Ask the Experts: Prevent Injuries

What are shin splints and how can I prevent them?

Also known as medial tibial stress syndrome, shin splints are another overuse injury that affects the lower leg. Shin splints have been cited as the most common cause of leg pain in runners. Pain develops on the medial (inside) of the shin (tibia), usually along the lower two-thirds of the leg. At the onset of shin splints, you may feel pain that subsides after the beginning of exercise, only to recur after the workout.

Shin splints can be caused by factors such as harsh running surfaces, poorly cushioned footwear and training plans that rapidly increase mileage. Anatomical variables that predispose an athlete to developing shin splints are strong or inflexible calf muscles and excessive pronation (inward roll) of the feet.

Preseason conditioning may be the most effective measure in prevention, with a focus on building a solid base of flexibility and strength. Pay special attention to flexibility in the gastrocnemius and soleus muscles in the calf. Strengthening the ankle dorsiflexor muscles (the muscles responsible for tilting the foot up at the ankle) will help to balance the muscles on the tibia. Preventing pronation of the feet through the use of arch-supporting insoles can also help.

If you start to develop this painful condition, reduce your training mileage and intensity significantly until walking is pain-free. During this period, you can maintain fitness through cross training.

Running in the deep end of a pool is particularly effective because it provides resistance without requiring your shins to bear any weight. Manage the pain with an ice massage. I also recommend women take a calcium supplementation of 1,500 mg/day.

After pain is gone, return to training at half the pre-injury volume and progress in 10 to 15 percent increases. Be sure to stretch, strengthen, and correct anatomical misalignments to prevent shin splints from reoccurring. If pain continues, follow up with a physician.

I am a triathlete and dread getting on my bike because of how sore my neck, wrists and shoulders get after a long ride. What can I do to reduce this soreness?

Neck and back pain are a frequent complaint among cyclists. Neck pain is especially common among triathletes who ride in a deep aerodynamic tuck. The goal of this position is to make the back completely flat, but even with aero bars, not everyone can easily achieve the proper position.

Attaching aero bars to an existing setup is one of the most common mistakes made by beginning triathletes. This position places the hip angle in an extreme bend, and forces the elbows in front of the shoulders, requiring the neck muscles to work especially hard to look ahead.

Strengthening the abdominals, lower back, hamstrings and muscles in the back of the shoulder blades should help reduce neck pain. If this fails, find a good sports medicine doctor or physical therapist.

You may find the aero position still places too much pressure on your elbows, causing neck pain, and even a regular riding position may place too much pressure on your wrists. In this case, you may have to revert to a more upright riding position. Raise your handlebars and/or shorten your stem to decrease some of the strain on your arms. Your body weight should be distributed roughly 60 percent over the back wheel and 40 percent over the front wheel.

Michael Ross is a sports medicine physician practicing in the Philadelphia area. He's the author of Maximum Performance: Sports Medicine for Endurance Athletes and Maximum Performance for Cyclists. He can be found on the Web at
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