Question MarkLast week I got an email from Jeanne, who is an aerobics instructor. She was asking about one of the guys in her class and some pains that he has been having. If you have opinions or follow up questions then feel free to post in the comments below, and you can always email me about this topic or if you have any questions of your own that you would like me to answer.

This should probably go thru the website, but here it is anyway:

I had a member ask me today about pain in his legs and based on what he described and showed me, I think he has posterior shin splints. I suspect flat-footedness, but he also squats heavy and lifts heavy in general. He says the pain backs off after about a mile, but comes back. I think he said he ran about 8.5 on Sunday…

I told him ice for sure, which he is doing, and maybe some over the counter anti-inflammatory drugs and maybe 7-10 days of no running.

Any thoughts? Have you run into this before with any runners you know? Have you ever tried “arch-strapping”? I noticed that is a some-times cure for pain associated with flat-footedness.

I do think the guy is somewhat flat-footed.

What are posterior shin splints?

Posterior shin splits are a very common running injury. The most common culprits are excessively worn running shoes and doing too much hill or speed work before preparing your body for that sort of workout. He is probably suffering from tight calf muscles which is exacerbating the problem.

Posterior shin splints are an inflammation of the tendons that attach to the inner side of the shin bone and causes pain in the inner surface of your shin bone extending down to the arches in your feet. They can often mask an underlying stress fracture, especially when there is acute pain and swelling. If he does have a stress fracture, then the best advice is to take time off from running for at least a few weeks or even a few months.

How do I treat posterior shin splints?

Assuming that he does not have a stress fracture, then I would say that taking a few days off from running and getting some swimming or biking in should help a lot while maintaining his level of fitness. I would also cut back on speed work for at least a week or two. The first thing to do when nagging pains start to appear is to follow the RID or RICE methods of injury treatment. It is important to try and determine what is causing the pain in the first place, though, so that it will not return once he starts running full weekly mileage again.

He should start stretching his calf muscles after every run, whether his shins are hurting or not. Icing immediately after a run will help to reduce any swelling, as will ibuprofen. After icing to reduce the swelling, applying heat will bring fresh blood into the area which can aid in repairing any damage, but will also cause the swelling to come back. I don’t recommend heat when there is already swelling. My theory is to ice early and ice often. My favorite method of icing from the ease of use standpoint and the use of time standpoint would have to be giving myself a short ice massage in any tender areas. He should plan on icing for at least a few weeks after the pain has subsided.

How can I prevent shin splints from returning?

How many miles does he have on his running shoes? One of the first things that I do when I begin getting pains like that is to determine which pair of shoes have too many miles and retire them. I rotate between 4 and 5 different pairs of shoes at a time – they last longer both in a calendar sense and in a miles sense.

He may also want to make sure that he is wearing shoes that are appropriate for his particular gait. Different shoes are designed for different styles of running and account for different body types. He might want to go to a local running specialty stop and seek the help of an expert when replacing his shoes.

Does he wear his running shoes when he squats or does deadlifts? If so, he might want to consider doing those types of exercises in flat shoes or in his socks. Running shoes have a small lift at the heel which throws off your center of gravity and makes those types of exercises less effective and more dangerous. I am not so sure that they could be causing the problems in his shins, though.

What about my arches?

When I had some issues with plantar fascitis last year, I got a boot that I wear that stretches out my arch, and that helped a lot. I would wear it whenever I was sitting in one place for any length of time and when I went to bed. The last time that I had shin pains, though, was when I was in college and I had a stress fracture; I didn’t even know about those boots at that point. I am not sure whether something like that would help or not, but it is unlikely to hurt. I have never strapped my arches in preparation for a workout, though, so I can not really offer any advice on the effectiveness of that. Any time that I would have needed to, I opted to cross train instead.


I hope that this general advice is helpful, but if the pain doesn’t go away then he should go see his doctor or a sports therapist. I also want to point out that I am not a doctor and do not pretend to be one, and that the advice above is just how I would treat myself in a similar situation and what I have done in the past before resorting to professional help.