Shin splints is a general term which covers a number of different underlying problems. The main ones are listed below.
- Medial tibial stress syndrome (periostitis). Doctors don’t completely understand this condition yet. Repeated stress on your bone may cause injury to the bone tissue and the periosteum – the tough membrane covering it.
- Stress fractures. These are small breaks in your tibia, caused by stress on the bone.
- Muscle strain. This is where you have a tendency to overstretch certain muscles in the front of your leg, damaging some of the muscle fibres.
- Chronic exertional compartment syndrome. This is quite rare. During exercise, it’s normal for more blood to flow to your muscles which makes them swell. Your muscles sit inside an enclosed compartment of stiff tissue, so they don’t have much room to expand. If this tissue doesn’t give well enough, the pressure increases and blood can’t flow into the muscle properly. This causes a lack of oxygen, leading to pain.
- Tendon dysfunction. This is a general overload of a tendon leading to changes in the tendon that cause swelling and pain.
If you have shin splints, the main symptoms are tenderness and an aching pain along the front or sides of your lower leg. For some people, the pain can be severe.
The pain usually happens when you’re exercising and may, at first, ease off as you exercise. However, if it becomes too severe to continue exercising, you need to stop what you’re doing. The pain may ease when you stop exercising, only to come back 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.
If you have shin pain, you can try and manage it yourself before making an appointment with your physiotherapist (a health professional who specialises in maintaining and improving movement and mobility) or GP. See ‘Self-help’ in our Treatment section for more information about what you can do to help yourself.
When to see your physiotherapist or GP
For most people, rest from the activity that brings on the pain will be enough to manage the condition. This will reduce the load on the tissues in your leg and allow them time to heal. But you should see your GP if any of the following is true for you.
- The pain is not improving or is getting worse, despite stopping and resting from exercise.
- You have pain most of the time and there’s no clear or obvious cause, if for example, you’ve not been doing a new activity or exercise regime.
- Any sign that you might have a possible stress fracture; for example, if pain when exercising is so severe you have to stop immediately.
- You have swelling of your calf, redness and/or heat, constant pain, change in the colour and sensation of your leg or unexplained weight loss.
If your GP suspects shin splints, they may refer you to a specialist in sport and exercise medicine, but often this is only available privately.
Your physiotherapist or doctor will ask you about your symptoms and 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 physiotherapist or GP will usually be able to diagnose shin splints without doing any further tests.
In some circumstances, perhaps when there isn’t a clear link or it looks like you might have a stress fracture, your doctor or physiotherapist may recommend that you have an MRI 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. If your doctor feels that a scan or X-ray would be useful in your circumstances, they’ll explain why.
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 a stress fracture, this can take up to 12 weeks to heal properly. You can keep yourself active during this time by doing other activities which don’t put strain on your legs. This may include swimming or using a stationary bike.
- 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. Ask your physiotherapist about how you could do this, and how it may help.
It’s important to listen to your body, find a level of exercise that it can tolerate and slowly build on that while allowing your shin enough time to heal.
Initially, your treatment will be about planning enough rest and reducing or stopping the activity or exercise for a time. Your physiotherapist can also develop a training programme for you to gradually increase your level of activity and help you return to your usual sports. There’s a lack of high quality evidence to show that treatments like massage and stretches are an effective treatment for shin splints. However, for some people these techniques might help to reduce pain and may be offered to you.
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. See our section ‘About shin splints’ for more information about compartment syndrome.
If your doctor thinks that surgery may help in your circumstances, they will discuss this with you.
Shin splints can develop when you put too much stress and strain your shin bone (tibia) and the tissues around it. The bone and tissues can cope with a certain amount of impact, such as everyday activity and a certain amount of exercise. But if you overload the bone and tissue past a certain point, they become damaged. If you don’t leave enough time in between activity or exercise for them to heal, they are damaged further and so the cycle continues.
You're more at risk of developing shin splints if:
- you’re overweight
- you’ve just started doing a vigorous activity such as running, or increased the intensity of your activity
- your sport or activity involves running or jumping on a hard surface
- you have poor running technique
- your shoes don't fit well or don't have enough cushioning and support, especially if you have flatter feet
- you change your running pattern and the surface that you run on – for example, going from running on a treadmill to the road
- you don’t leave enough rest time between bouts of exercise for your bone and tissues to heal
Doctors aren’t really sure yet what works to prevent shin splints. However, you may help reduce your risk of developing shin splints by starting new exercise regimes slowly – build them up gradually and allow enough recovery and rest time in between exercising. You can also do the following.
- Wear sports shoes or trainers that cushion and support your feet appropriately. This will depend on the shape of your foot. If you’re new to running, it’s a good idea to get your running shoes fitted at a running shop.
- Trainers lose their ability to absorb shock with age, which may increase your risk of getting shin splints. Replace your trainers after 300–500 miles.
- When you start an activity, or get back to one after a period away, build up the intensity gradually.
- Wear cushioned insoles to absorb some of the impact when you’re running or playing sport. And wear orthotic shoe inserts if your doctor or physiotherapist advises you to.
- Train and exercise on grass if possible and not always on hard surfaces such as roads.
For most people with shin splints caused by stress fractures, treatment involves simply resting the affected leg. However, your doctor or physiotherapist may ask you to wear a supportive brace, splint or a cast to help the fractures heal.
If your shin splints are caused by stress fractures, treatment usually involves stopping your exercise or sport and resting the affected leg. This is usually for a minimum of about two weeks. 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. Unlike a plaster cast, you can take a brace or splint off at night, if your doctor or physio recommends it.
Doctors also sometimes treat stress fractures using a cast. This is a hard protective covering around your leg that holds your bone in place and helps it to heal. Casts can be made of plaster or fibreglass. Doctors don’t routinely recommend a cast for stress fractures because they can weaken your muscles and bone.
It can be frustrating having to stop an activity that you enjoy. But you really do need to take shin splints seriously and follow sensible steps to recovery. You risk making your condition worse if you restart your training before you have fully recovered.
Resting from the activity or exercise that’s triggering your shin pain is the key treatment for shin splints. It’s very important that you stop doing the activity that brought on the condition, usually for about two weeks at least. This is so your bones and soft tissues have time to repair and heal fully. If you have severe shin splints caused by a stress fracture, your shin bone (tibia) might even fracture completely if you do not rest.
Having shin splints doesn't mean you have to give up exercise completely. 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, stop the activity and rest for a few days before starting the exercise at a lower level of intensity.
Ask your physiotherapist or GP about the safest way to get back to your previous levels of activity after getting shin splints.
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