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Shin splints

Shin splints is a general term used to describe pain along your shin bone (tibia) that usually develops or gets worse when you exercise. It's a common sporting injury, particularly if you’re a runner or dancer.

Your shin bone (tibia) is at the front of your lower leg. It’s the largest of the bones that run from your knee to your ankle.

Shin splints is a general term used to describe any condition that causes pain and tenderness down your shin. This pain may be down the middle of your shin or just inside the inner edge of your shin. The pain is caused by your muscles, tendons or bone tissue around your shin becoming injured.

Shin splints usually develop when you’re exercising. It can start if you’ve recently begun a new fitness regime or if you’ve been doing a lot of vigorous activity. Shin splints often get worse the longer you exercise. The condition usually develops in people who do repetitive activities and sports that put a lot of stress on the lower legs. For example, running, jumping or dancing.

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  • Symptoms Symptoms of shin splints

    If you have shin splints, the main symptoms are tenderness and an aching pain along the front of your lower leg. The pain usually happens when you’re exercising and may become worse the longer you’re exercising. Some people find that the pain stops when they stop exercising, only to come back a few hours later. If your shin splints are severe, you may have pain when you’re resting. Sometimes you may also have mild swelling around the area that’s painful.

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  • Diagnosis Diagnosis of shin splints

    If you have shin pain, see your GP or a physiotherapist (a health professional who specialises in maintaining and improving movement and mobility). You may also be referred to a doctor who specialises in sport and exercise medicine, but often, this is only available privately.

    You’ll be asked about your symptoms and your doctor or physiotherapist will examine you. They may also ask you about your medical history. There’s usually a clear link between pain in your shin and a sport or activity that you do.

    Your doctor or physiotherapist may recommend that you have a scan or X-ray to look at your shin in detail. These tests are often done to rule out other conditions that may affect your shins, such as large stress fractures. The tests you may have are listed below.

    • MRI scan. This uses magnets and radiowaves to produce images of your shin bone and surrounding soft tissues. Because MRI scans are the most accurate and don’t expose you to radiation, this is usually the test of choice.
    • An X-ray. This is a test that uses radiation to produce an image of the inside of your body.
    • CT scan. This uses X-rays to make a three-dimensional image of your shin bone. You’re exposed to more radiation than a simple X-ray when you have this test.
    • A bone scan. This looks for abnormalities or changes in your bones.
  • Treatment Treatment of shin splints

    Self-help

    There are many things that you can do yourself to treat shin splints. The main ones are listed below.

    • Stop doing the activity that caused your shin splints and rest for a few weeks. If you have stress fractures, these can take up to 12 weeks to heal properly.
    • If you need pain relief, you can take over-the-counter painkillers, such as paracetamol or ibuprofen.
    • Try cold ice packs to help relieve any pain. Wrap your ice pack in a towel – don’t apply it directly onto your skin. Hold it in place for 10 to 20 minutes at a time. You can repeat this several times a day if you need to.
    • Check your trainers or sports shoes to make sure they are giving your feet enough support and cushioning. Specialist running shops can give you advice and information about your trainers. Orthotic insoles for your shoes may also help to improve the way you run.
    • When you start exercising again, start slowly. If you get shin splints again, stop the activity and rest for a few days before starting the exercise at a lower level of intensity. Build up the amount of exercise you’re doing gradually.
    • Run on a soft surface such as grass, rather than on roads.
    • Changing your running style may help. Try taking quicker, smaller steps when you run.

    Non-surgical treatment

    Your physiotherapist can develop a training programme for you to gradually increase your level of activity and help you return to your usual sports. They may use a range of different treatments to help your recovery, including massage and stretching exercises.

    Surgery

    Most of the time, surgery isn’t required for shin splints. However, if your shin splints are caused by compartment syndrome and your pain is severe, your doctor may suggest an operation called a fasciotomy. This releases the pressure on the muscles in your lower leg.

    Occasionally, a stress fracture may need an operation to help it heal.

    Talk to your physiotherapist or a specialist for more information.

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  • Causes Causes of shin splints

    There are a number of different causes of shin splints. The main ones are listed below.

    • Stress fractures. These are small breaks in your tibia, caused by stress on the bone. They can develop after repeated exercise; for example, running or dancing over a long period of time.
    • Medial tibial stress syndrome. The cause of medial tibial stress syndrome isn’t fully understood. When you’re exercising repeatedly you may feel pain at the middle to lower third of the inside of your tibia. It may also be swollen and tender.
    • Compartment syndrome. This happens when your muscles swell. Your muscles sit inside an enclosed compartment, so they don’t have much room to expand. When your muscles swell, the pressure increases and blood can’t flow into the muscle properly. This causes severe pain.
    • Biomechanical overload. This is where you have a tendency to overuse certain muscles in the front of your leg. This causes them to become tired and painful more quickly.

    All of these conditions can develop when you put too much stress and strain on your shin bone. This happens when there’s repeated impact on the bone when you’re playing sports or doing activities where you’re running and jumping. It’s possible to have a stress fracture and compartment syndrome at the same time.

    You're more at risk of developing shin splints if:

    • you’re running or playing sport often, for long sessions and at a high intensity
    • your sport or activity involves running or jumping on a hard surface
    • you have poor running technique, such as overstriding
    • you increase the amount of exercise you’re doing too quickly
    • your shoes don't fit well or don't have enough cushioning and support
    • you change your running pattern and the surface that you run on – for example, going from running on a treadmill to the road
  • Prevention Prevention of shin splints

    You can help reduce your risk of developing shin splints by doing the following.

    • Wear sports shoes or trainers that cushion and support your feet.
    • Wear cushioned insoles to absorb some of the impact when you’re running or playing sport.
    • Wear orthotic shoe inserts if your doctor or physiotherapist advises you to.
    • Train and exercise on grass if possible and not on hard surfaces such as roads or running tracks.
  • FAQs FAQs

    If I have shin splints caused by a stress fracture will I need to wear a cast?

    Answer

    For most people with shin splints caused by stress fractures, treatment involves simply resting the affected leg. However, you may be asked to wear a supportive brace, splint or a cast to help the fractures heal.

    Explanation

    If your shin splints are caused by stress fractures, treatment usually involves stopping your exercise or sport and resting the affected leg. If your stress fractures are severe, your doctor may ask you not to put any weight on the affected leg. After a few weeks, you may be able to start gradually building up the amount of activity you do. After about eight to 12 weeks, you should be able to return to your usual level of sport or activity.

    Your doctor may suggest wearing a supportive brace or splint on your leg. This may speed up your recovery by preventing further damage to your bones and helping your bone to heal. You can take a brace or splint off at night, unlike a plaster cast.

    Some doctors also treat stress fractures using a cast. This is a protective cast covering your leg that holds your bone in place and helps it to heal. Casts can be made of plaster or fibreglass.

    If these treatments don’t work, your doctor may suggest an operation to repair the fractures.

    What can I do to keep my bones healthy?

    Answer

    You can keep your bones healthy by leading a healthy lifestyle. This means being active, eating a healthy, balanced diet, drinking in moderation and not smoking. It’s also important to make sure you get enough calcium and vitamin D.

    Explanation

    There are a number of things you can do to help keep your bones healthy. The main ones are listed below.

    • Eat a healthy, balanced diet. Calcium is important to help keep your bones strong and healthy. However, other vitamins and minerals are also important for healthy bones. Eat plenty of fruit and vegetables and wholegrain starchy foods such as rice and pasta. You should also eat some protein, such as eggs, fish and meat, and some dairy foods such as milk. Eat only small amounts of foods that contain a lot of sugar or fat.
    • Get enough Vitamin D. Vitamin D helps your body to use calcium, so it’s important to make sure you get enough. You may get enough vitamin D during the summer months by spending frequent, short spells in the sun without wearing sunscreen. The exact time you need is different for everyone, but is typically only a few minutes in the middle of the day. However, don’t let your skin redden. If you don't get much sun exposure and particularly during winter months, consider taking a vitamin D supplement. Ask your pharmacist or GP for advice first.
    • Keep active. Being physically active and doing weight-bearing activities, such as walking, helps to maintain healthy bones.
    • Don’t smoke. Smoking can affect how your bones repair themselves. There are plenty of methods you can try to help you quit.
    • Stick to the recommended limits for alcohol. If you drink too much alcohol, it can damage your bones and increase your risk of fracture. The recommended limits for women are no more than two to three units a day, and for men no more than three to four units a day. Although ‘Regularly’ means every day or most days of the week, it’s a good idea to have at least two alcohol-free days a week so you don’t go over the limits. So over a week, men shouldn’t have more than 21 units and women shouldn’t have more than 14 units. This does not mean you can save up all the ‘allowance’ for a weekend binge.

    What happens if I go back to training before my shin splints are better?

    Answer

    You risk making your condition worse if you restart your training before you have fully recovered.

    Explanation

    Resting is very important for the treatment of shin splints. This is so your bones have time to repair and heal fully. You risk injuring the bone or putting stress on other areas of your shin if you restart training before your shins are fully recovered.

    Having shin splints doesn't mean you have to give up exercise completely. You should take a rest from the sports and activities that cause your shin pain. You can keep yourself fit and active by doing sports that don't put any strain on your shins, such as swimming or cycling.

    When your shins are no longer painful, you can gradually restart your training or activity. Build up the amount and the intensity of your training slowly. If your symptoms return, then stop the activity and rest for a few days before starting the exercise at a lower level of intensity.

  • Resources Resources

    Further information

    Sources

    • Shin splints. The Merck Manuals. www.merckmanuals.com, published September 2013
    • Shin splints. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published May 2012
    • Simon C, Everitt H, van Dorp F. Oxford handbook of general practice. 3rd ed. Oxford: Oxford University Press, 2010: 503, 510–11
    • MacAuley D. Oxford handbook of sport and exercise medicine. Second edition. Oxford: Oxford University Press, 2012: 676–81
    • Franklyn-Miller A, Roberts A, Hulse D, et al. Biomechanical overload syndrome: defining a new diagnosis. Br J Sports Med 2014; 48:415–416. doi:10.1136/bjsports-2012-091241
    • Personal communication. Dr Leon Creaney. Consultant physician in sport and exercise medicine, 11 July 2014
    • Shin splints/medial tibial stress syndrome. Wheeless' Textbook of Orthopaedics. www.wheelessonline.com, published 29 January 2013
    • Carr K, Sevetson E. How can you help athletes prevent and treat shin splints? Fam Practice 2008; 57(6):406–08
    • Fractures. International Society for Fracture Repair. www.fractures.com, accessed 16 May 2014
    • Care of casts and splints. American Academy of Orthopaedic Surgeons. www.orthoinfo.aaos.org, published April 2011
    • Healthy bones. National Osteoporosis Society. www.nos.org.uk, accessed 16 May 2014
    • Alcohol guidelines. House of Commons Science and Technology Committee, www.publications.parliament.uk, published 7 December 2011
  • Related information Related information

  • Author information Author information

    Reviewed by Alice Rossiter, Bupa Health Information Team, August 2014.

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