Shin splints

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at July 31, 2016
StartDiseasesShin splints

Shin splints are a common ailment among runners, characterized by aching shins and pain after running or sprinting. Causes include tiny stress fractures in the lower leg, flat feet, muscles that are inflamed from overuse, or weak hip muscles. Treatment is generally easy and effective. Medial tibial stress syndrome (MTSS) is the medical term for shin splints.

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Definition & Facts

Shin splints is a condition which causes pain in the lower leg below the knee. These pains may occur on the inside of the leg, which are known as medial shin splints. They may also occur on the outside of the leg, in which case they are called anterior shin splints. 

Shin splints is a sports injury that affects many athletes, including those who run or play tennis, soccer, football, or other sports involving running and strength training of the legs. Other high-impact activities such as dance or aerobics can also cause a large amount of people shin splints.

Generally shin splints are caused by overworking muscles through increasing distance or intensity before building up muscle strength, or suddenly switching running surfaces. Less proficient athletes are more prone to shin splints, as are military personnel who have not exercised regularly. Studies also show women suffer from shin splints two to three times more than their male counterparts. 

Symptoms & Complaints

Shin splints cause generalized pain along the lower part of the tibia, usually to the side of the central tibia. This pain often appears in an area about four to six inches in length (10-15 centimeters). Often only one shin is affected, and it is usually on the dominant side.

The discomfort may begin as a dull ache but with continued use may escalate to a sharp pain that could require stopping the exercise routine or activity. The soreness may occur at the beginning of the exercise period, lessen somewhat, and then return at the end of the workout.

It is important to recognize the difference between shin splints and a stress fracture. Shin splints are a generalized pain as opposed to a stress fracture, which is a precise spot of excessive pain. Shin splints will feel more painful in the morning since the leg muscles have tightened up during the night. A stress fracture will feel less painful because the bone has relaxed overnight. Flexing the foot increases the pain of shin splints.

Causes

Shin splints may be caused by a number of circumstances. These include worn or inadequate shoes, lack of stretching before exercise, running on a slanted or hard surface, or always running in the same direction around a track. They occur more often in newer runners because the shin bone has not yet adjusted by becoming stronger in response to the new demands on it.

The pain is caused often by repetitive stress on the bone, muscle tissue inflamed by micro-tears, and possibly weak hip muscles. Usually the condition occurs in those who have recently begun exercising or those who have suddenly changed or intensified their workout routine.

Diagnosis & Tests

If the common self-administered treatments do not alleviate the pain it may be necessary to consult a physician. In order to ensure the pain is caused by shin splints and not a stress fracture, a professional may run a finger along the bone to test for a specific area of sharp pain. A localized point of pain may indicate a stress fracture instead of shin splints. X-rays may be needed to confirm the diagnosis. 

Treatment & Therapy

The primary treatment for shin splints is rest to allow the inflamed tissue to heal. It may be necessary to stop the high-impact activity completely for a period of time. If the pain is not too acute, reducing training may be enough to ease symptoms. Some athletes opt for cross-training to relieve stress on the shins.

Wrapping the affected area with elastic therapeutic tape, a bandage, or a neoprene sleeve may also hold muscles tight against the shin and reduce pain. Other effective treatments include:

  • Icing the painful area to reduce inflammation. Wrapping ice packs in towels and holding against the area for approximately 15 minutes every two hours or more if needed can help.
  • Taking an nonsteroidal anti-inflammatory drug/pain reliever such as ibuprofen, acetaminophen, or naproxen while keeping in mind that these medications may increase the risk of ulcers and bleeding, and should not be used in excess.
  • Stretching the calves and Achilles tendons gently in range of motion exercises while being careful not to overstretch.
  • Wearing the right running shoes. Using orthotics if needed, especially in cases of fallen arches can help treat or prevent shin splints.
  • Physical therapy. Consulting a physical therapist to determine if one's running position or other leg concerns may be causing the pain. A physical therapist may also be able to recommend an individualized plan of exercise and stretching to relieve pain and prevent future shin splints.
  • If the condition does not improve, the patient should consult a physician. Untreated, shin splints may lead to a more serious stress fracture. The doctor may order X-rays to check for fractures.

Prevention & Prophylaxis

There are several ways to prevent shin splints. Runners should be sure to warm up before exercising. Including exercises which focus on stretching and building the strength of the hips and ankles will help prevent shin splints. Exercises such as standing calf raises will help strengthen calf muscles.

Wearing shoes with adequate support for all areas of the foot can help prevent shin splints. Orthotics may be necessary, especially in the case of flat feet. After working out, stretching the leg muscles is important. One should immediately stop running if pain reoccurs in the shins.

If running on a slanted surface such as a road or track, one should switch directions to run on the same side of the road or opposite direction on the track. In order to reduce the amount of stress on the tibia during running, experts recommend increasing running stride by 10%. The optimal stride per minute is 180 steps.

Gradually building up workout length, impact, and intensity over time to allow the body to adjust is the safest way to avoid sports injuries. Shin splints are often caused by working out too intensely and too quickly, so incorporating stretching into the routine is crucial. Easing the impact on the shins when the pain begins, and considering alternative exercising routines until the shin splints have fully healed are also means of prevention.