Shin Splints

Overview

What are shin splints?

Shin splints occur when the muscles and bones in the lower part of the leg pull and tug at their insertion on the shin bone (the tibia) and it becomes inflamed (irritated and swollen) and painful. Athletes often have shin pain because they put repeated stress on the shin bone, muscles and connective tissues. Doctors sometimes call shin splints medial tibial stress syndrome, which is a more accurate name.

Shin splints are a very common overuse injury. With rest and ice, most people recover from shin splints without any long-term health problems. However, if left untreated, shin splints do have the potential to develop into a tibial stress fracture.

How do people get shin splints?

Shin splints develop from repeated stress to the shin bone by the pulling and tugging of the muscles and connective tissues in the lower leg. Frequent, repetitive pressure from running and jumping can cause the shin bone to become inflamed (swollen or irritated) and weakened. When the bone does not have time to heal, the damage can get worse and cause severe pain. Anyone who starts a new exercise routine or accelerates their sport or activity too quickly may be prone to developing shin splints.

Who is affected by shin splints?

Although anyone can get shin splints, certain people have a higher chance of developing the condition. Groups with a higher risk of shin splints include:

  • Runners, especially those who run on uneven surfaces or suddenly increase their running program.
  • Athletes who play high-impact sports that put stress on the legs.
  • Dancers.
  • People who have flat feet, high arches, or very rigid arches. In this situation, your muscles and bones may not absorb or distribute force from impact and loading activities as well.
  • Members of the military and people who march or walk a lot.
  • People who wear unsupportive shoes when exercising.
  • Walking extreme distances.
  • Anyone with underlying vitamin D deficiency, eating disorder or loss of normal menses.
  • Individuals with osteopenia or osteoporosis who may already have weaker bones.

Symptoms and Causes

What are the symptoms of shin splints?

The most common symptom of shin splints is lower leg pain. The pain can range from mild to severe, and the shin bone may be tender to the touch. Pain from shin splints can:

  • Commonly be seen on the inner lower part of the leg or front of the shin bone.
  • Start off as come-and-go discomfort with activity and progress to a steady and persistent pain even after the activity has ended.
  • Be sharp or a dull ache.
  • Get worse after activity.

Diagnosis and Tests

How are shin splints diagnosed?

Doctors diagnose shin splints by obtaining a thorough history and by examining you. Your doctor will look at your gait, how you walk, examine your lower leg, ankle and foot. A complete exam will involve moving your ankle and foot around, feeling for tenderness along the bone. Standing on the painful leg or hopping on that leg may help to diagnose if shin splints or a stress fracture may be present.

To rule out a stress fracture, your doctor will first order an X-ray, although stress fractures are not seen in about ⅔ of plain X-rays. Therefore, if your doctor is concerned, they may then order a magnetic resonance imaging (MRI) or bone scan. These tests allow your doctor to see if the shin splint has become a stress fracture because these types of test pick up the injury before an X-ray.

How do I know if I have shin splints?

If you have aching legs or lower leg pain that gets worse after exercise, you may have shin splints. The pain can be sharp or dull, and it may come and go. While shin splints are not a serious medical condition, you should visit your doctor to rule out a stress fracture.

Management and Treatment

What are the treatments for shin splints?

To relieve your symptoms, you need to give your bones and muscles time to heal. Shin splints usually improve with a combination of:

  • Rest: Take a break from sports, running, and other activities to give your muscles and bones a chance to recover. You may need to rest and take it easy for a few weeks or longer.
  • Ice: Apply a cold compress to your shins every 10 to 20 minutes, three to four times a day, for a few days. Ice helps relieve the swelling and pain of shin splints.
  • Pain relievers: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) can ease pain and swelling.
  • Supplements: Vitamin D3 supplement (1000 to 2000 IU daily) may help. Discuss supplements with your doctor.
  • Slow increase in activity level: When you do become active again, start slowly. Increase your activities gradually to reduce the risk of shin splints returning.
  • Supportive shoes and shoe inserts: For people who have flat feet, shoe inserts (orthotics) can be effective at relieving the pain of shin splints. Orthotics support your arches and reduce stress on the muscles and bones in your lower legs.
  • Physical therapy: Therapy can be helpful, especially with assistance returning to running.

What are the side effects of the treatment for shin splints?

Side effects from NSAIDs are rare but can occur. They usually happen only after you’ve taken the medication for a long time. You should use the lowest dose for the shortest time to minimize side effects.

Side effects of NSAIDs can include:

What are the complications associated with shin splints?

Complications from shin splints are rare. If you continue to run or play sports without letting your legs heal, shin splints can progress into a stress fracture. A stress fracture occurs when little cracks form in the bone. To treat a stress fracture, doctors often recommend using crutches or wearing a walking boot until the bones heal.

Prevention

How can you prevent shin splints?

While you may not always be able to prevent shin splints, you can reduce your risk of developing the condition or making it worse. To lower your risk, you can:

  • Wear supportive shoes when exercising. Running shoes should be replaced every 300 miles. Consider wearing orthotic inserts that support your arches. Stop in and chat with someone at a running shoe store where they can help match your foot type with a proper running shoe or orthotic.
  • Start slowly, and increase your activity level and intensity over time. Avoid sudden increases in activity. Stick to the 10% rule and don’t increase more than 10% per week in activity.
  • Stretch your muscles before exercising to warm them up.
  • Avoid surfaces that are hard, uneven or hilly when you’re running. If you run often, consider adding low-impact exercises (like swimming) to your exercise program to give your legs a break from the stress of running. Crosstraining and taking days off.
  • Rest between activities to allow your muscles and bones time to heal.
  • Use pain as your guide. If you are noticing shin pain, reduce your activity level until this improves. Do not try to push through pain.

Outlook / Prognosis

Are shin splints permanent?

Shin splints are not permanent. You should be able to ease pain from shin splints with rest, changing the amount of exercise you are doing and making sure to wear supportive footwear. If your shin splints do not go away over a long period of time, see your doctor. You may need to be tested for stress fractures or other conditions that could be causing the pain. Preventing shin splints from returning may require an evaluation of your diet, footwear, stretching and flexibility.

What is the outlook for patients who have shin splints?

The majority of people who have shin splints recover after taking time off from sports and activities. Shin splints often go away once the legs have had time to heal, usually in three to four weeks. Most people can resume an exercise program after their legs have healed. It takes longer to recover from a stress fracture, so it is best to have shin splints treated early.

Living With

When should I call my doctor about shin splints?

You should call your doctor if your shin pain is severe or if it doesn’t go away after a few weeks of rest. Call your doctor if your legs are very swollen, red or painful. These symptoms could be signs of an infection or another condition.

Last reviewed by a Cleveland Clinic medical professional on 02/05/2020.

References

  • Merck Manual. .Accessed 2/11/2020.Shin Splints (https://www.merckmanuals.com/home/injuries-and-poisoning/sports-injuries/shin-splints) (https://www.merckmanuals.com/home/injuries-and-poisoning/sports-injuries/shin-splints)
  • American Academy of Pediatrics. . Accessed 2/11/2020.Shin Pain (https://www.healthychildren.org/English/health-issues/injuries-emergencies/sports-injuries/Pages/Shin-Pain.aspx)
  • American Association of Orthopaedic Surgeons. .Accessed 2/11/2020.Shin Splints (https://orthoinfo.aaos.org/en/diseases--conditions/shin-splints/) (https://orthoinfo.aaos.org/en/diseases--conditions/shin-splints/)

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