Shin Splints

Overview

By Sarah Maurer

Exercise is a great thing for your body. But working out too hard too soon can lead to shin splints, a painful swelling of the muscles, tendons, and bone tissue at the front of the lower leg.

tibia and lower legShin splints, also known as medial tibial stress syndrome, cause pain along the inside edge of the tibia, which is the larger of the two bones connecting the knee and foot. They typically come in pairs (one for each leg) and are caused by repetitive pounding movements such as running and jumping. For this reason, they're usually seen in athletes, especially those who are new to sports.

Shin splints are usually more annoying than dangerous. However, if left untreated, they can progress to stress fractures, which take much longer to heal. They can also be confused with other causes of shin pain, some of which can be dangerous if left untreated.

Shin splints are very common, accounting for about 60 percent of all overuse injuries of the leg. About 10 to 20 percent of runners develop shin splints at some point in their careers.

Causes

Shin splints are almost always caused by repetitive stress associated with weight-bearing exercise. They're most common in runners, gymnasts, dancers, and people undergoing intense military training such as boot camp.

Shin splints are very common in newer athletes who are just getting into a sport and those who are returning after some time off. They can also happen when you ramp up the duration, distance, or intensity of your workout too quickly (for example, running faster or for longer distances).

Other activities that increase your risk:

  • Exercising on hard surfaces
  • Making frequent starts and stops (such as when playing tennis or basketball)
  • Running on hills or uneven terrain
  • Exercising in worn out or inappropriate shoes (for example, running in court shoes).

People with flat feet or high arches are more prone to shin splints.

Symptoms

Shin splints cause pain along the front and inner part of the shin. This pain may be sharp or dull. It usually (but not always) appears in both legs around the same time. Touching or pressing the shin area may make the pain worse.

Shin splint pain is usually most noticeable during and after exercise. Severe shin splints may hurt all the time, even when you're resting.

Some people with shin splints also have mild swelling around the tibia.

Diagnosis and Treatment

Shin pain has many causes, some of which can be dangerous or long-lasting. For this reason, it's important to get any significant pain around the tibia examined by a doctor.

Shin splints are usually diagnosed based on history and physical exam. Your doctor may also order imaging tests such as X-rays, bone scan and MRI to rule out other possible causes such as:

  • Stress fractures – small cracks in the bone due to repetitive stress.
  • Tendinitis – inflammation of the fibrous tissue that attaches the muscle to the bone.
  • Chronic exertional compartment syndrome – a rare condition in which exercise causes pressure to build within the muscles.

The best thing you can do to treat shin splints is to rest. Avoid the activity that brought on the condition for 2-4 weeks. To keep fit and healthy, switch to low-impact exercises like walking, swimming, or cycling.

Other treatments for shin splints include:

  • Ice. Apply ice packs for 15-20 minutes four to eight times a day. Wrap the packs in a towel or place them over clothing to protect your skin.
  • Medication. Take over-the-counter pain relievers like ibuprofen or acetaminophen as needed to combat pain and swelling.
  • Compression. Wrap the affected area in an elastic bandage to prevent further swelling.
  • Footwear. Wear supportive shoes that cushion your feet as your shins heal. If you have flat feet, consider orthotics to provide additional support.
  • Physical therapy. A therapist or athletic trainer can help you stretch and strengthen the lower leg and plan for a gradual return to your sport.

Don't resume the problem activity until you've been pain-free for at least two weeks. For your first workouts, start at a very low intensity, distance, and duration and build up slowly. Be sure to warm up properly before the activity, and stop immediately if you feel pain.

With proper care, shin splints usually heal within 3-6 months.

Prevention

To keep shin splints from derailing your training, follow these safety tips:

  • Wear good quality, sport-specific shoes while exercising. Staff at specialty running stores can analyze your foot structure and stride and recommend shoe models that compensate for your weak areas.
  • Track your total run distance and replace your shoes every 350 to 500 miles.
  • If you have flat feet, consider wearing orthotics for additional arch support. Basic orthotics are available over the counter. These devices can also be custom-made to fit your foot.
  • When starting a new exercise program, build your distance, intensity, and duration slowly. 
  • Include some low-impact cross training in your program. Exercises like biking, walking, and swimming give your shins a rest while providing a good cardiovascular workout.
  • Do some strength training at least once a week. Exercises that target the lower leg such as calf raises are especially beneficial.

Sources

  • Shin Splints (Jan. 2014). Mayo Foundation for Medical Education and Research. Retrieved May 22, 2015 from http://www.mayoclinic.org/diseases-conditions/shin-splints/basics/definition/con-20023428.
  • Shin Splints (May 2012). American Academy of Orthopedic Surgeons. Retrieved May 22, 2015 from http://orthoinfo.aaos.org/topic.cfm?topic=a00407.
  • Shin Splints (2010). University of Illinois McKinley Health Center. Accessed May 22, 2015 from http://www.mckinley.illinois.edu/handouts/shin_splints/shin_splints.html.
  • Shin Splints – Self-Care (Nov. 2012). US National Library of Medicine. Accessed May 22, 2015 from http://www.nlm.nih.gov/medlineplus/ency/patientinstructions/000654.htm.