Recurring shin splint/MTSS/stress fracture, suggestions?

are you making sure you run most of your mileage on soft surfaces?

It is most likely biomechanical.

First, in my opinion, everyone will get shin splints if they are a beginner. You just have to be smart, progressively increase mileage, and just let the body adapt to new stress.

However, if you are doing that, and you are still experiencing issues like you say...well, then you might have some biomechanical issues.

I was a competitive high/college runner that had shin splints/fracture every day of my life. It finally went away after finding correct shoes. When everyone was pushing towards more motion control/cushion/orthodics, I eventually went more minimal. Specifically, zero drops worked for me. It helped prevent the impact to go up my shins when I hit with each step. Maybe try some Altra's.

Good luck.

Hey, thanks for the prompt replies!

-Probably about 10-20% on grass, 60-70% on dirt/gravel, the balance on pavement.

-I'm actually nuts about Altras, love the toebox. I've tried NB and Asics but keep coming back to Altra. Been going back and forth between Olympus and Lone Peak, Escalante for daily wear. Tried Superfeet Green in running shoes (both NB Beacon and Altra Olympus), didn't notice much difference.

You're probably over-striding, which places too much force on the tibia. You'll have to "rewire" your stride - start by doing core exercises with a flat back (no air between the small of your back and the ground). Inhale deeply to your belly to ensure your whole back is flat to the ground. This encourages a good posture while running. Also try to lean forward slightly when you're running with a flat back.

Here are a few things that might help:

Strengthen your calves. Eccentric stuff and with weights.

Stretch. A ton. Calves. Hamstrings. Shins. Yes - stretch your shins.

Warmup a lot. The more the better. If I don't warm up I can end up with shin splints after my run.

Try different shoes. High drop. Low drop. Max. Min. See what works.

Good luck. Sounds annoying.

Pacing isn’t your problem, it’s volume. My guess is that you are fit from other sports, so your aerobic capacity can support more running than your musculoskeletal system can support. I’d recommend starting with a ridiculously low volume (6-9 miles per week in 3 runs). Do that for three weeks. Then you can increase by a mile a week, but every 4th week drop it back down by 3 miles. For instance, 6-7-8-6-9-10-11-7. Do that until you hit 20 miles/wk, at which point you can add 10%/wk to your total volume.

The cool kids are going to say that’s wimpy, but it’s a conservative approach that poses very little risk of a “too much, too soon” injury like shin splints.

This guys is getting close. Strengthen and stretch every day. Get a resistance band.

When I was in college I had similar problems. Find the right shoes, ice after your runs, and do some work to make your muscles stronger. You can get through it.

Hey Psmith,

I've had 6 tibial and 1 fibular stress fracture. Mine were all caused by a combination of poor technique and exceeding my body's tolerance to injury. I had 1 every year from the age of 17 to 24 - right in the prime of my running career.

I literally tried everything to stop them happening, including video analysis/gait analysis/technique changes, basic physio exercises, barefoot drills, calf strengthening and changing shoes around regularly. Not of it worked. I had no hormonal problems and bone density was 100%.

The ONLY thing that broke the cycle and continues to keep my injury free (no stress fx, no tendonopathies, no soft tissue injuries) is proper strength and conditioning training. This is the KEY to avoiding stress fractures and I am living proof of it.

Please, if you do one thing - hire a qualified strength and conditioning coach who works with athletes of all sports. A qualified S&C coach will should eventually having you doing HEAVY LOW REP (e.g. 4 x 5 reps) of back squats/front squats, deadlifts, Romanian deadlifts, Bulgarian split squats, lunge variations, barbell or dumbbell step ups and plyometrics (basic skipping, drop jumps, box jumps, squat jumps, etc.). Don't accept anyone who tells you to do stupid resistance band exercises. It won't help - I've tied it and the science does not support it.

There is a HUGE amount of evidence for HEAVY S&C training for runners and most of them are too stubborn/uneducated to try it and commit to it consistently 2-3 times per week.

Getting your vitamins and minerals from natural unrefined foods is much better than taking a calcium tablet for example. Taking iron tablets can cause issues with absorbing calcium which can cause weaker bones and shin splints.

But eating healthy high iron foods should not have that effect.

Possibly in a similar way that eating raw sugar can actually cause a drop in blood sugar whereas eating unrefined carbohydrates doesn't.

Do you take iron supplements??

Wow, thanks for all the suggestions, some good thoughts here! Trying to hit a few high points:

-I've heard about overstriding, try to keep my cadence up when running (really more of a granny shuffle at low paces, but hey, it pays the bills), will do hollow body holds hanging from a bar as a warmup/stretch on gym days.

-Training volume is probably a good line of inquiry, but it's frustrating because I've been ramping up super slowly this year anyway and I'm still here. Having said that, I've been following a strategy of holding volume constant for around a month between slightly larger jumps than you're talking about. So like 4-6 weeks of 3 x 30:00, 4-6 weeks of 3 x 45:00, 4-6 weeks of 3 x 60:00 (which is where I am right now). I suppose 30:00/30:00/30:00, 30:00/30:00/45:00, 30:00/45:00/45:00, etc., might be better. Also @slartibartfast you wouldn't happen to be interested in the role of archaic hominid introgression in the development of autism by any chance...?

-The good news about strength training is that I aready do it, in fact have a much stronger background in lifting than running, still do some maintenance squatting or trap bar pulling about twice a week. The bad news is that I don't think there's much low-hanging fruit for me here.

-No iron supps. Greek yogurt, hard cheese, and whey protein isolate for calcium, I guess most of my dietary iron comes from greens, egg yolks, and chicken. Not a lot of red meat.

I had the exact same problem that you have and ignored it until I was unable to run. I was unable to apply pressure or stand on my one leg. It took almost a year to heal. Best advice is to take a break from running, and jump on the elliptical, bike or pool for awhile. Laser therapy and strength training (calf raises/bands) help a lot too. It’s going to take some time to heal but hang in there!

Some people are prone to shin splints if they don't do a good cool-down after a run. They tighten up real bad and then the next time they run that tightness will translate to shin splints. Getting your calves shins quads hamstrings loosened up after a run could potentially help a lot.

Also make sure that you don't have extended periods of no movement. It sounds like you don't have a desk job so that might not be an issue. But sitting all day at a desk can really cause your calves and shins to tighten up which will result in that vague feeling referred to as shin splints..