Shin splints

Published by Bupa's Health Information Team, April 2010.

This factsheet is for people who have shin splints, or who would like information about it.

Shin splints is a general term used to describe pain along the shin bone (tibia) that develops or gets worse with exercise. It's a common sporting injury, particularly among runners and dancers.

About shin splints

Your shin bone (tibia) is the bone at the front of your lower leg that runs from your knee to your ankle.

Shin splints is a general term used to describe any condition that causes pain down the middle, or on either side of your shin. Depending on the type of injury you have, the pain may come on gradually or you may have a sudden twinge of pain. Shin splints usually develop in people who do repetitive activities and sports that put a lot of stress on the lower legs, such as running, dancing, aerobics, gymnastics, football and hockey.

Symptoms of shin splints

Common symptoms of shin splints include tenderness, aching or sharp pain along the front of your lower leg.

The pain is often worse when you do activities that involve supporting your body weight. You may feel pain along the length of your shin, or only along a small section.

The pain may build up during exercise and it will become more severe the longer you exercise.

Causes of shin splints

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

• Stress fractures. These are an overuse injury. They develop after repeated periods of stress on your bones; for example, running or dancing over a long period of time.
  
• Medial tibial stress syndrome. This is inflammation where the tendon attaches to the thin layer of tissue that covers the bone (periosteum).
  
• Compartment syndrome. This happens when your muscle swells. Your muscle is confined by the compartment it's in, so doesn't have much room to expand. When the pressure in your muscle increases it causes the symptoms of compartment syndrome.

All of these conditions can develop when you put too much stress and strain on your shin bone. This happens when there is repetitive impact on your shin bone during weight-bearing sports or activities.

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

• you increase your running distance
  
• you're an inexperienced runner
  
• your sport or activity involves running or jumping on a hard surface
  
• you do a lot of hill running
  
• you increase your frequency of running and don't allow a rest day between runs
  
• your shoes don't fit well or don't have enough cushioning and support
  
• your feet roll inwards (pronate)
  
• you change your running pattern and the surface that you run on; for example, going from running on a treadmill to running on the road

Diagnosis of shin splints

If you have shin pain, see your GP or a chartered physiotherapist. He or she will ask about your symptoms and examine you. Your GP or physiotherapist may also ask you about your medical history. There is usually a clear link between shin pain and a sport or activity.

If your symptoms don't improve, 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 which may affect your shins such as large stress fractures. Some of the tests you may have are listed below.

• An X-ray. Pictures of your shin bone are created using X-rays.
  
• A magnetic resonance imaging (MRI) scan. This uses magnets and radiowaves to produce images of your shin bone and surrounding soft tissues.
  
• A computerised tomography (CT) scan. This uses X-rays to make a three-dimensional image of your shin bone.
  
• A bone scan. This is similar to having an X-ray but uses gamma rays instead.

Treatment of shin splints

Self-help

You should rest your injury and think about what may have caused your shin splints.

Over-the-counter anti-inflammatory medicines such as ibuprofen can help reduce pain and inflammation. Follow the instructions in the patient information leaflet that comes with the medicine and if you have any questions, ask your pharmacist for advice.

Check your trainers or sports shoes to see whether they give enough support and cushioning. Specialist running shops can give you advice and information about your trainers. An experienced adviser can watch you run and recommend suitable shoes for you.

It's important that you think about how much exercise you're doing and if it's causing shin splints. You may need to reduce the amount of exercise you're doing or change your training routine.

Non-surgical treatment

A physiotherapist is a health professional who specialises in movement and mobility. He or she can help devise a graduated training programme to promote recovery and help you return to your usual sports activities. Your physiotherapist can:

• help to restore any loss of range to your lower limb joints and muscles that may be contributing to shin splints
  
• advise on a strengthening programme, especially to the calf muscle
  
• use acupuncture, tape or soft tissue techniques that may help reduce pain

A podiatrist (a health professional who specialises in conditions that affect the feet) can provide advice about foot care. He or she can also supply shoe inserts (orthotics) to control the inward roll of your feet if necessary.

Surgery

If your shin splints are caused by compartment syndrome and the pain is severe, your doctor may suggest an operation called a fasciotomy. This releases the pressure on the muscles in your lower leg. Talk to your GP or physiotherapist for more information.

Prevention of shin splints

The following steps can help reduce your risk of developing shin splints:

• wear supportive footwear that is appropriate for your sport or activity
  
• wear shoe inserts if your doctor, podiatrist or physiotherapist advises you to
  
• train and exercise on a grass surface if possible

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.