Shin splints are known by the medical term medial tibial stress syndrome. They are caused by repeated stress at the tibia (shinbone) area, leading to pain and soreness. It is most often seen in runners, athletes, and military personnel There are two types of shin splints: anterior and posterior (see Diagram 1 below).
Shin splints, also known as medical tibial stress syndrome, involve damage to the tibial bone area.
Shin splints are caused by repetitive stress on the tibial bone from activities such as running and jumping.
If not treated, shin splints can lead to tibial stress fractures.
The first treatment is avoidance of the activity.
For runners, a pair of quality running shoes (sneakers) is crucial in preventing and treating shin splints.
What are the structures involved with shin splints?
As shown in diagram 1, the tibia is the bone in the front of the lower leg and is affected by shin splints.
In addition, as you can see in diagram 2 (below), in the lower leg, there are numerous muscles and tendons (the thick connective tissue that connects muscles to bones).
With shin splints, what happens at the tissue level?
Our normal bone constantly undergoes a process called remodeling, in which bone is broken down and then formed again.
With shin splints, the repetitive stress produced from activities such as running causes bone microdamage that does not have time to repair, leading to inflammation of the tibial bone's connective tissue.
What are the risk factors for developing shin splints?
- Running, especially on hard or uneven surfaces
- Being in military training
- A new or increased level of exercise
- Female gender
- Previous history of shin splints
- Being overweight
- Poor quality or aging footwear
- Flat feet (pes planus) or having high arches (pes cavus)
- Vitamin D deficiency or osteoporosis (bone thinning)
What are the symptoms of shin splints?
As seen in diagram 1, shin splints can cause pain in front of the tibia (anterior shin splints) or towards the back of the tibia (posterior shin splints) at the inner area of the lower leg. The pain can be dull or sharp.
Initially, the pain can stop after exercise but can progress to pain when the leg is at rest.
What complications can result if the shin splint is not treated?
If left untreated, a fracture of the tibial bone can result, called a tibial stress fracture.
How are shin splints diagnosed?
A history is taken to ask about sports activities, work, active military, and other recreational activities. In addition, questions will be asked to find the exact location of the pain, factors that aggravate the pain, type of pain (sharp, dull), and times of day the pain occurs.
The physical exam will check for areas of tenderness in the front, back, and sides of the lower leg. In addition, your physician will examine your foot, ankle, and gait (walking pattern).
The pain of shin splints will usually be reproduced with the up and down movement of the ankle. In addition, some shin splints produce a physical finding called crepitus, which is cracking and creaking at the tibia with ankle movement.
Laboratory tests can check for various issues, including infection, rheumatoid arthritis, and other inflammatory conditions. The blood calcium level should be checked since low calcium levels can cause muscle cramps. The vitamin D level should be checked since low vitamin D levels are a risk factor for shin splints.
Imaging studies such as plain x-rays assist in ruling out underlying bony abnormalities such as stress fractures, osteoporosis, and spurs (bony prominences at the edge of the bones).
A computed tomography (CT or CAT) scan or magnetic resonance imaging (MRI) scan can be done to view soft tissue structures, such as muscles, tendons, ligaments, and cartilage. Both produce computerized images from different angles, allowing comprehensive three-dimensional viewing.
What are the treatments for shin splints?
Avoidance of the activity causing the shin splints. For runners, it's best to do other forms of cardiovascular exercise until the symptoms subside, such as biking, swimming, or using an elliptical machine. Other sports like walking or hiking could aggravate the shin splints.
It could take up to a few weeks of activity avoidance to recover; however, each person is different, with varying recovery times.
Ice, applied for 15-20 minutes at once, several times a day, to reduce inflammation and swelling. It is best to elevate the leg using a cushion or foot stand, but that is not always necessary.
We recommend gel ice packs that are reusable. However, use caution not to damage the skin. Some ice packs need to be wrapped in fabric, while other soft-touch packs can be applied directly to the skin.
Medications like acetaminophen (Tylenol) can help with the pain, in addition to non-steroidal anti-inflammatory medication such as ibuprofen (Advil), naproxen (Aleve), Celebrex, Meloxicam, Voltaren, and others.
Compression of the tibial area with an ace wrap can help with inflammation and prevent further swelling.
Physical therapy can help with instructing stretches for the calf muscles to take some strain off the tibia. In addition, there can be other foot stretches for warm-up purposes.
Weight loss can help to take excess pressure off the tibia.
Avoid exercising on concrete or hard surfaces.
Both prefabricated or custom-made orthotics can help, especially for persons with flat feet or a high arch.
Quality exercise shoes (sneakers) are critical in preventing and treating shin splints.
You should purchase a quality pair of sneakers specifically designed for that specific activity, i.e., running sneakers, tennis sneakers, etc. If you need more clarification, check out our article on choosing the best footwear.
In addition, runners should replace their sneakers every 4-6 months or 300-500 miles. Old or worn running sneakers are a frequent cause of shin splints.