What are shin splints?
Shin splints or Medial Tibial Stress Syndrome is the name often given exercise-induced pain in the lower leg.
What are the symptoms of shin splints?
The main symptom is pain in the shin area. The pain tends to be in the middle and lower shin and on the inner (medial) half. Pain first comes on after running or exercising, however, over time, the pain can come on during running or exercising. If severe, it may also occur when climbing stairs.
What causes shin splints?
Experts do not agree on the cause of shin splints. They are thought to be caused by overuse or over activity and typically occur in runners.
Some suggest that shin splints are caused by small tears in the structure of the membrane between the two bones of the leg below the knee (the tibia and fibula).
There are certain things that have been suggested that may make shin splints more likely, these include:
• A sudden increase in training frequency or intensity.
• A lack of calcium
• Hard running surfaces
• Running up an incline
• Previous leg injury
• Poorly fitting or inadequate running shoes that do not support the foot and ankles
• Various problems with muscles in the lower leg and foot position, including over pronation of the foot.
Do I need any tests?
X-rays of the affected area may be taken as part of any medical investigation in people with shin splints but are typically reported as entirely normal.
The main reason that your doctor may suggest an X-ray of your leg is to rule out a stress fracture in one of the bones. However, not all stress fractures show up on X-rays.
What is the treatment?
Rest. This is the main treatment for shin splints. This means avoiding any activity such as running that may have led to the shin splints.
Ice. Applying ice to your shin may help to relieve pain. You can make an ice pack by wrapping ice cubes in a plastic bag or towel. (Do not put ice directly next to skin as it may cause an ice burn.) A bag of frozen peas is an alternative. Gently press the ice pack on the injured part. The cold from the ice is thought to reduce blood flow to the damaged ligament. This may limit pain and inflammation. After the first application, me doctors recommend re-applying for 10 minutes every two hours (during the daytime) for the first 48 hours.
Elevation. Elevating the lower leg aims to limit and reduce any welling. Keep the foot up on a chair to at least hip level when you are sitting. It may be easier to lie on a sofa and to put your foot on some cushions. When you are in bed, put your foot on a pillow.
Painkillers. Analgesia such as paracetamol is useful to ease pain. It is best to take these regularly initially. Anti-inflammatory painkillers are an alternative. There are many types and brands – for example, ibuprofen. They relieve pain and may also limit inflammation and swelling. Side-effects sometimes occur with anti-inflammatory painkillers. Stomach pain and bleeding from the stomach are the most serious. Some people with asthma, high blood pressure, kidney failure, and heart failure may not be able to take anti-inflammatory painkillers.
What is the outlook (prognosis)?
With rest and treatment, you can fully recover from shin splints. However, they may return (recur) if you do not look at the underlying cause of your shin splints.
When you have recovered from your shin splints, you may benefit from seeing a specialist such as a sports physiotherapist or podiatrist. They may be able to help you to modify your exercise programme and may also be able to assess your legs, feet and shoes. This may show up some problems that may have caused your shin splints, such as over-pronation of your foot or poorly fitting training shoes. They may suggest the insertion of an insole inside your shoes..
Can shin splints be prevented?
Studies and trials have been done to look at preventing shin splints. No single prevention method has been found to be consistently effective and further trials are needed. However, one of the things that does show some promise is the use of shock absorbent insoles inside shoes while you are exercising. Special insoles to correct over-pronation of your foot (if you have this) may also be helpful. You should also regularly replace your running shoes. Graduated running programmes that build in rest days may also help.
FURTHER READING AND REFERENCES
• Shin Splints/Medial Tibial Stress Syndrome: Wheeless’ Textbook of Orthopaedics.
• Craig DI: Medial tibial stress syndrome: evidence based prevention. J Athl Train. 2008 May-Jun43(3):316-8
• Story J, Cymet TC: Shin splints: Painful to have and to treat. Compr Ther. 2006 Fall32(3):192-5
• Craif DI: Current developments concerning medial tibial stress syndrome. Phys Sportsmed. 2009 Dec37(4):39-44
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Date of creation: May 2019
Date of review: May 2021