What are Shin Splints?
Shin Splints are a common lower leg complaint often seen in our podiatry clinic, especially among our runners, footballers, and other athletes. The term shin splints is often given to any pain at the front of the lower leg. However, the typical "shin splint" symptoms occur at the front inside of the shin bone and can arise from a number of causes including most commonly Medial Tibial Stress Syndrome.
Other causes include:
- Tibial or fibular stress fractures
- Chronic exertional compartment syndrome
- Muscle strains or tears (particularly of the Tibialis Anterior and Posterior muscles)
- Arterial or nerve entrapment
- Deep vein thrombosis
- Fascial herniations
- Referred pain from the spinal lumbar region
The two common areas for "shin splints" are:
- Posterior shin splints, occurring on the inside of the leg along the tibia bone; Medial Tibial Stress Syndrome (MTSS)
- Anterior shin splints, in the front portion of the tibia in the muscle area (often caused by Tibialis anterior muscle fatigue or compartment syndrome)
Medial Tibial Stress Syndrome (MTSS)
The typical Medial Tibial Stress Syndrome pain usually develops gradually without a history of trauma often starting as a dull ache along the front or inside of the shin (distal 2/3 of the posterior aspect of the medial border of the tibia) after running or walking. This pain often gets worse with running and often coincides with an increase in training. Without rest, this pain can become more and more intense each time your active if not addressed. Left untreated this form of Shin Splints can develop into a tibial stress fracture.
The most common cause of Medial Tibial Stress Syndrome (the most common form of shin splints) is excessive stress on the Tibia (the shin bone) and leg muscles in the location where they are attached to the shin bone. This stress is often caused by the biomechanics of the runner/athlete, the surfaces they train on (esp on hard surfaces), or sports that involve jumping. Other causes include wearing worn out running shoes, running in circles or slopes, tight calves, blocking of the ankle joint, over pronation (flat feet) and less commonly high arched feet which are poor shock absorbers. These factors can lead to microfractures in the tibia. There is current debate over whether or not inflammation of the periostium of the tibia (sheath surrounding the bone) from increased stress on the lower leg muscles during exercise is a cause. If this is the case, then traction forces on the periostium from the muscles of the lower leg could cause this shin pain and inflammation. This has lead to the use of terms such as Medial Tibial Traction Periostitis. It important to note that other causes of shin pain may include conditions such as Compartment Syndrome as well as conditions to do with the Tibialis Anterior muscle as well as other listed above. These alternative diagnoses will have very different treatments and such a proper diagnosis should be made.
Treatment and Prevention
Treatment for Medial Tibial Stress Syndrome varies from person to person depending on the cause of the stress and the persons biomechanics (the way they run). Treatments may include taking a break from the exercise or activities that aggravate the problem until the pain subsides, icing the area immediately after running or other exercise can also be effective, along with gentle calf stretching before and after training. Aspirin or Ibuprofen are often used to relieve pain and reduce inflammation.
It is important to remember not to train through the pain of shin splints. Runners may be suggested to decrease mileage for about a week and avoid hills or hard surfaces. If your podiatrist discovers a muscle imbalance, poor running form or flat feet are aggravating the problem a long-term solution might involve a stretching and strengthening program or orthotics to support the foot and correct over-pronation. In more severe cases, ice massage, heat treatments, prolotherapy and therapeutic ultra-sound might be used.
For those runners who are unable to reduce their intensity or training we generally suggest a session of foot mobilisation to loosen the joints as well as a simple full length varus wedge, calf compression sleeve or orthotics for those who require arch support or some form of biomechanics control. We often combine these treatments with a stretching and strengthening program of the leg muscles, foot wear advice, and training alterations. We also suggest avoiding running on hard surfaces and will look at ways to keep your fitness at its peak without causing more damage to your shins.
If requested advice for alterations in running style - i.e. to go from bare foot running to supportive running shoe or vica versa depending on the athlete may also be given by our Podiatrists
Above all else is the importance of proper diagnosis. As listed above there are a number of different causes of shin splints and each have treatments that can vary greatly. Proper diagnosis will ensure your best chance of both a speedy recovery of your shin pain and help to prevent the re-occurrence of further shin splints.