What are shin splints?
Shin splints is the common term for Medial Tibial Stress Syndrome (MTSS), a pain experienced along the lower two thirds of the inside edge of the tibia (shin bone). This condition is caused by repeated trauma and stress to the connective tissue around the tibia and presents as a dull ache which usually comes on at the early stages of exercise, eases slightly but is then mainly experienced after the activity.
Shin splints are diagnosed by a thorough subjective assessment including a history of injury onset and reviewing any aggravating activities. Tendinopathy and compartment syndrome can also present with similar symptoms so care must be taken to exclude these if treatment is not resolving the symptoms. More severe cases of MTSS can lead to a stress fracture when the muscle pulls on the tibia to the point where it cracks. These stress fractures are usually treated with a brace and do not require surgery.
Shin splints can be differentiated into two specific causes:
Anterior shin splints – involving the tibialis anterior muscle, responsible for lifting the foot
Posterior shin splints – involving the tibialis posterior muscle which controls the medial aspect of the foot arch during stance phase of a stride. If this muscle is weak it causes the arch to collapse and over pronate
Tight calf muscles and specifically a tight Achilles tendon can also cause the development of shin splints
Who Suffers from Shin Splints?
Shin splints are most prevalent in athletes, especially those who participate in sports involving running and jumping and they make up 13-17% of all running related injuries. (1)
Other athletes who are prone to developing shin splints are football and rugby players who spend prolonged periods running on hard turf in football boots. It is also seen regularly in dancers who spend hours on hard wooden floors and stages in minimalist footwear. Those that work in the defence forces and especially those undergoing basic training also can suffer from shin splints due to the time spent having to run in heavy boots. Running on uneven, sloped or hard surfaces can cause an increase in symptoms.
Over-pronation of the foot, rolling in of the ankle joint, can be a predisposing factor as the muscles fatigue more quickly and are unable to absorb adequate shock from the ground.
Another common cause is a sudden or significant increase in activity, e.g. athletes or teenagers going on training camps where they’re spending increased numbers of hours training or those who have taken up a new sport (especially running,) or an increase in training load leading up to an event.
Another common cause of shin splints, is poor foot and leg biomechanics which can originate at the foot, knee or even the hip and pelvis.
Osteoporosis, being overweight and smoking can also contribute to an increased risk of developing shin splints
How are Shin Splints treated?
Historically treatment for shin splints has been a choice of either complete rest or “running through it” however both have been shown to have their disadvantages. Ignoring the symptoms and continuing sport with no change to load and intensity can further increase the inflammation and potentially lead to a stress fracture. “Relative rest” has been proven to be the best approach. Cardiovascular fitness can be maintained with low impact options such as an exercise bike, swimming or water running.
Recovery can range from a few weeks to a few months depending on the severity of the symptoms, however it may require an element of patience, especially for those wanting to return to sport and high impact activities.
The first and most important step in the treatment of shin splints is an appropriate amount of rest and avoidance of any aggravating activities. Over the counter analgesia and anti-inflammatories can be used for pain relief and these are usually adequate to control the pain.
Ice can be applied over the shins, especially after they have been aggravated during sport, but should be on for no longer than 20 minutes at a time and never directly over the skin. Compression can also assist with relieving discomfort either by using compression socks/tights, calf sleeves or compression bandaging.
If the inflammation is due to tight calf muscles then treatment should focus on releasing these through daily stretching, deep tissue massage, dry needling and foam rolling. This is usually a gradual and time-consuming mission. If it is a more biomechanical cause then gait assessment, advice on appropriate footwear based on foot type and running style, and prescription of orthotics may be required.
It is advisable for athletes such as footballers to return to training wearing running shoes instead of football boots where possible as they provide more cushioning. The return to exercise should be gradual to prevent the calf muscles from tightening up again
Strengthening exercises focusing on the calf but also incorporating quadriceps, hamstrings and glute and core will benefit the biomechanics of the lower limb
Physiotherapy treatment may involve any of the following:
- Electrotherapy such as ultrasound
- Deep tissue massage
- Joint mobilisation to maintain range of movement
- Taping of foot or ankle if required – this can assist to determine if orthotics would be beneficial
- Dry needling
- Gait analysis and correction
- Strengthening and balance exercises
Running and high impact activities should only be recommenced once pain has resolved and care should be taken to start at a gentle level and increase distance, pace training load gradually over a 3-6-week period.
(1) Clement, D. B.; Taunton, J. E.; Smart, G. W.; McNicol, K. L. (1981). “A Survey of Overuse Running Injuries”. The Physician and Sportsmedicine. 9(5): 47–58