“Shin splints” is a general term used to describe pain on the shin bone. The most common cause for this type of pain is inflammation of the sheath surrounding the shin bone (the tibia).
The pain may be directly on the front of the shin bone or more towards the inside of the shin bone. When the pain occurs inside the shin bone, it is called medial tibial stress syndrome (MTSS).
When the pain occurs on the outside of the shin bone, it is referred to as anterior shin splints. The term anterior shin splints is a little dated because this outside area of the shin bone is a more common area for stress fractures and chronic compartment syndrome.
Over the years, the term “shin splints” has become a catch-all term for any problem in the leg, including problems with the bone, the muscle, and the connective tissue.
The pictures of the runner below show common areas of shin pain. The picture on the left shows the common area of pain for medial tibial stress syndrome, and the picture on the right shows the common area of pain for anterior shin splints.
Both conditions are exercise-induced, causing inflammation of the tissue connecting the muscle to the bone and inflammation of the sheath of tissue that surrounds the bone.
The bone is also affected. This is due to traction forces of the muscle on the bone and typically occurs in runners, those starting a new activity, or those changing the intensity of their exercise routine.
Related: Foot Tendonitis
Shin Splint Home Treatments
A period of rest of 2-4 weeks is recommended. This does not have to be bed rest, eliminating the aggravating activity.
If the activity started after increasing the intensity of a run, introducing hills into a training regimen, adding sprints, eliminating these things back off on running, or cross-training with swimming and biking.
Icing for 15-20 minutes 2-3 times a day, especially after activity (if training continues), may help reduce inflammation and relieve symptomatically.
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Related: Best Ice Packs
Freeze a dixie cup of water and then peel the top quarter of the paper down. Place the ice directly on the shin, moving the ice along the area of pain. Icing is particularly helpful during the first 2 to 3 days after the shin splint pain.
3. Calf Stretching
After icing for 2-3 days, you should start stretching. The most important stretch for shin splint pain is calf stretching. Start with gentle stretching; this should not be painful.
The runner’s stretch seen on the right is a good stretch to start with. Hold the stretch for 60 seconds, and repeat 3 times. Do this 3 times a day. The stretch should not be painful. Don’t hang your heels off a step to stretch the calf; this may overstretch the area. More on stretching.
4. Appropriate Shoes:
Soft, flexible shoes may be comfortable at first but are the main cause of many common foot problems. Shoes should be rigid and bend only at the toes, where the foot bends.
A shoe that collapses will contribute to overpronation and stress at the arch and the calf and shin splint pain.
The shoe should also be wedged at the heel to add a lift to the heel and take the stress off of the calf. Choose a shoe that matches the activity you are participating in. Running shoes for running, walking shoes for walking, and hiking shoes or boot for hiking.
Take the shoe by the heel and place the toe area on the floor to test your shoes. Press down on the shoe. If the shoe collapses, it is too flexible. The shoe should bend only at the toes. More on choosing a running shoe.
5. Control Overpronation
Orthotics are the best way to control overpronation. For those with a considerable amount of overpronation in association with flatfeet, a custom-made semi-rigid functional orthotic should be made by a podiatrist. These can be expensive when not covered by insurance.
A more affordable option is a prefabricated semi-rigid functional orthotic. Prolab has two types of prefabricated orthotics comparable to custom-made devices in materials and design.
Superfeet or ArchMolds Insoles may be more comfortable for those who cannot tolerate rigid orthotics. Superfeet Green is designed for runners and walkers. It is recommended to be evaluated by a podiatrist to see what option may be best for you.
Symptoms of a Shin Splint
- pain at the beginning of an activity
- achy pain is longitudinal along the shin
- pain may subside as the activity continues
- pain is generally relieved with rest
- deep achy pain may return a few hours after the activity
- tenderness with direct palpation along the shin
- mild swelling along the area of pain and tenderness
- pain with forced movement of the foot up or down
- pain may be increased when walking up or down hills
Stress fractures occur in a more localized shin area and generally have a more pinpoint region of pain.
Any activity tends to cause pain instead of the specific activities listed above. Some believe that medial tibial stress syndrome is a mild form of a stress fracture or a precursor to a stress fracture.
This theory is not yet well accepted. An X-ray and sometimes a bone scan is used to rule out a stress fracture if it is suspected. An MRI may also be used.
Chronic compartment syndrome (CCS) can mimic the pain associated with anterior shin splints or medial tibial stress syndrome.
Chronic compartment syndrome is an exercise-induced condition caused by increased pressure around the muscles and tissues in the leg, compromising the circulation and function of the tissues and resulting in pain and sometimes numbness.
This condition can be difficult to diagnose and distinguish from the more common causes of leg pain. The image to the right shows only one possible but common area of pain.
Causes of Shin Splint
- Faulty foot mechanics – generally in the form of tight calf muscles and over-pronation (discussed below).
- Inappropriate shoes – soft, flexible shoes without support.
- Lack of shock absorption in the shoes
- Beginning a new running or exercise program (too much too soon)
- Change in intensity, frequency, or duration of training
- Running or walking surface – hills, stairs, uneven or hard surfaces
- Female athlete triad (eating disorders, lack of menstrual period & osteoporosis) – most common in teenagers
- Biomechanics – Geometry of the foot and leg
- Nutritional status – insufficient protein and/or calcium intake
- High BMI (body mass index) – a higher weight to height ratio
A Closer Look at Foot Mechanics
Faulty foot mechanics are a common cause of many foot problems but are one of the most common causes of medial tibial stress syndrome and inappropriate shoes.
Even though the pain seems to occur on the front of the shin bone, the affected muscles attached to the shin bone reside in the back and inside of the leg. More on foot mechanics.
The general action of the calf muscles is to flex the foot and toes down and stabilize the arch. When the larger calf muscles are tight, they increase the amount of abnormal pronation and contribute to midfoot collapse.
When the smaller, deep calf muscles are tight, they increase the traction forces on the tibia. Overpronation causes excess stress on the deep muscle group in the calf because these muscles attempt to slow and resist pronation. Pronation places excess stress and traction at their attachment, contributing to medial tibial stress syndrome development.
Tight calf muscles also cause an imbalance between the muscles on the front of the leg and the muscles on the back of the leg (calf muscles).
When the tight calf muscles overpower the muscles on the front of the leg, it is difficult for the muscles to lift the foot when walking.
This aggravates the muscles on the front of the leg and places excess traction force at their attachment, contributing to the development of anterior shin splints.
If you do not improve within 4 weeks, make an appointment with your doctor.