If you’re a runner, you’re likely no stranger to occasional aches and pains. Even among the fittest athletes, miles and miles of pounding the pavement can take its toll. The result is often some type of overuse injury.
Two common ones that typically affect runners are shin splints and stress fractures. “They are two completely different pathologies,” says Joshua Goldman, MD, a UCLA Health sports medicine specialist and long-distance runner. “But because the pain occurs in a similar location and both affect runners, they’re often confused.”
Learning to spot the warning signs of each will help you keep your body healthy for miles to come.
What are shin splints?
Shin splints, also called medial tibial stress syndrome, are the more common — but less serious — of the two injuries. “It’s really an issue of the connective tissue that attaches your calf muscle to the shin bone,” explains Dr. Goldman. “Repetitive strain on those tissues leads to inflammation and pain.”
Shin splint pain typically occurs during both the push off and landing of your running stride. You’ll feel it throughout the bottom third of the tibia (shinbone), typically on the inner side of the bone.
What are stress injuries?
Unlike shin splints, which affect the soft connective tissue (also called fascia), stress injuries directly affect the bone. They most commonly occur in the bones of the lower leg or feet.
Our bones are constantly breaking down and rebuilding (it’s part of the reason why impact activities help increase bone density). But when your activity level increases and your rest and recovery time decreases, the bones can’t keep up with the repair.
Stress injuries are often graded on a scale of 1 to 4. A low-grade stress injury (grade 1 or 2) means swelling in the deep connective tissues or bone marrow. A grade 3 injury typically results in swelling around the exterior shell of the bone. And grade 4 is a true stress fracture, where the shinbone has cracked.
What causes shin splints and stress injuries?
In theory, any type of impact activity can increase your risk of both shin splints and stress injuries. Repetitive impact, doing too much too soon and covering high mileage with not enough rest can lead to these injuries. Because running involves all of those risk factors, runners are typically at the highest risk.
“Bad running mechanics can also play a role in both shin splints and stress injuries,” says Dr. Goldman. Gait analysis and working on strengthening the muscles that support the feet and cushion the shinbone can help your body handle impact better.
Beyond your body mechanics, diet and nutrition also affect your risk of stress injuries. “For your body to constantly repair your bones, it needs calcium and vitamin D and a sufficient amount of stored energy,” says Dr. Goldman. “If you’re not taking in enough calories and are deficient in key nutrients, the body can’t rebuild bone.”
How to prevent these common running injuries
Because the two injuries have some features in common, there are strategies that can help you prevent both. These include:
- Cross-training with low-impact activities (including cycling, swimming and water running)
- Increasing the number and duration of workouts gradually
- Running on softer surfaces when possible
- Taking at least one rest day each week
- Wearing supportive, well-cushioned shoes
To help prevent shin splints, it’s also important to work on your body’s biomechanics. “The tiny proprioceptor muscles in the ankle need to be strong to help prevent your arch from flattening with every step,” explains Dr. Goldman. Moves such as single-leg calf raises and balance exercises increase the strength of those stabilizing muscles.
When to see the doctor about shin pain
Because both injuries result in shin pain, it can be difficult to figure out what’s happening on your own. Typically, shin splints cause pain during both push off and landing of your running stride. A stress injury only hurts on the landing.
“Shin splints are painful, but they’re not going to evolve into something more dangerous and won’t progress into a stress fracture,” says Dr. Goldman. Treatment typically involves rest, ice and anti-inflammatory medication.
“If you have a stress injury, you need to stop running and let it heal,” he says. “If you don’t, the bone can fracture and eventually snap in half.” While the bone is healing, you can focus on strengthening the muscles that protect the bone and improving your diet.
If you experience shin pain that doesn’t go away on its own after a couple of weeks, Dr. Goldman suggests you see a doctor for an accurate diagnosis. They can put together a treatment plan and give you the tools you need to prevent future injury.
