Shin Splints

Medically reviewed & edited by Dr. Max Trotz,
MBBS (State Examination), MRCP (Edin), DCH

Shin splints is a medical condition that is characterized by pain along the inner edge of the shinbone (tibia). It is technically known as medial tibial stress syndrome.  This injury is common among athletes in sports that involve a lot of impact, like running or jumping. Besides runners, dancers and military recruits often experience this injury as well.

Typically, shin splint treatment involves rest, icing, a gradual return to activity and the use of orthotics. Calf sleeves can be worn to apply compression to the injured tissues for pain relief and healing.

Shin splints usually develop over time as an overuse or repetitive stress injury. They are usually not traceable to a specific event, as is usually the case with a traumatic injury.

Cause

As stated above, shin splints usually affects athletes in sports that require plenty of running, jumping or other high impact activities. The resulting shocks cause repeated trauma to the connective muscle tissue surrounding the tibia (the larger of the two shin bones). More specifically, it is believed to be the result of traction of the tibialis posterior muscle origin on the interosseous membrane and tibia.  This, in turn, produces inflammation of the muscles, tendons and bone tissues surrounding the tibia. The area most frequently affected is the medial border near the junction between the middle and the distal third of the tibia.

Shin splints frequently develop after a sudden increase in the intensity of an athlete’s exercise routine. For example, athletes who suddenly increase their weekly number of training days or the length of training sessions may experience this injury.

Risk Factors

In addition to sudden increases in training intensity, the following can increase the risk of experiencing shin splints:

• Various problems with muscles in the lower leg and foot position. These include pes planus (flat feet) or unusually rigid foot arches and hyperplantarflexion;
• Training with poorly suited shoes (i.e.shoes without shock absorbing insoles)  or worn out footwear;
• Being an avid runner or dancer;
• Military recruits appear to face a higher propensity to develop the condition. This may be due to the transition from relatively sedentary civilian life to spending long hours running, marching and getting into shape as a soldier:
• Running up an incline or on hard surfaces;
• Previous leg injury
• A lack of calcium

Symptoms Of Shin Splints

As mentioned above, the primary symptom of shin splints is sharp leg pain, sometimes accompanied by swelling. The pain and swelling occur specifically along the medial (inner) edge of the tibia.

The tibia is the larger of the two bones in the lower leg. It is situated at the front of your lower leg, just ahead of the other bone (the fibula).

Shin splint pain can be either sharp or dull in nature. In addition, the patient may observe the following:

• Initially, pain is present only after running or exercise. However, with increasing severity, pain can be present both during and after physical activity as well as when climbing stairs
• Touching the painful area can further aggravate the pain.

Individuals who experience these symptoms should visit a doctor or sports medicine specialist for a formal examination and diagnosis.

Diagnosis & Treatment

Diagnosis

To make a diagnosis, a doctor will conduct a physical examination of the lower leg. He or she will need to identify the precise location of the pain and tenderness the patient is experiencing.

X-rays are not useful, since shin splints do not show up in them. An X-ray would only be indicated if a stress fracture needed to be excluded. It is sometimes difficult to distinguish a shin splint from a stress fracture on an X-ray. In these cases, a bone scan or an MRI scan can help to achieve this.

It is important to identify all the problems that may be causing the pain. If other problems are not detected, it may be difficult to attain complete healing of the shin splints.

Other potential problems that can contribute to the leg pain include tendonitis and stress fractures. Tendonitis in particular can produce pain similar to that caused by shin splints. An  MRI scan can help to determine if tendinitis or a stress fracture  may also be present.

Stress fractures are small cracks in the tibia produced by the stress of hitting the ground repeatedly at high force.

Another injury that produces symptoms similar to shin splints is chronic exertional compartment syndrome. This is a result of intense exercise that significantly increases intramuscular pressure, resulting in severe leg pain. Contrary to shin splint pain, however, the pain of chronic exertional compartment syndrome tends to recede when the exercise is over. Unlike tendinitis and stress fractures, this condition is usually diagnosed by measuring the pressure inside the leg before and after exercise sessions.

Treatment

As with many overuse injuries, doctors will first attempt treatment using a conservative (non surgical) approach. This will usually include:

• Recommending that the patient stops exercising for several weeks and rests instead;
• If the patient really wants to exercise, he or she can switch temporarily to lower impact activities like swimming or cycling;
• Applying ice or a cold compress to the lower leg. For example, 20-30 minutes at a time and at intervals of 2-3 hours can be effective in reducing pain and inflammation;
• For additional relief of pain and inflammation, using a non-steroidal anti inflammatory medication such as Advil or a different painkiller like Paracetamol;
• Applying compression to the leg by wearing a sleeve like the EmbioZ Leg Compression Sleeve or a compression shin splint such as the BioSkin Shin Splint;
• Elevation of the leg to limit and reduce any swelling. Keeping the foot at hip level when sitting or putting your foot on a pillow when in bed;
• Wearing shoes with greater shock absorption capabilities. Shoe inserts can also help by providing arch support to those with flattened foot arches;
• Exercises to stretch the lower leg muscles can help them to recover more quickly.
• Only resume training gradually. Stop as soon as you feel any pain and take another few days of rest before restarting exercise.

It is important to follow the doctor’s suggestions carefully. Individuals who fail to treat a shin splint injury properly can risk having the condition become permanent.

Surgery is reserved for cases where all other treatment options fail. The surgical procedure is a fasciotomy, whereby an incision is made in the tissue overlying the muscles of the lower part of the leg.

How To Prevent Shin Splints

Shin splints is a painful and unpleasant injury. So, it is only natural to ask whether and how it can be prevented in the first place. The normal suggestions are:

• Wear shoes with proper cushioning and arch support. The use of shock-absorbent insoles inside shoes and special insoles to correct over-pronation can be useful in certain situations. This is particularly important when exercising or playing a sport that requires high impact activity like running or jumping;
• Try to avoid sharp increases in training intensity. If you want to increase your fitness level, increase training intensity gradually. Graduated running programmes that build in rest days may help in this regard. Allow your body to adjust to each level before the next increase;
• Cross train by mixing high impact activity like running with lower impact exercises like swimming. This will allow your lower leg muscles to temporarily “rest” without bringing your exercise program to a complete halt.