Conditioning: Phase 2

The following is the second of four phases that will guide you from shin splints toward healthy running. Progress from each phase as instructed.

Duration: 2 Weeks (at least)
Goal: Introductory Loading and Strengthening
Frequency of Exercises: 3 x per week (day off in between unless otherwise specified).
Warm Up: For at least 5 minutes before activity (e.g. Pre-Run Warm up).

Anterior Tibialis Exercise (With Band): (if pain at front of shin) 3 x 10 reps. In a long sitting position with your uninvolved knee bent, place a band on the toes and the other end anchored to a door, couch, etc. Slowly bring up the toes into resistance, and then slowly come back down. Pain should not exceed 2/10, and there should be no lingering soreness the next day. Purpose: gradually increase load on anterior tibialis to build up resilience.
Posterior Tibialis Exercise (With Band): 3 x 16 reps. On a smooth surface, place a towel under your toes, keeping your heel on the ground). Wrap a band around your toes, and anchor the other side of the band on a door or other structure. Place your hands in between your knees to prevent the knees from moving. Keep your first toe down on the ground and rotate your ankle inward slowly, then back out. You should feel this on the inner part of your calf. If you feel it in the hip, you are rotating your leg too much. Purpose: strengthen posterior tibialis, which helps support the ankle and counter excessive pronation.

Side Planks: 3 x 30 seconds. On your side, bring your elbow below your shoulder and come up on your feet. Keeping your body in a level position, hold this position for at least 30 seconds or until fatigue. If it is too difficult, you can start on your knees. Purpose: increase hip strength and lateral core stability to reduce knee caving inwards and foot pronation when running.
Front Plank: 3 x 30 seconds or until fatigue. On your elbows and knees, bring your knees off the ground and hold. Try to keep your body level throughout this exercises by keeping your hips level and engaging your abdominals and glutes. Keep your elbow below your shoulders and push up to engage your scapular muscles. Purpose: strengthen core and glutes for running form stability.
Single Leg Balance (Arch Up): If too difficult, you can use a finger on a wall for support. Keeping your heel and toes on the ground, focus on bringing your arch up a little and hold that position as best you can for 30 seconds. You should feel the muscles working along the arch and calf. Purpose: increase recruitment and strength in the ankle/foot muscles supporting the arch.

Arch Exercise (3 Parts): Think of your sole as having three key points of contact with the ground: two points on the ball of the foot and one at the heel. Stand with your feet shoulder-width apart and lift up all your toes. Hold that position for 10 seconds, maintaining the three-point anchor and a stable curved arch. Next, still maintaining the sole’s 3-point connection to the ground, lift up your big toes while keeping the little toes down for 10 seconds. Finally, bring your big toes down with little toes up, watching that your foot does not rotate inward, collapsing your ankle. Hold that for 10 seconds. If difficult, you may have to train your toes by positioning them with your hands. Purpose: improve arch posture and tissue strength to absorb the impact forces of foot strike while stabilizing the foot and shin muscles.
Arch & Shin Exercise (3 Parts): Standing with your feet and knees together, assume a crouched position balanced on your forefeet while you sit on your heels. You should primarily feel your arch and toe muscles working to stabilize your weight. Your legs should be mostly relaxed while doing so. Hold that position for 10 seconds and then slowly lower your knees to the ground. Briefly hold that position and then return to the first position. Finally, shift back to your heels while maintaining a tight crouched position. Here, you should feel your front shin muscles working the hardest. Purpose: strengthen feet and shin muscle groups.

Calf Raises (Ball Between Heels): 3 x 16 reps. Place a ball between your heels/ankles while on a step. As you come up, keep the ball stable in between your ankles. Go up on your toes and back down. Purpose: Put more demand on ankle and calf muscles for stability.
Walking and/or Biking; can begin Run/Walk Progression.
Stretching: 1 minute per side.
- Gastrocnemius: Standing with one foot back, place your toes on a half roll or rolled up towel to increase stretch. Lean forward while keeping your knee straight.
- Soleus: Next, holding a split stance, bend your knee and get a lower stretch. Purpose: improve calf mobility to decrease strain on the anterior tibialis.
Foot Stretching (3 Parts): Keeping your feet and knees together, sit on your knees with an emphasis on the balls and toes of your feet, and place your weight back onto your heels. You should feel your arches stretching. Next, settle your weight on the knuckles of your toes, which should stretch the top of your feet. If painful, shift some of your upper body weight off the heel. Finally, plantar flex your foot so as to rest your weight on the front of the ankle, thereby stretching your shin muscles. Purpose: improve foot and ankle flexibility while also removing tension.

TO GRADUATE TO PHASE 3

Required: Can walk level ground for 30 minutes without pain in shin
Required: None to very minimal tenderness from palpation (touch) along front or inside of shin
Required: Single leg heel raises and anterior tibialis loading (with resistance band) x 12 reps without pain for at least 4 exercise sessions

Principles of Shin Splints: A Review

CAUSE – overloading the muscle attachment to the bone of the shin (tibia), generally rooted in muscle weakness from either the soleus, tibialis anterior, and/or foot arch
NEED – manage pain, such as by self-massage and/or icing, and strengthen mechanics
PLAN – once pain is reduced, progressively load and strengthen the tissue

Still Need Help?

You are welcome to meet virtually with our PT for additional feedback and assessment. Otherwise, continue to the next step to learn how best to manage the pain from your injury.