Everything You Need to Know About Shin Splints

Jim Brown January 23, 2009

Overview

Shin splints, also referred to as medial tibial stress syndrome or tibial pain syndrome, is a term for pain in the front or inner part of the lower leg. Shin splints are one of the most common sports injuries and can develop in everyone from recreational runners to high school soccer, basketball and tennis players.

Shin splints can involve inflamed muscles, tendons, and the thin layer of tissue that covers the bone. Although painful enough to knock you to the sidelines for a while, most cases of shin splints can be effectively treated conservatively with ice, rest, over-the-counter pain relievers and wearing (or changing) shoes that provide more protection for your feet, ankles and lower legs. 

How it Happens

Shin splints happen over a period of time when constant pounding and stress are placed on the bones, muscles, and joints of the lower leg. The result is irritation and inflammation, both of which cause pain. Factors that contribute to shin splints may include:

• Running downhill – When you run downhill, your foot impacts the ground in a plantar-flexed position (toes pointed down), which puts additional stress on the muscles on the front of your shin, rather than distributing weight evenly through your foot.
• Sudden increase in training frequency, duration, or intensity  –  Anytime you violate the 10 percent rule (do not increase training routines by more than 10 percent a week), there is a risk of injury, including shin splints.
• Old shoes – As your running shoes wear down, they don’t properly absorb shock and the arch support tends to flatten out. Both shoe problems, combined with flat feet, poor running mechanics, and overuse, aggravate the inflamed tissue of the lower leg.
• Exercising on hard or inclined surfaces  –  This places stress on the leg, which can cause inflammation.
• Previous history of shin splints  –  Athletes who have had shin splints are more likely to have a recurring problem with them.
• Failure to rehab a previous bout of shin splints  –  Returning to normal training too soon is a common problem among all athletes and can easily cause a setback.
• Flat feet, rigid arches, and over-pronation (ankles roll inward on impact)  –  These are examples of mechanical malfunctions that could cause pressure to be distributed unevenly on the lower legs.

By the Numbers

13-20
Percentage of running injuries attributed to shin splints.

60
Percentage of overuse injuries that involve the leg.

Who’s At Risk

Runners are most susceptible, but shin splints often affect basketball players, tennis players, soccer players, and hikers. Also at risk are jumpers, dancers, military personnel and anyone who walks briskly, runs or jogs on hard or unfamiliar surfaces.

Symptoms

• Gradual onset of symptoms
• Lower leg pain
• Pain when foot or toes are bent downward
• Mild swelling
• Tenderness (along front or inner part of the lower leg)
• Pain that (at first) subsides when not exercising; later, continuous pain

Initial Treatment

• Rest (avoid activities that cause pain; cross-train with low impact activities such as pool training, bicycling or elliptical machine training)
• Ice (15-20 minutes at a time, four or more times a day)
• Compression (with an elastic wrap or compression sleeve)
• Elevation (prop your feet and legs up when resting and at night)
• Over-the-counter anti-inflammatory drugs (aspirin, ibuprofen, naproxen)
• Arch supports (to cushion the impact and disperse the stress)
• Seek medical help if pain persists for a week or more

Comeback Strategy

• A doctor may take an X-ray or MRI to rule out a stress fracture or other causes.
• Rehab may take a week in mild cases and several weeks in severe cases. When you think the problem is completely gone, take one extra day before resuming normal training.
• Use a foam roll to break up muscle adhesions and increase blood flow to your peroneals (outside lower leg) and soleus (between the center and outside of your lower leg).

Prehab

Incorporate these prehab exercises into your comeback routine:

1. Massage Stick/Tennis Ball – Lower Leg (self massage to the lower leg, focusing on the inside of the shin and deep in the calf)
2. Standing Ankle Dorsiflexion Stretch in Neutral and Internal Rotation (traditional calf stretch while maintaining a good arch position with foot straight ahead and foot turned in with hips square to the wall; often people will turn their feet out and not feel much of a stretch)
3. Eccentric Calf Raises (start with two feet calf raise, maintaining a neutral foot position raising up over 1st/2nd toe, then shift weight to one foot and slowly lower down; hold on to the edge of a counter or a bar or support; 2 sets of 10)
4. Intrinsic Towel Crunches in Plantar Flexion (seated, starting with the ankle in front of your body with ankle plantar flexed on top of a towel; use toes to crunch up towel; 2 sets of 25

How to Avoid This Injury

• Avoid sudden, dramatic changes in exercise duration, intensity, frequency, and location.
• Replace running shoes every 300 – 500 miles.
• Run on softer surfaces.
• Consider a pair of off-the-shelf orthotics (shoe inserts) to help prevent overpronation (ankle rolling inward).
• Cross-train in sports or activities that place less stress on the lower leg, such as walking, cycling, and swimming.

Movement Prep

1. Mini Band Squat (for hip tightness, weak buttocks, and running technique)
2. Knee Hugs (for hip tightness, weak buttocks, and running technique)
3. Pillar Bridge – Front (for core stability)
4. Pillar Bridge  – Lateral (for core stability)
5. Rapid Response 2 Inch Runs
6. 1 Leg Stepover Run  – Shin
7. Wall Drill – Load and Lift

Jim Brown, Ph.D. has written 14 books on health, medicine, and sports. His articles have appeared in the Washington Post, New York Post, Sports Illustrated for Women and Better Homes & Gardens. He also writes for the Duke School of Medicine, UCLA School of Medicine, Cleveland Clinic and Steadman-Hawkins Research Foundation.

Tags: Injury Prevention, Triathlon, Injury, Prehab, Basketball, Rehabilitation, Elliptical, Shin Pain, Lower Body

References

1. Anna J. Hartman, MS, ATC, CSCS, Manager, Performance Physical Therapy Services, Athletes’ Performance, Phoenix, Arizona
2. American Academy of Orthopaedic Surgeons
3. National Institutes of Health (Medline Plus)
4. Scientific American
5. The Mayo Clinic
6. The Physician & Sportsmedicine
7. University of Michigan Health System