If you caught Anna X Sitar’s recent Miami run recap, you saw a runner girly’s nightmare play out in real-time.
One minute, it’s aesthetic yellow running set fits, oatmeal orders, and the excitement of a new route in the Miami humidity. The next minute, pain hits, and the Happy Pace run club is forced into a walk break.
Shin splints 😭.The uninvited guest that haunts nearly every runner at some point.
The comments section on her post was exploding with theories: from stopping stomach sleeping, to avoiding narrow-toe shoes, to doing heel raises on a curb before running.
But while the internet ponder on sleep positions, the scientific community have also recently been debating how we manage this type of pain: a brand new editorial published in the Journal of Orthopaedic & Sports Physical Therapy (2025) argues that pain we often used to call "Shin Splints" or "Medial Tibial Stress Syndrome" should maybe be renamed, rethought, and rehabbed differently.
The old advice was "stop running until it doesn't hurt." The new advice? Keep going (but follow some strict rules).
Here is the science-backed breakdown, the "super shoe withdrawal" phenomenon, and the protocol that a lot of my physio friends had no idea about.
⚠️ The Important "Bestie" Disclaimer
Before we dive into the "gatekept" science, we need to have a serious talk. I am a science nerd who reads the British Journal of Sports Medicine for fun; I am not your doctor.
Bone stress injuries are serious. If you ignore a stress fracture, it can become a full break that requires surgery and months on the couch. The information below is for educational purposes to help you understand your body, but it is not medical advice. If you have severe pain, pain at rest, or pain that makes you limp while walking, please go see a physio or sports doc immediately. We want you running for life, not just for this training block.
1. The "Super Shoe Withdrawal" Is Real
Anna hit on a biomechanical issue that sports medicine professionals are currently being bombarded with. She mentioned she usually runs in the New Balance SC Elites (a carbon-plated super shoe) for every single run, but decided to switch to a standard trainer to "save them."
The result? Immediate pain… but why?
The Science: Carbon plates act as a lever. They improve your running economy by doing a significant amount of the mechanical work for you. Specifically, they offload the soleus (the deep calf muscle) and the toes. When you run in super shoes exclusively, your calves get a "holiday." They don't have to work as hard to propel you forward because the stiff plate provides that "pop."
When Anna switched back to a normal, more flexible shoe, her soleus suddenly had to handle a load it hadn't felt in months.
The soleus attaches directly to the tibial fascia. When that muscle is fatigued or "surprised" by a sudden spike in workload, it pulls excessively on the connective tissue of the shin. It wasn't the Miami heat; it was most likely the shoe swap.
2. The Name Change You Need to Know
For years, we called it "shin splints" (which is too vague) or "medial tibial stress syndrome / “MTSS" (which sounds terrifying).
The Science: The term "MTSS" is misleading because it implies there is actual damage to the bone. But imaging studies show that a lot of people with pain actually don't have structural bone damage, while some people without pain do (make that make sense).
The New Name: The scientists are proposing LIMP (Load Induced Medial-Leg Pain). Yes, the acronym is unfortunate 😫. But the meaning is empowering.
Load Induced: It happens because you did too much, too soon (hello, Super Shoe withdrawal).
Pain: It is a pain signal, not necessarily a broken bone.
This distinction matters because if you think your bone is breaking, you stop moving completely (which weakens the tissue). If you know it’s just a "load management" issue, you can fix it while still training.
3. The "Stomach Sleeping" Theory (Debunking the Comments)
In the comments, a reader dropped a theory that sounds like an old wives' tale: "My coach asked if I ever slept on my stomach... apparently people who sleep on their stomach... are more likely to get shin splints."
The Verdict: SORT OF TRUE (but probably not really). This is one of those insider tips that coaches have circled for years, but rarely make it to the mainstream.
The Science: When you sleep on your stomach, your feet are usually pointed (plantarflexion). This potentially keeps your calf muscles (gastrocnemius and soleus) in a shorter position for 6-8 hours a night. Limited ankle dorsiflexion range of motion is a top risk factor for medial tibial pain… but it’s really hard to prove if sleeping on your stomach is the actual cause of that (it’s probably several other more obvious things). If you wake up with tight calves, you might start your run with altered mechanics. Your heel might lift too early, potentially forcing the tibia to absorb more shock than it is used to.
The Fix: This is not medical advice nor supported by science, but old coaches’ tips might suggest that if you’re a tummy sleeper, scoot down so your feet hang off the edge of the mattress (keeping the ankle neutral). It looks weird, but your shins might thank you.
4. The "Red Flags": How to Know If It’s Serious
Before you try to rehab this yourself, you need to rule out a bone stress injury. Here are the home tests and signs that indicate you need to stop running immediately and see a professional to get an X-ray/MRI.
🔴 The "Pin-Point" Test: Press your finger along your shin bone.
Safe-ish: If the pain is spread out over a large area (like 5cm or more) and feels like a dull ache or bruise, it is most likely LIMP (soft tissue irritation). You should still seek advice from a medical professional.
DANGER: If you can find one specific spot (the size of a coin) that makes you jump through the roof when you press it, that is a classic sign of a stress fracture. Stop running.
🔴 The "Night Pain" Test: Does it throb when you are lying in bed, doing absolutely nothing?
DANGER: Pain at rest is a major red flag for bone pathology. LIMP usually only hurts when you move or load it.
🔴 The "Hop Test": *
The Test: Hop 10 times on the painful leg on a hard surface.
The Result: If you cannot land the hop because of sharp, shooting pain, do not try to "tough it out." That is your bone telling you it cannot handle impact.
5. The Athlete Girl Protocol: The "LIMP" Fix
If you passed the Red Flag check (pain is diffuse, no night pain, hopping is uncomfortable but doable) and been assessed by a clinician, here is the 2025 Delphi Consensus (Hoenig et al.) protocol they might use to start with to keep you moving if they’re up to date with the latest science. Remember, every person is different!
Step 1: The "24-Hour Rule"
This is the part that might shock a lot of runners. Previously, we have always been told to rest completely. New science says total rest decreases tissue tolerance. You need to load the tissue to tell it to get stronger.
The Rule: You might be allowed to run with mild discomfort (up to 3/10 pain) during the activity.
The Check: The crucial metric is the next morning. If the pain is worse the next morning than it was the day before, you exceeded your capacity. Dial it back. If the pain returns to baseline the next day, you are in the "Safe Zone" for adaptation.
Step 2: Biomechanical Hacks
The research suggests two main ways to reduce the "load" immediately without stopping the run:
Increase Cadence: Increasing your steps per minute by 5-10% reduces the vertical loading rate (impact) on the tibia significantly. Think "quick feet" to stop over-striding.
Shorten Stride: Landing with your foot too far in front of you acts as a brake. Land under your hips.
Step 3: The "Soleus" Lift
A commenter suggested heel raises, but here is the specific detail that matters:
Straight Leg Raises: Target the Gastrocnemius (the big calf muscle).
Bent Knee Raises: Target the Soleus (the deep muscle usually responsible for shin pain).
The Prescription: You need to do Seated Calf Raises (knees bent at 90 degrees) with heavy weight. This conditions the soleus to handle the load, so your shin bone doesn't have to.
The Takeaway: Anna didn't need to panic, and neither do you. She likely experienced Load Induced Medial-Leg Pain (LIMP) because her calves were surprised by the lack of a carbon plate.
Don't let LIMP stop you. Pass the Hop Test, respect the 24-hour rule, and load those calves!
xx, Athlete Girl
Sources: Anderson LM, et al. Medial tibial stress syndrome needs a new name—Make no bones about it. J Orthop Sports Phys Ther. 2025. Hoenig T, et al. International Delphi consensus on bone stress injuries in athletes. Br J Sports Med. 2025. Warden SJ, et al. Optimal load for managing low-risk tibial and metatarsal bone stress injuries in runners. J Orthop Sports Phys Ther. 2021.
