Shin Splints

  • Medical Author:
    William C. Shiel Jr., MD, FACP, FACR

    Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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Shin splints facts

  • Shin splints are a type of "overuse injury" to the legs.
  • The pain is characteristic and located on the outer edge of the mid region of the leg next to the shinbone (tibia). It can be extreme and halt workouts.
  • The diagnosis requires a careful focused examination.
  • A multifaceted approach of "relative rest" can restore a pain-free level of activity and a return to competition.
  • The relative rest approach includes a change in the workout, ice, rest, anti-inflammatory medications, stretching exercises, possible change in footwear, and gradual increase in running activities.

What are shin splints?

Shin splints are injuries to the front of the outer leg. While the exact injury is not known, shin splints seem to result from inflammation due to injury of the soft tissues in the front of the outer leg.

Shin splints are a member of a group of injuries called overuse injuries. Shin splints occur most commonly in runners or aggressive walkers.

What are risk factors for shin splints?

Risk factors for shin splints include running and over-training on hills, inadequate footwear for athletic activity, and poor biomechanics of the design of the legs and feet.

What are shin splints symptoms?

Shin splints cause pain in the front of the outer leg below the knee. The pain of shin splints is characteristically located on the outer edge of the mid region of the leg next to the shinbone (tibia). An area of discomfort measuring 4-6 inches (10-15 cm) in length is frequently present. Pain is often noted at the early portion of the workout, then lessens, only to reappear near the end of the training session. Shin splint discomfort is often described as dull at first. However, with continuing trauma, the pain can become so extreme as to cause the athlete to stop workouts altogether.

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Learn about treatment of shin splints.

Treatment for Exercise & Sports Injuries

Medical Author: Melissa Conrad St?ppler, MD
Medical Editor: William C. Shiel Jr., MD, FACP, FACR

Sports injuries refer to the kinds of injury that occur during sports or exercise. While it is possible to injure any part of the body when playing sports, the term sports injuries is commonly used to refer to injuries of the musculoskeletal system.

Some of the most common sports injuries include:

  • Sprains—tears to the ligaments that join the ends of bones together. The ankles, knees, and wrists are commonly affected by sprains.
  • Strains—pulls or tears of muscles or tendons (the tissues that attach the muscles to the bones)
  • "Shin splints"—pain along the outside front of the lower leg, commonly seen in runners
  • Achilles tendonitisor rupture of the Achilles tendon—These injuries involve the large band of tissue that connects the calf muscles to the heel
  • Fractures of the bones
  • Dislocation of joints

Acuteinjuries usually occur suddenly while participating in sports or exercise. They may result in sudden and severe pain, the inability to bear weight on a limb, or inability to move the affected part of the body. Chronicinjuries usually result from overuse of one area of the body over a period of time. Symptoms of chronic injuries include soreness, dull aching pain, and pain during participation in physical activity.

What causes shin splints?

A primary culprit causing shin splints is a sudden increase in distance or intensity of a workout schedule. This increase in muscle work can be associated with inflammation of the lower leg muscles, those muscles used in lifting the foot (the motion during which the foot pivots toward the tibia). Such a situation can be aggravated by a tendency to pronate the foot (roll it excessively inward onto the arch).

Similarly, a tight Achilles tendon or weak ankle muscles are also often implicated in the development of shin splints.

How are shin splints diagnosed?

The diagnosis of shin splints is usually made during physical examination. It depends upon a careful review of the patient's history and a focused physical exam (on the examination of the shins and legs where local tenderness is noted).

Specialized (and costly) tests (for example, bone scans) are generally only necessary if the diagnosis is unclear. Radiology tests, such as X-rays, bone scan, or MRI scan, can be helpful in this setting to detect stress fracture of the tibia bone.

What is the treatment for shin splints?

Previously, two different treatment management strategies were used: total rest or a "run through it" approach. The total rest was often an unacceptable option to the athlete. The run through it approach was even worse. It often led to worsening of the injury and of the symptoms.

Currently, a multifaceted approach of relative rest is successfully utilized to restore the athlete to a pain-free level of competition.

What is the multifaceted relative rest approach?

The following steps are part of the multifaceted approach:

  • Workouts such as stationary bicycling or pool running: These will allow maintenance of cardiovascular fitness.
  • Application of ice packs reduces inflammation.
  • Anti-inflammatory medications, such as ibuprofen (Advil/Motrin) or naproxen (Aleve/Naprosyn), are also a central part of rehabilitation.
  • A 4-inch wide Ace bandage wrapped around the region or a Neoprene calf sleeve also helps to reduce discomfort.
  • Calf and anterior (front of) leg stretching and strengthening address the biomechanical problems discussed above and reduce pain.
  • Pay careful attention to selecting the correct running shoe based upon the foot type (flexible pronator vs. rigid supinator). This is extremely important. In selected cases, shoe inserts (orthotics) may be necessary.
  • Stretching and strengthening exercises are done twice a day.
  • Run only when symptoms have generally resolved (often about two weeks) and with several restrictions:
    1. A level and soft terrain is best.
    2. Distance is limited to 50% of that tolerated preinjury.
    3. Intensity (pace) is similarly cut by one-half.
    4. Over a three- to six-week period, a gradual increase in distance is allowed.
    5. Only then can a gradual increase in pace be attempted.

What is the prognosis (outlook) for shin splints?

The extent of injury that occurs prior to any rehabilitation program plays a significant role in determining the time frame necessary for complete recovery. Generally, the outlook is excellent for full recovery, but physical therapy treatment can be necessary.

Can shin splints be prevented?

To the extent that shin splints are an overuse injury, shin splints can be prevented by gradually increasing exercise activities. Proper footwear can also help to prevent shin splints.

Medically reviewed by Aimee V. HachigianGould, MD; American Board of Orthopaedic Surgery

REFERENCES:

Koopman, William, et al., eds. Clinical Primer of Rheumatology. Philadelphia: Lippincott Williams & Wilkins, 2003.

Ruddy, Shaun, et al., eds. Kelley's Textbook of Rheumatology, 6th ed. Philadelphia: Saunders, 2001.

Last Editorial Review: 10/28/2015

Reviewed on 10/28/2015
References
Medically reviewed by Aimee V. HachigianGould, MD; American Board of Orthopaedic Surgery

REFERENCES:

Koopman, William, et al., eds. Clinical Primer of Rheumatology. Philadelphia: Lippincott Williams & Wilkins, 2003.

Ruddy, Shaun, et al., eds. Kelley's Textbook of Rheumatology, 6th ed. Philadelphia: Saunders, 2001.

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