What is the Best Treatment for Anterior Tibialis Pain?

The anterior tibialis, or more accurately called the tibialis anterior is a muscle-tendon unit that runs down the front of your shin, just on the outside of your shin bone.

The tibialis anterior muscle is the meaty part of that unit, and the tibialis anterior tendon is the short sinewy piece that extends from the bottom of your shin diagonally across your ankle, attaching to the top of your foot next to the peak of your arch.

Its main function is to dorsiflex the ankle—pulling your foot up towards your knee.

If you have tibialis anterior tightness, you will already know it plays a small but crucial role in running.

Tibialis anterior tendonitis (tendinopathy) is the most common injury to cause anterior tibialis pain, but a tibialis anterior tear, known as a tibialis anterior muscle strain does occur on occasion.

Much like other tendon injuries, it presents as a dull aching pain along the front of the ankle or the lower shin, on the outside of the leg.

Initially, it may hurt only at the beginning of a run, then fade.

However, if the condition worsens, more running will cause more pain, and you may experience tibialis anterior pain at night.

If you are dealing with tibialis anterior pain, and want to find the best stretches, exercises, and treatment for tibialis anterior tendonitis, look no further, we will have everything you need to get you back to running as quickly as possible.

What does the tibialis anterior do?

After heelstrike, the tibialis anterior contracts eccentrically to slow the transition from heelstrike to mid-stance.

It also acts to stiffen the ankle during midstance, allowing your foot and ankle to store and return energy like a spring.

It also positions your foot to ready it for impact while your leg is still in the air, but these first two functions are the most important and most likely to result in injury.

Injuries to the tibialis anterior are not common.

A study of over two thousand injured runners included a list of the 26 most common injuries; tibialis anterior tendonitis or muscle strain was not among them.1

Anterior compartment syndrome, which can be mistaken for a tibialis anterior muscle injury, was included on the list, which highlights the importance of getting the diagnosis right.

How to Know If You Have an Tibialis Anterior Injury

Now:

There are a few other injuries that need to be ruled out when you have pain along the front of your shin or the front of your ankle.

The first is a simple fix—loosen up your shoe laces and make sure you are lacing them correctly.

Sometimes carelessly tying your shoes too tightly can cause “lace bite,” aggravation along the front of the ankle that can be mistaken for a true tibialis anterior tendon injury.

If you’re lucky, your tibialis anterior pain might have just been the result of a footwear malfunction.

The other two injuries that must be ruled out are more serious.

Anterior tibial pain vs. anterior tibial stress fracture

The first is a tibial stress fracture—not the run-of-the-mill kind, which occurs on the inside edge of the tibia, but one that occurs on the “leading edge” of the shin, or the anterior surface in medical terms.

These are problematic because they occur on the tension side of the bone.

What does that mean?

The stress of weight-bearing pulls the crack in the bone apart with each, making it very difficult for the bone to heal.2

Anterior tibial stress fractures cause a sharp, localized pain on the leading edge of the shin bone, and the spot will be painful if you push on it.

There might be some muscular tightness too, but a stress fracture will always be painful on the bone.

If you have bone pain on the front of your shin, you should definitely see a doctor—an MRI or bone scan might be needed to definitively rule out an anterior tibial stress fracture.

Anterior tibial pain vs. compartment syndrome

The final injury that must be ruled out is exertional anterior compartment syndrome.

This is important:

If you have persistent muscular pain on the outside of your shin, especially if it is accompanied by numbness, tingling, coldness, or a “full” feeling inside the muscle, you should also see a doctor.3

Exertional compartment syndrome occurs when the sheath that contains your tibialis anterior muscle is too small.

During exercise, as bloodflow to the muscle increases, the muscle swells up and presses against the sheath.  Pressure builds up inside the sheath, causing pain.

The good news is that compartment syndrome can be easily diagnosed via a compartment pressure test, which involves checking the intramuscular pressure with a needle during exercise.

Maybe not good news as such, but it is easy to diagnose if you have a medical professional you can trust to refer you to the right place.

Tibialis Anterior Pain and Tibialis Anterior Tendonitis Treatment

Assuming you’ve ruled out the above conditions and know that you are dealing with a case of anterior tibial tendinopathy or a simple muscle strain, you can move on to determining how to treat it.

Here’s the deal:

Due to the injury’s rarity, there are no scientific papers evaluating the efficacy of treatment methods.

However, since the tibialis anterior has a well-defined and simple role in running, we can devise treatments that follow the same universal rules that apply to all running injuries.

Our two goals should be to reduce stress on the injured area and make the injured area stronger and more resilient.

Reducing tibialis anterior stress

Reducing stress on the tibialis anterior is relatively easy.

Since the most demanding task it carries out is decelerating the rate of plantarflexion at the ankle during heelstrike, anything we can do to make the heelstrike less prominent and slow plantarflexion will help.

If you have tibialis anterior tendonitis, you might notice that your foot on the affected side sounds like it is slapping the ground very loudly when you run.

This happens because the muscle and tendon don’t want to expose themselves to the stress associated with decelerating that “slap-down.”

Two ways to battle this are wearing shoes with a lower heel-to-toe drop and running on a softer surface.

Lower heels create less mechanical leverage on the ankle at heelstrike, and a softer surface spreads out the “slap-down” of your foot over a longer period of time, easing the peak stress on the tibialis anterior.

Tibialis anterior tendonitis exercises

To increase the strength of the tibialis anterior, you should work to strengthen the muscle and tendon.

Fortunately, this is easy to do without any specialized equipment.

Two great exercises are heel-walks and toe raises against a wall.

To perform heel-walks, take off your shoes (preferably on carpet, grass, or another soft surface) and walk only on your heels, using your shin muscles to keep your forefoot off the ground.

You can start with three or four sets of ten meters, and increase the distance of each set over time as your strength improves.

Toe raises involve standing about one foot back from a wall, facing away from it.

Then, lean back until your shoulders rest against the wall.

Now, use your shin muscles to raise your forefoot off the ground, keeping your ankles, knees, hips, and shoulders in a line angling away from the wall.

This exercise works the tendon eccentrically, which is known to promote tendon healing.4

You can start with three sets of 15 repetitions slow and 15 repetitions fast, building to three sets of 30 repetitions slow & fast over time.

Other tibialis anterior tendonitis treatment

Though strengthening the tibialis anterior and reducing stress on it when you run should be the main focus of your rehab program, there are a few other things you can do that might help speed your recovery.

Here’s one inexpensive method worth a try:

Tibialis anterior tendonitis taping using kinesiology tape will reduce stress on the tendon.

Use a single strip of kinesiology tape, starting from the top of your midfoot and running along the length of the tibialis anterior tendon.

Apply full tension for the segment of the tape that crosses the ankle joint—you want to take advantage of the tape’s elastic properties to augment the tibialis anterior.

Calf sleeves or compression socks are worth a try too:

The compression and tactile feedback on the skin might help nudge your shin muscles along in the healing process.

Some runners find them useful for calf and Achilles tendon injuries, and given that the tibialis anterior is an analogue of that muscle-tendon unit on the opposite side of the body, it might be worth a shot.

Do Tibialis Anterior Injuries Require Time Off?

Realistically, you’ll probably need at least a few days off from running, even if you catch this injury early.

The rarity of tibialis anterior injuries in medical literature is, in some respects, good news.

How so?

It may be that evidence shows this injury heals relatively quickly, thus leading to relatively few runners seeking medical help for it.

Cross Training While Injured and During Recovery

Cross training is recommended while you're injured and as you slowly return to running.

The best form of cross training for this injury is Aqua Jogging. Studies have shown that aqua jogging can enable a well-trained runner to maintain running fitness for up to 4-6 weeks.

Aqua jogging is a form of deep water running that closely mimics the actual running movement.  Your feet don’t actually touch the bottom of the pool, so it is zero impact and safe for almost any type of injury. In my experience, the only time to avoid aqua jogging is when you have a hip flexor injury, which can be aggravated by the increased resistance of the water as you bring your leg up. Because aqua jogging closely mimics natural running form, it provides a neuromuscular workout that, in addition to aerobic benefits, helps keep the running specific muscles active. The same can’t be said for biking and swimming. The only downside to aqua jogging is that you need a pool that is deep enough to run in without touching the bottom. If you’re lucky enough to have access to a pool of this size, aqua jogging should be your first cross training choice.

In one study, a group of ten runners trained exclusively with deep water running for four weeks and compared 5km race times pre deep water running and post deep water running.

The researchers found no statistical difference in 5k time or other markers for performance, such as submaximal oxygen consumption or lactate threshold.

In a second study, researchers measured the effects of aqua jogging over a six week period.

This time, 16 runners were separated into two groups – one who did aqua jogging workouts and the other who did over land running.

Using the same training intensities and durations, the researchers found no difference between the groups in maximal blood glucose, blood lactate, and body composition.

It get’s better:

Research has also demonstrated that aqua jogging can be used as a recovery tool to facilitate the repair of damaged muscles after hard workouts.

These findings make aqua jogging an important recovery tool in addition to being the best cross training method for injuries.

Need one more reason?

The calories burned aqua jogging are even higher than running on land, so if you want to avoid weight gain while you take time off from running, this is definitely the exercise for you!

Aqua Jogging Workouts For Runners

If you're interested in aqua jogging to rehab your injury, then the absolute best way is to use one of my favorite programs, Fluid Running.

First, it comes with an aqua jogging belt and waterpoof bluetooth headphones so you have everything you need to aqua jog effectively.

Second, they have an app that pairs with the headphones so you can get workouts, guided instructions on how to aqua jog properly, and motivation while you're actually pool running.

This has been an absolute game changer for me when I am injured.

I used to dread aqua jogging workouts because they were so boring and it took all my mental energy to stay consistent.

But, with workouts directly in my ear, it's changed the whole experience and I actually look forward to the workouts. So much so that I now use aqua jogging as a cross training activity in the summer, even when I am not injured.

Fluid running is an awesome deal when you consider it comes with the belt (highly recommended for better form), the waterproof headphones (game changer for making pool workouts fun), a tether (to add variety to the workouts you can do) and the guided workout app (to make your cross training structure and a whole lot more interesting).

That's why we've partnered with them to give you 2 additional running-specific workouts you can load into the app when you use the code RTTT .

Check out the product here and then on the checkout page, add the code RTTT in the coupon field and the workouts will be added to your order for free.

If you'd rather do the aqua jogging workouts on your own, here are some great ideas to get you started!

Medium Effort Workouts

The Pyramid

10 minutes easy warm up - 1:00 hard, 30 seconds easy - 1:30 hard, 30 seconds easy - 2:00 hard, 30 seconds easy - 2:30 hard, 30 seconds easy, go to 5:00 in 30 second intervals and then come back down the pyramid (4:30 hard, 30 easy, 4:00 hard, 30 easy etc). Finish with 10 minutes easy cool down.

Wave your hands in the air like you just don’t care

10 minutes easy warm up, 1 minute medium (87-92% of maximum heart rate or what feels like tempo effort), 1 minute sprint (95-100% of maximum heart rate or all out sprint), 30 seconds hands in air (keep moving your legs in the running motion, but put your hand above your head), 1 minute rest, Repeat 10-15 times. 10 minutes easy cool down.

Hard Workouts

One of the difficulties of cross training is replicating those truly lung-busting, difficult workouts.

So, if you’re going to be pool running quite a bit due to injury or limited training volume, invest in a bungee cord designed for sprinters.

Tie one end of the resistance band to a sturdy object (pole, lifeguard stand, pool ladder) and bring the other into the water with you.

Put the strap around your waist and begin aqua jog away from your starting point.

You’ll begin to notice the bungee tighten and resist against you (depending on the length of your pool, you may need to wrap the bungee around the supporting object or tie it in knots to make it shorter to feel resistance).

Spend a few moments testing yourself to see how far you can pull the bungee.

This is a great challenge and a fun way to compete with yourself during an otherwise boring cross training activity.

Now for the hard part:

Pick a point on the pool wall or side of the pool that you feel stretches the bungee to a very hard sprint that you could maintain for 60-90 seconds.

This will be your “sprint” marker that you’ll use on sprint intervals (95-100% of maximum heart rate or all out sprint).

Now:

Find a point that feels like the end of a hard tempo run.

Mark this spot as your “medium” interval distance.

When you complete the hard workouts, you can use these reference points to ensure that you maintain a very hard effort.

The springboard

10 minutes easy warm up, 90 seconds easy (slowly moving out and stretching the bungee), 2 minute medium, 1 minute sprint, 1 min rest (let the bungee pull you back – this is kind of fun). Repeat 10 times. 10 minutes easy cool down.

The race simulation

10 minutes easy warm up, 90 seconds easy (slowly moving out and stretching the bungee), 5 minutes medium (focus and concentrate, just like during the hard part of a race), 30 seconds sprint, 2 minutes rest. Repeat 4 times. 10 minutes easy col down

The lactic acid

10 minutes easy warm up, 90 seconds easy (slowly moving out and stretching the bungee), 2 minutes sprint, 90 seconds rest. Repeat 12 times, 10 minutes easy cool down.

I guarantee that with the bungee, you’ll get your heart rate through the roof.

You can challenge yourself and make aqua jogging more fun by seeing how long you can stay at your maximum stretched distance or seeing how far you can push it.

Likewise, if you have a friend who is injured (or someone willing to be a good sport) you can try pulling each other across the pool for some competitive fun.

Cross training can be tough, especially when you’re injured or want to be increasing your volume faster.

However, I hope that providing a variety of workouts, either through the Fluid Running app (which also makes it easier to keep track of the workout while in the water) or on your own can add a fun challenge in the pool and you can emerge from your injury with minimal fitness loss.

Returning to running after tibialis anterior injuries

Even though there are no specific guides to returning to running following tibialis anterior injury, we can use protocols developed for other tendon injuries.

It appears to be safe to run on a tendon during the healing process, as long as the pain is only mild, and does not get worse day to day.

One study stipulates that pain must be below a “5 out of 10” on a pain scale, where 10 is “worst pain ever” and 0 is “no pain at all.”5  Brad Beer backed this up in our injuries special podcast episode.

This is important:

Pain must not get worse week to week, and pain must not persist the next day.

If these conditions are not met, you need to back off your running.

What’s the bottom line?

As long as you’ve ruled out other injuries in the same area, tibialis anterior tendonitis or muscle strain doesn’t need to keep you on the sidelines for long.

Focus on reducing stress on the tibialis anterior by wearing shoes with a lower heel and sticking to softer surfaces when you run, and increase the tendon and muscle’s strength by doing heel walks and wall toe raises.

Optionally, you can try kinesiology taping and compression wear to help speed your recovery.

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