing torment as an individual
continues to run. There is usually little of the numbness, weakness, and
swelling associated with compartment syndrome, and pain is usually not
present when an athlete is at rest. Often, the bone will hurt when it is
tapped near the damaged area, and occasionally a hard nodule will appear
on the surface of the bone at the trouble site.
If you're diagnosed with a stress fracture, you should be sure to have a
nutritional analysis carried out (your problem might be the result of
inadequate calcium intake or poor calcium absorption). In addition,
athletes who develop stress fractures should get their sex-hormone levels
checked (adequate testosterone concen-trations in males and oestrogen
levels in females are required for optimal bone maintenance).
How can you differentiate MTSS from stress fractures and compartment
syndromes? The pain of MTSS is usually less localized, compared to
stress-fracture pain (it tends to run up and down a region of the lower
leg near the tibia), and usually can't be produced merely by tapping on
the tibia. In addition, MTSS produces none of the numbness associated with
How long does MTSS last?
If you are unfortunate enough to come down with MTSS, your recovery period
will usually last from one to six weeks, depending on how severely you are
stricken. If you have a mild case of MTSS (your shin hurts moderately, and
only after workouts), immediately cut your weekly mileage by about 30 per
cent, and start doing our recommended exercises (we're assuming that your
busy schedule prevented you from carrying out the routines faithfully,
allowing MTSS to crop up). Start easily with the exercises, doing only one
set of each, and stop if you feel any pain. Ice the affected area down
thoroughly after activity, and of course keep the whole area as loose and
flexible as possible. Within a week or two, you should be able to get back
to your normal training, but be sure to carry out the
shin-splints-preventing exercises steadfastly.
If you have a somewhat tougher case of MTSS (mild pain crops up during
workouts but doesn't seem to slow you down much), trim weekly mileage by
around 50 per cent, ice and stretch religiously, consider taking
non-steroidal anti-inflammatory medications (but only if you are not prone
to the gastrointestinal upsets which have been linked with these
compounds), and become a devotee of our shin-strengthening exercises
(start gradually with them, though, since they can further inflame tender
shins if overdone). Use bicycling workouts to maintain fitness. In two to
three weeks, you should be ready for regular training.
If your MTSS produces sharp pain while you are training, stop all running
workouts, ice and stretch, take NSAIDS as directed by your doctor, and -
when pain subsides - systematically begin utilizing our exercises,
starting with a few two-legged wall shin raises at first and gradually
progressing to the others. Use the exercise bike to maintain fitness, and
return to normal training in four to six weeks.
Remember that if you carry out our shin splints treatment routine several
times a week and refrain from making bizarre and sudden changes in your
training, your encounters with MTSS should drop to a frequency rate of
Owen Anderson and Walt Reynolds