What Are Shin Splints?

Shin splints (also known as tibial stress syndrome) is a physical condition that describes microscopic boney damage and inflammation of the muscular attachments to the tibia (shin bone). People with shin splints will often report shin pain, increasing with physical activity and exercise. This is particularly common in those who participate in repetitive high-impact activities, such as running and jumping [1]. About 35% of active Australians may experience shin splints, including Australian Football Rules players and marathon running [2].
 

Types of Shin Splints

There are two common locations of shin splints, including the front and inner part of the shin. Different parts of the tibia (shin bone) are affected depending on which muscle attachment points are involved.

Anterior Shin Splints

Anterior shin splints are caused by stress and strain on the tibialis anterior muscle. This is a muscle located around the middle to the outer part of the shin that helps absorb the impact of running and lifting the ankle upwards. Over time, it can lead to pain along the muscle’s attachment to the front part of the shin.

Posterior Shin Splints

Posterior shin splints are similar to anterior shin splints but located around other parts of the tibia. Instead of the tibialis anterior, the same problems can occur to the tibialis posterior. This muscle is responsible for proper foot mechanics and certain movements of the ankle. Similarly, pain can occur along its attachment to the shine, around the inner part of the leg.
 

Shin Splints Symptoms - What Does Shin Splints Feel Like?

Shin pain is the most common symptom of shin splints. Most people report pain along either side of the tibia (shin bone). The pain often starts as dull and achy pain which spans over a continuous strip (>5cm long). Shin splints symptoms can occur during or after physical activity and/or exercise. When severe, shin splints can become sharp and painful even to touch.
 

Shin Splints Causes

So, what causes shin splints? From a physical perspective, shin splints are caused by microscopic damage to the boney areas of the tibia (shin bone). Healthcare professionals describe this sensation as periostitis. A physical problem that is caused by inflammation along the borders of the bone and the overworked muscles that connect to it.

Repetitive High-Impact Exercise and Activities

Shin splints occur when the area fails to heal after repetitive high-impact exercise [3]. Forceful muscle contractions and strain from stressful activities, like running and jumping, can eventually cause injury to the shin region.

Risk Factors

A few sessions of high-impact activities (e.g. sprinting, running, etc.) are usually insufficient to cause shin splints. Typically, the volume and insufficient recovery time can be the main culprits. This is especially prominent in active individuals, such as runners and military personnel. Other factors that increase the risk of shin splints include [4]:

• Being overweight/obese and/or having a high BMI
• Previous history of shin splints
• Being female
• Having a pronated foot posture
• A sudden increase in training
• Being a deconditioned and inactive individual
• Weak calf muscles
• Running on hard surfaces

 

Tests and Diagnosis

If you have shin pain or suspect shin splints, you should consult your GP. Necessary tests and assessments may be performed to help finalise a diagnosis. This ensures appropriate treatment and management of the condition. Examples of tests that your GP may recommend, include:

Physical Examination

A physical examination by your GP or other relevant healthcare professional may be required. Your GP performs observations on your leg, ankle, movement and walking patterns to determine the likelihood of certain conditions.

Imaging

Imaging assessments, such as bone scans, MRIs, ultrasounds and X-rays may be performed to help determine whether there has been any injury to the structures of the leg. While imaging may not always diagnose shin splints, it may be able to rule out other potential injuries, such as stress fractures [5].
 

Shin Splints Treatment

Your GP may be able to provide or refer you for treatments to help you recover from shin splints. Below may be a list of treatments your GP may recommend to help manage your condition.

Rest and Modified Activity

There is no secret on how to fix shin splints. Rest is the most reliable way to help your shin splints heal and recover. Depending on the severity of your shin splints, you may need to stop continuous high-impact activities, such as running and jumping. Modifying your exercise or physical activity may also be suggested while you recover. Lower impact activities (e.g. walking, cycling, etc.) or upper body exercises can help preserve your health and fitness as the shin splints heal.

Medications

Your GP may prescribe medications to help reduce the inflammation and pain from shin splints. Instructions will be provided about when and how to use the medications.

Physiotherapist

Your GP may refer you to a physiotherapist. They are health professionals that specialise in musculoskeletal and physical conditions, such as shin splints. Physiotherapists will be able to guide, manage and help rehabilitate your injury so that you can return to sports and exercise. Additionally, they will provide strategies about safely resuming your training and preventing shin splints from occurring again. Other treatments that you may expect from a physiotherapist includes:

• Shin splints exercises
• Education
• Strategies around managing and preventing shin splints
• Stretches for shin splints
• Manual therapy
• Taping for shin splints
• Electrotherapy

Podiatrists

Your GP may also refer you to a podiatrist. They are health professionals who specialise in foot, ankle and leg problems. Using their knowledge of leg and foot biomechanics, they may be able to provide strategies about how to prevent shin splints. Examples of treatments that your podiatrist may provide include:

• Footwear recommendations
• Strategies around managing and preventing shin splints
• Education
• Gait and alignment analysis
• Orthotics

 

Recovery

Recovery can vary from person to person. Factors such as age, the severity of the injury and general fitness may influence the course of healing. Research suggests that the time taken to recover can vary from 17 days to 9 months [6]. Consult your GP about the realistic timeframe of your recovery. With the appropriate treatment and management plan, most people with this condition can fully recover.
 

Complications

Those with shin splints can experience lingering pain, which leads to discomfort and a drop in performance. Continual re-aggravation of shin splints can cause more severe injuries, such as stress fractures. More drastic measures, such as wearing a moon boot or even surgery, may be required.
 
 

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References

1. McClure, C. J., & Oh, R. (2019). Medial tibial stress syndrome.
2. Yates, B., & White, S. (2004). The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. The American journal of sports medicine, 32(3), 772-780.
3. Galbraith, R. M., & Lavallee, M. E. (2009). Medial tibial stress syndrome: conservative treatment options. Current reviews in musculoskeletal medicine, 2(3), 127-133.
4. Mattock, J., Steele, J. R., & Mickle, K. J. (2018). A protocol to prospectively assess risk factors for medial tibial stress syndrome in distance runners. BMC Sports Science, Medicine and Rehabilitation, 10(1), 1-10.
5. Blackman, P. (2010). Shin pain in athletes: assessment and management. Australian family physician, 39(1/2).
6. Moen, M. H., Holtslag, L., Bakker, E., Barten, C., Weir, A., Tol, J. L., & Backx, F. (2012). The treatment of medial tibial stress syndrome in athletes; a randomized clinical trial. Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology, 4(1), 1-8.