endurance running Archives - Praxis Physiotherapy

Shin Splints: Causes, Treatment & How to Get Back to Running Stronger

by Stephen Timms | Nov 27, 2019 | Ankle and Foot, Return to Sport, Running Injuries, Sports Injury

Key Takeaways

Shin splints (MTSS) are an overuse bone stress injury.
Training load errors are the biggest contributor.
Hip strength and force control play a major role.
Early management prevents stress fractures.
Strength + smart loading beats rest alone.

Mid Potion Achilles Tendinopathy Location

Shin Splints

Shin splints, known in the research as medial tibial stress syndrome (MTSS) are one of the most common running injuries we see at Praxis Physiotherapy across our Teneriffe, Buranda and Carseldine clinics.

If you’re noticing a dull ache along the inside of your shin that worsens with running, skipping or sport, you’re not alone. The good news? With the right plan, shin splints are highly manageable — and preventable.

Let’s break down what’s actually happening, why it develops, and what you can start doing today.

What Are Shin Splints (Medial Tibial Stress Syndrome)?

Shin splints are an overuse bone stress injury affecting the inner (medial) border of your tibia (shin bone).

What does it feel like?

Aching pain along the lower inside shin
Sharp pain when running or jumping
Tenderness to touch along the bone
Morning stiffness or pain when first starting activity

Unlike a stress fracture (which is more focal and severe), shin splints usually present as a broader area of tenderness along the bone.

What’s Actually Happening? (The Pathology Explained Simply)

MTSS is no longer thought to be just an “inflammation” problem.

Current evidence suggests shin splints develop due to repetitive loading that exceeds the bone’s capacity to adapt. When running loads increase too quickly, the tibia experiences repeated bending stress. If recovery isn’t adequate, this leads to:

Bone stress reaction
Irritation of the periosteum (bone lining)
Localised pain along the medial tibia

If ignored, MTSS can progress to a tibial stress fracture, which requires significantly longer time away from running.

That’s why early management matters.

Why Do Shin Splints Develop?

A large systematic review by Winkelmann et al. (2016) identified over 100 potential risk factors for MTSS, with several consistently seen in clinical practice.

Key Risk Factors Supported by Research

1. Training Load Errors
Rapid increases in running volume, intensity, or frequency are one of the strongest contributors.
(Winters et al., 2013; Nielsen et al., 2012)

2. Higher Body Mass Index (BMI)
Greater body mass increases tibial loading forces.

3. Biomechanical Factors

Increased navicular drop (foot pronation)
Greater plantarflexion range
Hip muscle weakness and poor pelvic control

4. Previous History of MTSS
Recurrence risk is higher without proper rehabilitation.

Importantly flat feet alone are rarely the sole cause.

What we often see clinically is this chain reaction:

Poor hip control → knee collapses inward → foot over-pronates → increased traction stress on medial tibia.

The foot is often the victim, not the culprit.

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Why Rest Alone Isn’t Enough

Yes — rest reduces pain. But rest does not improve:

Load tolerance
Running capacity
Strength deficits
Movement control

This explains why shin splints are common in recreational runners but less frequent in well-structured training programs. Higher-level athletes typically follow progressive loading plans that allow bone and tendon adaptation.

Research consistently supports graded loading and strengthening as key components of recovery (Moen et al., 2012).

How to Manage Shin Splints (Early Stage Tips)

If your symptoms are mild to moderate, here are evidence-informed starting points:

1️⃣ Relative Rest (Not Complete Rest)

Reduce running volume by 30–50%.
Avoid sharp increases in load.
Swap some runs for cycling or swimming temporarily.

2️⃣ Strengthen the “Shock Absorbers”

Focus on:

Calf strength (bent and straight knee)
Tibialis posterior strengthening
Glute medius and hip control exercises
Single-leg stability work

Improving hip strength can reduce tibial loading by improving force control through the limb.

3️⃣ Manage Running Workload

Follow the “10% rule” cautiously.
Allow recovery days between harder sessions.
Avoid sudden terrain changes (e.g., grass → concrete).

4️⃣ Consider Footwear

Ensure shoes are not worn out (>600–800km).
Orthotics may help some individuals — but only after assessment.

When Should You See a Physio?

Seek professional assessment if:

Pain persists longer than 2–3 weeks
Pain becomes sharp and localised
Hopping on one leg is painful
Symptoms worsen despite reducing load

Early intervention reduces the risk of progression to stress fracture.

How Praxis Approaches Shin Splints

At Praxis, we don’t treat “shin splints.”
We treat your specific loading problem.

Your plan may include:

✔ Comprehensive running and strength assessment
✔ Individualised load management plan
✔ Targeted strength and control program
✔ Manual therapy where appropriate
✔ Gradual return-to-run progression
✔ Prevention strategy for long-term performance

Because no two runners load the same way, and no two recovery plans should be identical.

If you’re dealing with shin splints, or want to prevent them from coming back, our team can help.

Book an in-depth running and lower limb assessment today.

📍 Clinics in Teneriffe, Buranda & Carseldine
📞 (07) 3102 3337
💻 Book online

💪 Trusted by athletes. Backed by evidence. Here for everyone.

The Praxis Team.

PREVENT | PREPARE | PERFORM

References

Winkelmann ZK et al. (2016). Risk factors for medial tibial stress syndrome in active individuals. Journal of Athletic Training, 51(12), 1049–1052.
Winters M et al. (2013). Medial tibial stress syndrome: a critical review. Sports Medicine, 43(12), 1315–1333.
Moen MH et al. (2012). Treatment of medial tibial stress syndrome: a systematic review. Sports Medicine, 42(11), 965–981.
Nielsen RO et al. (2012). Training errors and running-related injuries. International Journal of Sports Physical Therapy, 7(1), 58–75.

Images:

The above images are owned by the “Trainer Academy (https://traineracademy.org/) ” and used in this article with thanks.

References:

Hopper D, Deacon S, Das S, et al. Dynamic soft tissue mobilization increases hamstring flexibility in healthy male subjects. Br J Sports Med. 2004;39:594–598
Weerapong, P., Hume, P.A. & Kolt, G.S. The mechanisms of massage and effects on performance, muscle recovery and injury prevention. Sports Med 2005; 35: 235
Morelli M, Seaborne DE, Sullivan SJ. Changes in h-reflex amplitude during massage of triceps surae in healthy subjects.J Orthop Sports Phys Ther. 1990;12(2):55-9.
Arroyo-Morales M1, Fernández-Lao C, Ariza-García A, Toro-Velasco C, Winters M, Díaz-Rodríguez L, Cantarero-Villanueva I, Huijbregts P, Fernández-De-las-Peñas C. Psychophysiological effects of preperformance massage before isokinetic exercise. J Strength Cond Res. 2011 Feb;25(2):481-8.

https://www.massagemyotherapy.com.au/Home

Is running bad for your knees?

by Stephen Timms | Nov 28, 2018 | Knee, Pain, Return to Sport, Running Injuries, Sports Injury

Running. Probably one of the most maligned exercises when it comes to knees and overuse injuries. The thought that running ‘wears’ out your knees and causes osteoarthritis (a chronic disease often associated with joint pain and stiffness, reduced mobility and reduced quality of life) is one of the most common comments I hear as a physiotherapist – typically by non-runners. But do we have it right? Is running actually bad for your knees?

I recently attended the University of Queensland Sports Masters presentation day. The keynote speaker was a Dr Jean-Francois Esculier, a Postdoctoral Fellow at the University of British Columbia on the topics of running and knee osteoarthritis. Originally trained as a physiotherapist, Dr Esculier gave us an excellent overview of his latest research his take on whether or not running is detrimental to knee health.

First, there was an acknowledgement that echoed the sentiments in the opening paragraph. A study in which Dr Esculier undertook attempted to ascertain the perception about running and the knee joint health among the public and health care professionals. The results suggested that many non-runners perceived running as detrimental to knee health. Understandably, with no clear guidelines, health care professionals displayed high rates of uncertainty regarding running as a risk factor to develop knee osteoarthritis (KOA), and about the appropriateness of running with pre-existing KOA [1].

Osteoarthritis often results in cartilage loss, in bone rubbing on bone, which can cause inflammation, pain, stiffness, reduced mobility and reduced quality of life [7].

The paucity of clear training parameters for runners also has a knock on effect with a staggering 75% of runners report being injured whilst running each year with the knee being the most common region of complaint [2]. From my experience as a clinician, the factor that is most often associated with an injury are training errors. Too much too quick. Boom bust. No physical preparation. No listening to your body or allowing adequate recovery time. No periodisation or plan – just run and run.

The remainder of the talk that covered many interesting relatable topics (that will likely be areas for future blogs) but the information that most interested me and should answer the question as to whether running is bad for your knees was the following:

Cartilage change with running:

With the improvements in MRI scanning, more papers are looking at the cartilage volume of knees immediately after a long distance run. According to current evidence [3], cartilage may exhibit short-term decreases in thickness, volume and cartilage water flow (T2 relaxation time) secondary to temporary loss of fluid following repeated compressions associated with running. However, cartilage size tends to return to baseline within hours suggesting that cartilage may well tolerate mechanical loading sustained during running and adapt to repeated exposure.

The response of cartilage to longitudinal load is exactly what Van Ginckel et al [4] investigated. After providing a 10 week “Start To Run” program to novice runners, the reserachers looked at the glycosaminoglycan (GAG) content before and after the running intervention and compared to sedentary controls, who did no running. For those of you (like me) who had no idea what glycosaminoglycan / GAG content is, it is essentially a surrogate marker for cartilage quality (specifically, GAG is an important structural matrix compound in regulating the cartilage tissue’s endosmotic swelling pressure and thus, the tissue’s compressive strength).

The results suggested that a gradually built up running scheme appears to positively effect GAG content, and thus cartilage quality. In fact, running appears to be a chondroprotective effect on the knee when compared to a sedentary lifestyle in a female asymptomatic subjects. The author’s went onto say that running schemes like this might be considered a valuable tool in osteoarthritis prevention strategies [4].

Osteoarthritis (OA) rates in competitive vs recreational vs non-runners:

The body’s ability to adapt to considered and appropriate load is likely explanation as to why when we look at the rates of lower limb osteoarthritis (OA) across the population, we find some interesting results. A systematic review [5] of the literature looked at the association of recreational and competitive running with hip and knee OA. The overall prevalence of hip and knee OA was 13.3% in competitive runners, 3.5% in recreational runners, and 10.2% in controls. Exposure to running of less than 15 years was associated with a lower association with hip and/or knee OA compared with non-runners.

Recreational runners had a lower occurrence of OA compared with competitive runners and controls. These results indicated that a more sedentary lifestyle or long exposure to high-volume and/or high-intensity running are both associated with hip and/or knee OA. However, it was not possible to determine whether these associations were causative or confounded by other risk factors, such as previous injury [5].

SUMMARY

Running appears not to cause osteoarthritis in your knees unless you are a competitive long distance runner. Even then, you are only slightly above the average for non-runners but enjoy the myriad of other benefits that exercise brings. Further, increased mileage in recreational runners appears to be actually protective for your knees and reduces your risk of needing a knee replacement [6]. Caution however must be taken to monitor detailed training parameters such as frequency, speed and distance, so that an optimal dosage for knee joint health tailored to the individual patients with knee osteoarthritis.

So the next time someone tells you that you shouldn’t be running because you’ll get OA, or if your health expert recommends to stop all activity because you have been diagnosed with mild / moderate osteoarthritis of the knee, we can help! As always, we at Praxis are more than happy to help you navigate your way back to performing – whatever that may look like! Give us a call (07) 3102 3337 or book online www.praxisphysio.com.au today

Until next time, Praxis What You Preach

There is no need to accept knee pain as ‘normal’. Call us now on (07) 3102 3337 or book online to have one of our physios develop a plan to reduce your pain and restore your function!

To read more about how running can help your knees (that’s right – running!) check out our related posts on running written by our published principal physio, Stephen.

Team Praxis,

PREVENT | PREPARE | PERFORM

Why lifting is your missing endurance link: A guide for long distance runners (Part 1)

by Stephen Timms | Aug 10, 2018 | Uncategorized

You have the shoes, the GPS watch, training schedule and alarm set for 5am. You are dedicated and that race is right around the corner. Whether it is your first 5km or your 50th marathon, the thrill of crossing the finish line drives us all. Whilst you may know your average km split time like the back of your hand, do you know how strong your lunges or deadlifts are? If you haven’t stepped foot in a gym recently, then research suggests you could be missing out on a host of positive effects on your running.There has been a whole host of research in this area so deciphering the literature can be a difficult task. Thankfully, a recent paper by Blagrove et al [1] has done much of the hard work for us. The paper entitled Effects of Strength Training on the Physiological Determinants of Middle- and Long-Distance Running Performance: A Systematic Review aimed to provide a comprehensive critical commentary on the current literature that has examined the effects of strength training modalities on the physiological determinants and performance of middle and long-distance runners. They also offered recommendations for best practice which you can read about in the Part 2 blog post.

Running is a surprisingly complex task and as such there are many factors that affect performance. Physiological, biomechanical, psychological, environmental, and tactical factors all inter play to result in determining the average runner from the elite. With respect to physiological markers of performance, maximal oxygen uptake (known as VO2max), running economy, and the sustainable percentage of VO2max go a long way to determining performance [2]. In fact, these three elements can predict performance with up to 95% accuracy in well trained runners.The difference between VO2max in the elite running population however is surprisingly marginal. On the contrary, running efficiency displays a high degree of inter-individual variability and thus a potential area to better discriminate between runners and their respective performance [3]. Defined as the oxygen or energy cost of sustaining a given sub-maximal running velocity, running efficiency is underpinned by a variety of anthropometric, physiological, biomechanical, and neuromuscular factors [4]. More specifically to the purpose of this article, force generation and stretch–shortening cycles are the neuromuscular factors that are the most relevant.Whilst force production of a muscle is a straight forward concept, the stretch shortening cycles may not be. Stretch shortening cycles describe the pre-stretch and recoil action of a muscle and tendon unit that occurs in a dynamic action just as jumping. Think of the stretch shortening cycle like a spring whereby energy is stored and released within the spring, or in real terms, the musculo-tendinous unit. To produce higher forces, the more motor units (muscle) are required [5]. There is a strong correlation between the cross-sectional area of a muscle and its ability to produced force. Several other factors are involved, but for the most part, a larger muscle will produce more force than a smaller muscle. However, force production becomes more difficult when activities are dynamic. This is because there is a reduction in force produced per motor unit due to the faster shortening velocity involved in the stretch shortening cycle [5].In general, strength training activities can positively affect both muscle force as well as improve the stretch-shortening cycle through several different adaptations including muscular and neural changes [6, 7]. Hypertrophy is the term to describe an increase in muscle size. It is the cyclical process whereby muscle cells are exposed to repeated bouts of exercise causing micro damage to the muscle cells. Micro damage causes an inflammatory response and it is the pain you feel for the next 48hrs after a bout of exercise (also called delayed onset muscle soreness or DOMS for short). It is also the stimulus for the body to mitigate future damage by repairing the damaged tissue and adding more muscle cells. This is what is commonly known as the super compensation cycle. Hypertrophy is aided by rest, dietary protein, certain hormones (e.g testosterone) and has a very strong genetic component as well [7].

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Neural adaptation tends to be one of the earliest changes and accounts for most of the strength increases observed in the initial stages of all strength training [8]. Those who are exposed to repeated bouts of resistance training generate significant strength gains with minimal hypertrophy early in the process. The body achieves this via synchronous activation (the ability to recruit more muscle cells in a simultaneous fashion) and reduction in neural inhibition (a natural response of the central nervous system to feedback signals arising from the muscle) [9]. Inhibition allows muscle to avoid overworking and potentially damaging itself due to unaccustomed load. This response is rapid as it utilises the nerve and muscle cells already present. These adaptations are in direct contrast to the untrained muscle in which atrophy (muscle wastage) and reduced neural drive are typical.What this all boils down to is that following a period of strength training there is an increase in absolute motor unit recruitment resulting in a lower relative intensity of that muscle unit to deliver the same outcome as previous. If the bouts are habitual and frequent enough, muscle cells hypertrophy and become larger, increasing their ability to generate force. As a result, the trained muscle will be able to recruit a higher threshold of larger motor units. Combine all of this with an enhanced stretch shortening cycle and you have some excellent adaptations to improve running efficiency.

With respect to the dosage, the Blagrove paper suggested, a strength training intervention, lasting 6–20 weeks, added to the training program of a distance runner appears to enhance running efficiency by 2–8%. In real terms, an improvement in running efficiency of this magnitude should theoretically allow a runner to operate at a lower relative intensity and thus improve training and/or race performance. Improvements were observed in moderately-trained, well-trained and highly-trained participants, suggesting runners of any training status can benefit from strength training. For the particulars of the dosage, exercise selection and periodisation, check out Part 2 blog post.

Until next time, continue to Praxis What You Preach…

Prevent. Prepare. Perform.