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Shin Splints: Causes, Symptoms and Treatment
Shin splints is an overuse injury causing pain along the inner edge of the shinbone, commonly affecting runners and athletes who increase training intensity too quickly.
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Shin splints is an overuse injury causing pain along the inner edge of the shinbone, commonly affecting runners and athletes who increase training intensity too quickly.
What are Shin Splints?
Shin splints is a common overuse injury characterized by pain along the inner edge of the tibia (shinbone). Medically, it is referred to as Medial Tibial Stress Syndrome (MTSS). It is one of the most frequently encountered sports injuries, particularly among runners, military recruits, and individuals who rapidly increase the intensity or volume of their physical activity.
Causes
Shin splints develop due to repetitive mechanical stress on the tibia and surrounding muscles and connective tissues. Common contributing factors include:
- Rapid increase in training load or intensity
- Running on hard or uneven surfaces
- Inadequate footwear lacking proper cushioning or support
- Foot misalignment, such as overpronation (inward rolling of the foot)
- Muscle weakness or imbalance in the leg and hip muscles
- Insufficient recovery time between training sessions
Symptoms
The hallmark symptom is a dull, aching, or sharp pain along the inner border of the shinbone. Symptoms may include:
- Diffuse pain along the tibial shaft, most commonly in the lower third
- Pain that begins at the start of exercise, may ease with warm-up, and returns afterward
- In advanced cases, persistent pain even at rest
- Mild swelling or tenderness to touch along the bone
- Possible warmth of the skin over the affected area
Diagnosis
Diagnosis is primarily clinical, based on a thorough physical examination and medical history. The physician checks for characteristic tenderness along the tibial border. To rule out other conditions, the following investigations may be used:
- X-ray: to exclude stress fractures
- MRI (Magnetic Resonance Imaging): for detailed assessment of bone and soft tissue
- Bone scintigraphy: when an early stress fracture is suspected
Treatment
Conservative Management
Most cases respond well to conservative treatment:
- Rest or activity modification: reducing or temporarily stopping the aggravating activity
- Ice therapy: regular application of ice packs to relieve pain and swelling
- Physiotherapy: targeted exercises to strengthen the calf, foot, and hip muscles
- Stretching: regular stretching of the calf and tibialis anterior muscle
- Orthotics or supportive footwear: to correct foot misalignment
- Pain relief: nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may be used short-term for pain management
Return to Sport
Returning to sport should be done gradually and progressively. Returning too early significantly increases the risk of recurrence. Recovery typically takes between 4 and 12 weeks, depending on severity.
Prevention
To prevent recurrence, the following measures are recommended:
- Gradual increase in training load (following the 10 percent per week rule)
- Incorporating adequate rest and recovery periods
- Wearing appropriate, well-cushioned footwear
- Regular strength and stability training
- Analyzing and improving running technique if necessary
References
- Moen MH et al. - Medial Tibial Stress Syndrome: A Critical Review. Sports Medicine, 2009;39(7):523-546. Available via PubMed.
- Galbraith RM, Lavallee ME - Medial tibial stress syndrome: conservative treatment options. Current Reviews in Musculoskeletal Medicine, 2009;2(3):127-133.
- American Academy of Orthopaedic Surgeons (AAOS) - Shin Splints: Clinical Guidelines and Patient Information. Available at orthoinfo.aaos.org.
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