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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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Things worth knowing about "Shin splints"

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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