Shin splints

Posted by Karl McDonald on 19 May 2014

Shin splints is the name often given to pain in the lower leg, which is caused by exercise.

Shin Splints

Shin Splints

Shin splints is a general term for pain in the shin rather than a specific diagnosis. It is sometimes called medial tibial stress syndrome and is one of the most common problems in the lower leg in people who run, jump, exercise or play sports.

Typically shin splint pain is felt more over the medial (inner) part of your shin. Pain felt over the lateral (outer) part of your shin may or may not be due to shin splints.

It is important that you see a health professional if you are experiencing pain in this area with exercise. Getting the correct diagnosis, and more importantly, seeing someone who can identify the actual causes of the pain will influence greatly the correct treatment and the overall outcome.

There is no one  “treatment recipe” that will “fix” your shin pain. The causes of shin pain are varied and specific to each individual. Accordingly, the rehabilitation plan also needs to be specific to you. It is important that the causes are treated and not just the symptoms (primarily PAIN) or your pain will return quickly and severely interrupt your training.

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 medial (inner) 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 come on when climbing stairs.

What causes shin splints?

The exact cause of shin splints is not known. They are thought to be caused by “overuse” or over activity and typically occur in runners. 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 in your diet.
  • Hard running surfaces (particularly a sudden change from soft to hard surfaces).
  • Incline running
  • Poorly fitted or inadequate running shoes that do not give your specific foot type the required support.
  • Tightness or weakness problems with muscles in the lower leg.
  • Weakness of abdominal and/ or hip (gluteal) muscles.
  • Foot position- this can include over-pronation of the foot, thereby stressing the shin muscles. If your physiotherapist identifies this as a cause Sportsmed have a preferred podiatrist who is highly trained in this area to ensure you have the right footwear and/or fit you with a customized orthotic.

One, or a combination of these factors can lead to shin splints. Experts differ in their opinion as to exactly what is happening to cause the pain associated with shin splints but basically it is an inflammation and irritation of the tibia (the larger of the shin bones) and the muscles that attach to it.

What else could the pain be?

Stress fractures of the tibia (one of the two bones in the leg below the knee) can also cause shin splint-type pain. A stress fracture is a type of incomplete fracture in a bone. Stress fractures tend to occur as a result of overuse and left untreated shin splints can lead to stress fracture. In some cases untreated stress fractures can lead to an actual fracture of the tibia.

What is the treatment?

The key to treating shin splints is the correct identification of the primary causes and “fixing” them. This can often involve a biomechanical assessment (also known as a muscle balance assessment) used by Sportsmed physiotherapists to identify areas of tightness and or weakness, which are leading to you over loading your lower leg when running. If you only treat the symptoms (the pain) and these areas of tightness and weakness are not identified and corrected with a tailored rehab programme your pain will soon return.

It is also important to treat the pain. This may involve the dreaded “R” word…

Rest. This may mean avoiding any activity, such as running, that may have led to the shin splints. It may not mean stopping running altogether. For example, it may mean changing the surface you are running on or it may mean doing less running sessions and cross training (swimming, cycling, rowing, boxing) other sessions. This depends on many variables and you (your coach) and your physiotherapist are the best people to sit down and make a plan for this 

Ice. Applying ice to your shin and raising your leg after activity may also help to relieve pain from shin splints. The cold from the ice is thought to reduce blood flow to the inflamed area. This may limit pain and inflammation. Apply for 15-20 minutes and then re-apply every two hours.

Massage. A Sportsmed physiotherapist can massage the muscles which have become tight due to overuse to help settle down the pain associated with shin splints. This is important but as stressed many times if the cause of the tightness is not identified and “fixed” the pain will return sooner or later. 

Painkillers such as paracetamol are useful to ease pain. They should not be used to mask pain so that you can continue to run. It is best to take these regularly initially. Anti-inflammatory painkillers are an alternative. There are many types and brands. 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 so you should see your Doctor first

What is the prognosis (outlook)?

With the correct intervention you can fully recover from shin splints. However, the chances are that they will recur if you do not look at the underlying cause of your shin splints.

Can shin splints be prevented?

Studies and trials have found that no single prevention method has been found to be consistently effective in preventing shin splints. This is not surprising considering the multi-factorial nature of the problem and that the causes are very much individual specific. 

If you are serious about your running or starting up running then it is advisable to see a sports physiotherapist. They can identify potential problem areas before they become an issue and help you structure your training to help progressively load your muscles, hence avoiding the problem. Similarly, if you have early signs of shin splints immediate intervention is the best option. Don’t delay seeking professional help at Sportsmed because if you wait until the pain is severe it is likely you will be advised that part of your treatment will involve the dreaded R word!!!