Picture this: It’s a refreshing spring morning, perfect for a run. After finishing some warm-up stretches, you start jogging at a comfortable pace down your usual nature trail route. The sunlight filters through the trees and a light breeze keeps you feeling good as you pick up the tempo. At the halfway mark, you suddenly buckle forward as a sharp pain radiates up your shin. Hobbling to a nearby bench, dismay washes over you as you realize this is the intense ache runners dread – shin splints.
Shin splints are a common and often painful overuse injury that afflicts many runners and athletes. Medically known as medial tibial stress syndrome (MTSS), shin splints cause pain and tenderness along the tibia, the large bone in the lower leg.
While splints can be frustrating and debilitating, especially for runners, the good news is that they are largely preventable and very treatable with some rest and rehab. Read on to learn all about the causes, symptoms, risk factors, and most importantly, treatments for shin splints.
What Are Shin Splints?
Shin splints specifically refer to pain along the tibia, the large shin bone in the lower leg. The pain occurs due to inflammation where the shin bone attaches to the muscles and tendons around it.
There are two types of shin splints:
- Anterior shin splints – pain on the front outside part of the shin due to inflammation of where the muscles attach to the tibia. This is the most common type.
- Posterior shin splints – pain on the inside edge of the shin bone on the border of the calf muscle. Less common.
The term “shin splints” covers a few overlapping conditions including:
- Medial tibial stress syndrome (MTSS) – tiny tears in the muscles along the shin bone. The most common cause of shin pain.
- Stress fractures – tiny cracks or severe bruising within the tibia bone itself. Less common.
- Chronic exertional compartment syndrome – swelling within the lower leg compartments that compress nerves. Least common.
Shin splints are usually caused by MTSS rather than bone bruising or fractures, but it’s important to get an accurate diagnosis from a sports medicine doctor.
Symptoms of Shin Splints
The most common shin splint symptoms include:
- Pain and tenderness along the inner shin bone, either on the front outside area or back inside border depending on anterior or posterior shin splints
- Aching or throbbing pain in the lower leg that starts out mild and gradually worsens over time
- Pain that starts after exercising when your shin muscles are cooling down
- Swelling or redness over the shin bone
- Difficulty walking, running, or other impact activities without shin pain
- Loss of muscle function or strength
Severe or worrisome shin splint symptoms can include:
- Inability to walk without limping
- Night pain or tenderness over the shin at rest
- Unrelenting pain that persists even with rest
- Signs of a stress fracture like a specific point of tenderness over the tibia
Causes and Risk Factors
Shin splints are caused by repetitive impact or overuse that strains the muscles, tendons, bone attachments, and periosteum (covering over the bone). Too much too soon is often the culprit.
Risk factors that can contribute to shin splints include:
- Starting a new sport like running or basketball with intense practice too quickly
- Increasing intensity or mileage too rapidly when running
- Prior history of shin splints or stress fractures
- Exercising on hard or uneven surfaces, like concrete
- Worn-out or ill-fitting shoes with poor support
- Poor biomechanics like overpronation or high arches
- Muscle weakness or imbalance in the feet, calves, or hips
- Tight calf muscles or limited ankle flexibility
Runners are especially prone to shin splints because of the repetitive pounding that running causes. But shin splints can also happen in other high-impact sports like basketball, tennis, soccer, dancing, CrossFit-style plyometrics, or aerobics.
Prevention
While some risk factors for shin splints are unavoidable, like your genetics and bone structure, many causes can be prevented with some simple training adjustments like:
- Allow for proper rest and recovery days between intense workouts
- Build up sports participation or mileage gradually over several weeks to months
- Run on softer surfaces like trails, tracks, or treadmills
- Stretch and foam roll tight calf muscles
- Strengthen lower leg and hip muscles with resistance band exercises
- Wear proper footwear for your sport with adequate arch support and shock absorption
- Use custom orthotics if you overpronate or have high arches
- Consider adding a joint supplement if you have arthritis or inflammation
Treatment and Rehab for Shin Splints
If you develop shin pain from shin splints or other stress injuries, stop the aggravating activity right away. Running or jumping through shin pain will only make it worse. Treatments aim to calm inflammation and restrengthen the area.
Treatment basics include:
| Treatment Basics | Description |
|---|---|
| Rest | Take at least 2 weeks off the aggravating activity to allow shin recovery. |
| Ice | Apply ice packs wrapped in cloth for 15 minutes several times a day to reduce swelling and pain. |
| Compression | Wear a compression leg sleeve over the shin to help reduce inflammation. |
| Elevation | Prop up your leg above heart level whenever possible to minimize swelling. |
| Medications | Anti-inflammatory meds like ibuprofen can ease pain. Don’t use it for over 2 weeks. |
Once the worst pain settles, begin rehabbing with gentle exercises like:
Calf stretches: Ease calf tightness with stretches like a wall lean calf stretch – stand facing a wall 1 leg back with heel down for 30 seconds.
Towel grab ankle pulls: Sit and gently pull the towel wrapped under your foot towards you to strengthen your shin muscles.
Alphabet writing with your feet: Trace letters of the alphabet slowly with your feet and toes to increase mobility.
Standing calf raises: Rise up and down slowly on your toes to build calf and shin endurance.
Balance exercises like single-leg stands can also help with muscle control.
As the pain continues improving, transition to impact exercises by:
- Walking or using an elliptical
- Running gently on soft surfaces like grass or tracks
- Doing lower-impact strength moves like mini-squats and lunges
Avoid hills or speed work initially when easing back into running. Consider wearing a shin compression sleeve for extra support and use ice after impact activities if swelling returns.
See a physical therapist or athletic trainer specializing in running injuries if pain persists over 2 months despite rehab. They may recommend custom orthotics for biomechanical issues or use tools like electrical stimulation to heal irritated tissues.
Surgery is rarely needed except in cases of severe chronic compartment syndrome or major stress fractures.
Prevention of Recurrent Shin Splints
Many runners will experience repeat bouts of shin splints, especially if training for marathons or increasing weekly mileage. Prevent future shin splints with:
- Ongoing calf and lower leg stretches before and after running
- Strengthening moves for shins, calves, and hips 2-3 days a week
- Watching mileage build up with no more than 10% increases per week
- Alternating shoe types to vary impact
- Running on softer surfaces whenever possible
- Regularly replacing running shoes – most last 300-500 miles
- Using custom orthotics if foot structure requires
- Taking anti-inflammatory supplements like turmeric or glucosamine seasonally
Glossary
MTSS: Medial Tibial Stress Syndrome – tiny muscle tears along the shin bone attachment – most common shin splint cause.
Stress Fractures: Tiny cracks or severe bruising within the shin bone itself. Less common cause.
Chronic Compartment Syndrome: Swelling within lower leg muscular compartments that compresses nerves. Least common cause.
What’s the Outlook for Shin Splints?
With proper rest, rehab, training adjustments, and prevention methods, most cases of shin splints resolve within 2 to 6 weeks.
Sources:
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
The Centers for Disease Control and Prevention (CDC)
The American College of Sports Medicine (ACSM)
Muskan Thakur is a skilled physical therapist based in Los Angeles, USA. She completed her Bachelor of Physical Therapy (BPT) from Delhi University in 2010. Ms. Thakur furthered her studies by completing a clinical residency program focused on orthopedic physical therapy at Duke University in the United States in 2012. She then attained her Master’s in Public Health (MPH) from the Institute of Public Health in Delhi in 2015. With over 10 years of experience, Ms. Thakur employs a holistic approach combining manual therapy, therapeutic exercise, education, and lifestyle modifications to treat neurological, orthopedic, and musculoskeletal conditions.
