Shin splints

What is it?

Shin splints are injuries that commonly occur in runners. They cause pain along the inner side of the shinbone (tibia).

Shin splints develop because of overuse of the posterior tibialis muscle in the lower leg near the shin. In most cases, this overuse is related to a sudden increase in the intensity of an athlete's training program — suddenly running faster, farther or for longer periods than before. When shin splints first appear, the leg pain tends to start near the end of a training session. However, if the athlete ignores the pain and tries to "run through it," symptoms eventually will begin earlier and earlier during training, until they affect the athlete's overall performance.

Although shin splints are most common in runners, they also can occur in basketball players, soccer players and other athletes in sports that require periods of intense or prolonged running. Even walkers are at risk if they walk too fast or too far.

Symptoms

Shin splints cause muscle pain and tenderness along the inner side of the lower shin. These symptoms tend to affect about 2 to 6 inches of muscle and tendon in the shin area. Pain usually continues after exercise ends, and you may even feel it when you are resting and not putting weight on the affected leg.

Diagnosis

Your doctor will ask whether you play a sport that requires a lot of running or brisk walking and whether you recently increased your training intensity. Also, your doctor will ask about the timing of your pain in relation to your training sessions and whether pain continues when you are at rest.

Your doctor usually can diagnose shin splints based on your symptoms, your history of athletic activity and a physical examination. Your doctor will examine your shin area to confirm that the pain and tenderness are located in your leg muscle (or its tendon) rather than in the shinbone itself. This is because symptoms of shin splints can be confused with the pain of a tibial stress fracture, a small stress-related break in the shinbone. A tibial stress fracture is another type of overuse injury that is common in athletes who run.

Other important problems that can occur along with shin splints or can mimic the symptoms of shin splints include a stretch or tear of a nearby muscle or tendon or inflammation of the bone surface (periostitis). Compartment syndrome, a rare condition in which pressure in a muscle group rises to a dangerous level, is another problem that may be considered, although the pain of compartment syndrome usually is more severe, is located on the outside of the leg and starts hours after exercise.

In most cases, a doctor does not need special diagnostic tests to confirm that you have shin splints. However, additional tests are sometimes necessary to check for a stress fracture. Initially, your doctor may order an x-ray; however, if there is a high suspicion of a stress fracture and the x-ray is normal, an MRI scan may be recommended. In rare cases, for example if your doctor suspects you may have compartment syndrome, you may need a test that measures the pressure within the muscle groups in the lower leg.

Expected duration

If you rest your legs and take a temporary break from running, the pain of shin splints usually subsides within one to two weeks. However, once your pain is gone and you resume training, you should start at a low intensity and then gradually build up. Otherwise, your shin splints may return.

Prevention

To help prevent shin splints, you can:

• Follow the 10% rule — Don't increase the time or intensity of your workouts more than 10% per week.
• Warm up before participating in running sports.
• Follow an exercise program aimed at stretching and strengthening your leg muscles, especially muscles in your lower legs and around your ankles.
• Wear customized shoe inserts, such as arch supports or heel wedges. These may be helpful if your doctor determines that your shin splits are partly related to flat feet or an imbalance in the way you walk.
• Run on softer surfaces (such as a treadmill or a dirt path rather than a road).

Treatment

If you have shin splints, your doctor probably will recommend that you follow the RICE rules:

• Rest the injured muscle — Take a break from running for 7 to 10 days.
• Ice the injured area to reduce swelling.
• Compress the muscle with an elastic bandage.
• Elevate the injured leg.

In addition, you can take acetaminophen (Tylenol) or a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Advil, Motrin and others), to ease pain and tenderness. To maintain your overall fitness level while you rest your legs, try swimming, water jogging or other athletic activities as recommended by your doctor.

As your pain gradually goes away, your doctor may suggest that you start with a walking program before you begin running again. If your shin pain returns when you walk, then you will need to rest your legs again until you are pain-free for two or three days. As part of your rehabilitation, your doctor also may recommend an exercise program to strengthen the muscles in your lower legs and around your ankles.

If you have flat feet or a mechanical imbalance in the way you walk, and this increases your risk of shin splints, your doctor may recommend that you use arch supports or heel wedges in your shoes.

When to call a professional

Call your doctor if you have severe pain, tenderness or swelling near your shin, especially if this pain makes it hard for you to walk. Also call if you have milder shin pain that has not improved after two or three weeks.

Prognosis

Call your doctor if you have severe pain, tenderness or swelling near your shin, especially if this pain makes it hard for you to walk. Also call if you have milder shin pain that has not improved after two or three weeks.

Additional info

National Institute of Arthritis and Musculoskeletal and Skin Diseases
https://www.niams.nih.gov/

American Orthopaedic Society for Sports Medicine
https://www.sportsmed.org/

National Athletic Trainers' Association
https://www.nata.org/

American Physical Therapy Association
https://www.apta.org/