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Fix Your Shin Splints (Medial Tibial Stress Syndrome) By Seth Donelson (DPT)

Stew smith overuse injury physical therapy running shin splints

Shin Splints (Medial Tibial Stress Syndrome)
By Seth Donelson (Doctor of Physical Therapy)

It never fails, emails and DMs blow up every Spring (well about a month into Spring) concerning shin splints.  Learn more about your new nemesis and "fix your shin splints."

This article was submitted by our local Physical Therapist Seth Donelson who trains with my group here in Maryland. Not only are we excited to have him join us and experience our workouts, but also he assists by providing common injury articles such as this:


This document covers basic information about how shin splints occur, how to identify them, and ideas to guide treatment and prevention. There are 2 graphics that summarize the risk factors for shin splints and identification/treatment, but I highly recommend you review the written information as it contains more detailed information. This is not a substitute for medical care or advice. If you’re unsure of the severity of your condition or feel it may be more serious, then seek out professional medical care.

Pathophysiology and Risk Factors:

Shin splints, formally known as Medial Tibial Stress Syndrome (MTSS), are typically classified as early stress injuries. Stress injuries are generally believed to be on a continuum with shin splints being the least severe while stress fractures are the most severe (1). Shin splints are stress reactions that occurs from the muscles of the lower low pulling on the tibia (shin). This pulling action causes inflammation and remodeling on the outer surface of the bone. This process is normal, but shin splints occur when the bone cannot remodel fast enough, typically due to overtraining. (1,2,3)

Factors that are consistently linked to increased risk for stress injuries are significant increases in bone loading (i.e. dramatic increase in running volume or intensity), lack of calf flexibility, high Body Mass Index (BMI), increased pronation/arch collapse of the foot, a history of MTSS, inadequate nutrition, and inadequate recovery (1,2). Additional items to be considered are that weak muscles can absorb less impact during running and asymmetries between legs (foot strike pattern, strength, flexibility) may lead to differences in loading/impact capacity and altered running mechanics (3).

Prevention: (What Most People Get Wrong)

This is arguably the most important section to read. As there is not a best course for treating shin splints, preventing them is of the utmost importance. The key to prevention is gradual exercise progression and ensuring that you’re eating and resting enough to recover from your workout. You’ll want to be familiar with the 10% rule as this is going to guide your exercise progression.

  • 10% Rule - don’t increase your running and/or weight-lifting volume, intensity, or frequency by more than 10% per week. An example would look like this: you can run 10 miles a week while still feeling healthy and injury free; it’s safe and reasonable to add another mile next week or to increase your pace for one of your shorter run days by 1 mile (10%).

  • Nutrition – It’s generally recommended to consume 0.6 – 1.0 g/lbs of protein (1.4–2.0 g/kg), approximately 30% of your calories from fat, and the rest of your calories from carbohydrates. A sample from a 2000 calorie diet and 160 lbs person would look like this:
    • Protein – 384 – 640 calories or 96 to 160 grams
    • Fat – = 600 calories or 67 grams
    • Carbohydrates – 760 to 1016 calories, or 190 to 254 grams
    • This was based on a 2000 calorie diet. To determine how many calories you should be eating, you need to consider your resting metabolic rate (RMR) and your activity level. Calculators can be found online to give you a good estimate.

  • Rest/Recovery – Resting isn’t just about how much sleep you’re getting, it’s also about what activities you’re doing outside of your training routine. A key example is the person that runs 6 miles in the morning and then works a heavy manual labor job afterwards or plays volleyball for 2 hours in the evening. The stress on your body is cumulative from the whole day.

- Inflexible ankles and hips (see tread / mobility article for help)
- Poor quality shoes / improper foot / ankle support and alignment
- Start off with low volume (mileage) when beginning again.


Shin splints typically present as:

  • Vague, diffuse pain along the along the lower 2/3rds of the tibia (>5 cm span) associated with exertion (2)
  • Initially - pain is worse at the beginning of exercise and gradually reduces during training and shortly after stopping exercise (3)
  • Advanced - pain with less activity (slow jog or walking) and at rest (3)

Symptoms that may indicate a more severe or alternate condition

  • Bony tenderness, usually less than a <5 cm span
  • Bony tenderness on the front of the tibia
  • Cramping, burning, numbness, or tingling in the lower leg or foot
  • Swelling
  • Pain during normal daily activities


There is a limited body of high-quality research dedicated to treating shin splints/MTSS. Most of the treatment recommendations have come from clinical experience and expert opinion (3). As a result, prevention and early intervention are vital for maintaining high performance and function in the long term. It may be helpful to implement movements that help indicate your readiness for returning to running. If it is painful to walk or hop with both feet, then you’re not ready to run. If you can hop on one leg or run in place with no pain, then begin implementing running back into your routine.

Phase 1: Early treatment

  • Rest from running/loading 3-4 days at first sign of injury, or longer if injury has progressed
  • Ice for 15-20 minutes after activity
  • Cross train with low impact activities (i.e. biking and swimming)
  • Limit calf stretching to once a day or < 1:30 minutes total

Phase 2: Little to no pain

  • Reduce running/loading by 50% (volume, intensity, frequency) and gradually progress 10% each week in one of the three listed domains at a time
  • Address gait/running asymmetries
  • General stretching and strengthening of the lower extremities 2-3 days/wk (straight leg calf raises, bent knee calf raises, toe raises/heel walks, lunges, single leg hip thrust, squat, deadlift, plank variations)
  • Scale back exercises that cause pain

Phase 3: Full participation

  • Running and loading progressed with no pain
  • Recognize early signs of overuse injury and act early

Additional Resources to Maximize Learning:



1:  Kiel J, Kaiser K. Stress Reaction and Fractures. [Updated 2020 Aug 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from:

2: McClure CJ, Oh R. Medial Tibial Stress Syndrome. [Updated 2020 Aug 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: 

3:  Galbraith, R. M., & Lavallee, M. E. (2009). Medial tibial stress syndrome: conservative treatment options. Current reviews in musculoskeletal medicine, 2(3), 127–133.  

4:  Beck, B. R. (1998). Tibial Stress Injuries. Sports Med, 26(4), 265-279.


Where to Find More Information About Optimal Performance Training Programs

When you start training again, consider the seasonal tactical fitness model.  I call it A WAY to train and obviously not the only way to train. But it offers the opportunity to never neglect your weaknesses, helps with flexibility and mobility, but will also put you at a level of physical abilities where you are happy with your overall ability to just about anything. We have a systems where the seasons dictate our training. When it is nicer outside, we tend to run and do more calisthenics.  When it is colder and not so nice, we lift more, run, less, and still maintain our outdoor activities with shorter runs and rucks. Check it out: Seasonal Tactical Fitness Periodization System.  

My most recent programs that walk you through these four cycles with 12 weeks of each season in two programs. 

These Seasonal Tactical Fitness BLOCK Periodization programs will walk you through 4 x 4 weeks cycles with 16 weeks of each season in two programs. (32 total weeks)

The Specific Military / Special Ops Physical Fitness Workouts Where Optimal Performance Will Be Tested Each Day

Navy SEAL Workout Phase 1
Navy SEAL Workout Phase 2 - 3
Navy SEAL Workout Phase 4  Grinder PT
Navy SWCC Workout

Army PFT Workout (Prep For Rucking, OPAT, ACFT)
Army Special Forces / Ranger Workout
Army Air Assault School Workout
Army Airborne Workout


Advanced Running Program - Special Ops Supplement Plan
USMC OCS / TBS Workout


The Combat Conditioning Workout
Air Force PJ / CCT Workout  Battlefield Airman Prep Course
The UBRR Upper Body Round Robin Workout / Spec Ops version


The Coast Guard Rescue Swimmer / Navy SAR Workout
The Service Academy Workout (West Point, Navy, Air Force Academy)
The Navy, Air Force, Marine Corp Boot Camp Workout


The Law Enforcement Physical Fitness Workouts

The FBI Academy Workout  |   FBI Workout Vol 2  
The DEA Workout
The FLETC Workout - Ace the PEB
The PFT Bible: Pushups, Sit-ups, 1.5 Mile Run
The Fire Fighter Workout - Ace the CPAT


Online Coaching Options

Online PT CLUB - Weekly Workouts created personally for you.

New Member's Only Content / Services Program!

If you want access to years worth of workouts, many of the top eBOOKs, favorite workouts of the week, free fitness APP, closed Facebook Group, video / picture library of exercises, and more access to LIVE Q/A sessions check out the Stew Smith Fitness Members Section

The dashboard below has the links to all the information, archives, videos, and links to workouts, podcasts, live Q and A lessons. 


Do You Want my REAL TIME Seasonal Periodization Training - Delivered Weekly?

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Stew Smith Training programs. 

Stew Smith Fitness Membership – You have access to years of workouts for both beginner / intermediate and advanced / special ops levels of fitness. Each week you will receive new and unpublished workouts being tested by Navy SEAL veteran / Stew Smith CSCS and his local group of future tactical professionals in both basic training and advanced spec ops training programming. The latest videos, articles, and other programming will be part of the weekly data feed to members as well. We go through the Seasonal Tactical Fitness Periodization program one week at a time.

Join the Online PT CLUB:
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If You Need a More Personalized Approach to Fit Your Needs, Goals, Time per Day, Days per week, Facilities, Abilities, etc...

Try Online Coaching

Over weight? Out of Shape? Not meeting personal and professional standards of fitness and health? Try some one - on - one personalized assistance with your training goals and consider Online Coaching by Stew Smith CSCS. No matter what your goals, you and Stew will create a program together that works for you. 

VIDEO TESTIMONIAL:  Jim started with me several years ago needing help with his fitness and health. Over the years, we became friends and even business partners on a few joint ventures - I still send him weekly workouts. Here is a video testimonial that was placed in the middle of his podcast - I was shocked but wanted to share as it is a great story and quite typical of clients on any of the Online Training Programs.

Before You Buy - Give Stew a Call - There is a human behind this purchase! 410-271-0837 

and let Stew be your coach!

Or Questions?  Just email me at

Or Try Workout Programming Specifically Designed for any Tactical Fitness Goal:

Which Program is Right For Me - Special Ops Candidates 



Navy SEAL Workout Phase 1 Beginner Weeks 1-9 
Navy SEAL Workout Phase 2 - 3 - Intermediate Weeks 1-12
Navy SEAL Workout Phase 4 Grinder PT - Four weeks before Hell Week

Navy SEAL / SWCC, EOD, Diver Program Series - Phase 1 is what I call a beginner guide, but it is still challenging.  It is geared toward those who are scoring minimally or failing their Navy PST test - 500yd swim, pushups, situps, pullups, 1.5 mile run.  It is easier than The Complete Guide to Navy SEAL Fitness and a good prep course before attempting it. 

Phase 2 and 3 of the Navy SEAL / SWCC, EOD, Diver program is about the same level of intensity as Navy SEAL Fitness and is also a good follow-up plan after Phase 1

Phase 4 ot the Navy SEAL Key to Mental Toughness is by far my toughest workout ever created.  It resembles a day of BUDS, complete with "wet and sandy", runs after eating, high rep punishment push-ups, 4 mile timed runs, 2 mile swims with fins, log PT simulation, and even a HellWeek Simulator with 3 workouts a day.  

Navy SEAL Weight Training Book
Complete Guide to Navy SEAL Fitness Book

The Pipeline of Training Options: 


It depends:  The Complete Guide to Navy SEAL Fitness is a classic and focuses on high rep calisthenics and running and swimming base.  You will build up your running over 12-18 weeks to 20 miles but very fast paced focus on both the 1.5 mile run for the PST and the 4 mile timed run for weekly run test at BUDS. If you are an athlete with a strong power / strength background in lifting and not running or swimming, Navy SEAL Fitness is ideal for you. IF you need some place to start Navy SEAL Fitness is ideal for you as well because a calisthenics base / running / swimming progression is a good place to build a foundation.  Though you will likely need to spend some time in the Navy SEAL Weight Training Book OR if Navy SEAL FItness is too challenging, go with Navy SEAL SWCC, EOD, Diver, PST Phase 1 Workout.  Phase 1 is a good starting point if Navy SEAL Fitness program is too tough. 

Navy SEAL Weight Training - This is part two (winter lifting phase) of my SEAL Prep program. If you have done the Navy SEAL Fitness (12 weeks to BUDS) program a few times and need a break, this is the next program that integrates lifting with the Navy SEAL Prep training. 

Special Ops – Most of my programs tend to focus on getting TO and THROUGH a specific tactical training program. So you may see a mix of all the seasons in some of these books, but if you are training long term, you can take advantage of Seasonal Periodization and save yourself some of the over-use, long term pains that tend to follow many of the tactical preparations - especially on the spec ops level of training. 

Start training today with workouts that focus on the specifics of getting to and through tactical profession training from firefighter, police, swat, military to special ops. We have programs to help you get TO and THROUGH training.


Seasonal Tactical Fitness Programs 

Especially These That Are Used For Local Spec Ops Candidates Last Year


Tactical Fitness Series - Tactical Fitness, Tactical Strength, and Tactical Mobility is an ALL-encompassing program that focuses on lifting, calisthenics, run, ruck, swim, speed, agility, and flexibility / mobility. Many people focusing on USMC (OCS, RECON, MarSOC) Army Ranger / SF, Air Force Special Warfare, SWAT / Federal Law Enforcement, and Navy Special Warfare have done very well focusing on the Tactical Fitness Series and developing themselves into an all-round Tactical Athlete

The Warrior Workout Series - If you are solid with making your own workouts, but need some ideas.  This three part series has 300 workouts (100 / book) to pick from focusing on all the elements of fitness and training programs. Each book is organized with periodization cycles in mind along with calisthenics only, weights / calisthenics mix, cardio options and more. Warrior Workout 1   -  Warrior Workout 2  -   Warrior Workout 3. 

At - List of Products and Services

  1. FREE Articles
  2. Podcasts and Swimming Videos at page  
  3. eBooks
  4. Books and eBooks in PRINT
  5. Stew Smith Fitness Club membership site
  6. Online Coaching  


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