All About Shin Splints.

What are shin splints?

If you’re a keen runner or keen sports person and you have pain over the front of your lower legs when you exercise, you may have shin splints.  The picture demonstrates the site of the pain.

Site of pain in shin splints

If the condition is severe it can also give you pain when climbing stairs.

The condition is also called medial tibial stress syndrome.

What causes shin splints?

Medical and sports experts don’t agree on what causes shin splints but over use or over activity is one possible cause and why they are common in runners.  But why should you get shin splints when your running  buddy, who does the same level of activity as you, not get them?

There are thought to be several risk factors for shin splints and these include:

  • A lack of calcium
  • Previous leg injury
  • Sudden increase in sporting activity, frequency or intensity of activity
  • Running up hill
  • Running on hard surfaces
  • Poorly fitting sports shoes that don’t support the foot and ankle
  • Problems with the lower leg muscles and position of the foot that mean the foot rolls forward and inward more than normal.

Specific medical reasons for shin splints are something else that experts don’t agree on.

Some think they may be caused by mircofractures in the surface of the bone at the front of the leg (the tibia); others suggest there are small tears in the membranes between the 2 leg bones (the tibia and fibula).  They may also be caused by inflammation in the leg tendons or of the membranes surrounding the 2 bones.

What investigations and treatment do I need?

Your doctor may order x-rays but these are usually normal in people with shin splints.  They will however rule out stress fractures of the bones (different to the microfractures described above).

You may have a bone scan of the lower leg or an MRI scan which will also help make the diagnosis between shin splints and stress fractures.

The treatment for shin splints is:

  • Rest – avoid the activity that caused them.  Rest for 2-4 weeks and when the pain has gone completely, make a gradual return to your exercise routine but stop if the pain returns, and rest again.  If you’re going stir crazy without your exercise fix then try swimming or cycling where there is no pounding pressure through the lower leg.  Be sure to warm up a stretch before exercise.
  • Apply ice – gently press an ice pack (or bag of frozen peas) to the lower leg for up to 10 minutes 2 or 3 times a day.  Be sure that the ice is wrapped in a towel to prevent ice burns or damage to the circulation.
  • Raise the legs – to reduce any swelling, sit with your legs elevated to at least hip level as much as you can.
  • Painkillers – paracetamol will help with the pain and if you’re able to take ibuprofen or non-steroidal anti-inflammatory drugs (you don’t have asthma, kidney or liver problems) then use these to as they will help to reduce any inflammation.

How can shin splints be prevented?

If this is a recurring problem for you then time invested with a specialist sports physical therapist will be well spent.  She will be able to advise you on your running style and foot/leg alignment.

No single preventative method has been identified for shin splints but special insole or orthotics may help to prevent over-pronation (where to foot rolls forward and inward too much) if you have this.

Work to an exercise regimen that includes rest days and/or low impact exercise such as swimming, cycling, yoga, Swiss Ball workouts, Pilates etc.

Replace your running/sports shoes regularly and see a specialist fitter for advice rather than buying them off-the-shelf from a general sportswear store.  Sports shoes are not all made the same and some brands or styles are better for certain feet than others.  The experts at a specialist fitter will be able to advise you.

What else could this pain be?

If pain is in the outer aspects of the lower leg (see the picture here) then it may be cause by compartment syndrome.

Site of pain for compartment syndrome

You may have symptoms of numbness in the legs and make you feel clumsy when you’re walking.  So see your doctor about this.

A sharp pain and tenderness over the shin an inch or 2 below the knee might indicate stress fractures.  Again, see your doctor about these and she will order x-rays/scans to confirm or rule out the diagnosis.


Elspeth Raisbeck