Shin splints

Shin splints

Description, Causes and Risk Factors:

Shin splints, also called medial tibial stress syndrome (MTSS), is an overuse injury of the lower leg. It is caused by overuse of the lower leg muscles (calf, posterior tibial and ?exor muscles of the toes). These muscles are important in maintaining your balance during standing, running and jumping. They attach to the shin (tibia) and repeated traction pulls at the attachment leading to in?ammation of the periosteum: the ?brous layer that surrounds the bone.

Shin splints have two main causes:

    Exerting excessive pressure on the lower leg muscles.

  • Excessive impact on the muscle.

Other Risk Factors:

    People with flat feet or rigid arches have a higher risk of developing shin splints.

  • Running downhill.

  • Running on a slanted surfaces or uneven terrain.

  • Running with inappropriate shoes, including proper shoes than have worn out.

  • Taking part in sports that include bursts of speed and sudden stops.

  • An increase in activity, intensity or period of exertion can easily lead to shin splints, if the muscles and tendons struggle to absorb the impact of the shock force, especially when they are tired.

  • Females have a higher risk of complications from shin splints, e.g. stress fractures, especially if their bone density is diminished, as may occur in osteoporosis.

Four grades of pain can be attributed to shin splints:

    Grade one - pain occurs after exercise.

  • Grade two - pain occurs during and after exercise.

  • Grade three - pain occurs before, during and after exercise, and it affects performance.

  • Grade four - pain is so severe that exercise cannot be undertaken.

When you first begin to notice discomfort or pain in the area, you can treat yourself with rest, ice, compression, and elevation (RICE). Over-the-counter medications may also be used to reduce discomfort and pain.


Signs and Symptoms:

    Pain over the inside lower half of the shin.

  • Pain at the start of exercise which often eases as the session continues.

  • Swelling.

  • Shin area is tender and sore to touch.

  • Overlying skin may be red and inflamed.

  • Pain when the toes or foot are bent downwards.

  • Lumps/bumps can be felt along the inside of the shin bone.


The diagnosis of shin splints is founded through a physical examination and review of the individual's medical history. A detailed account of their current training schedule and any recent adjustments made to it, such as increased mileage, is considered. In addition, review of the subject's footwear is also appropriate, considering pes planus is a common cause for shin splints.

Physical examination: focal point is on the shins and legs where local tenderness is noted. The medical practitioner will apply pressure to the foot whilst maneuvering the ankle, so as to identify any points of tenderness. Furthermore, by stretching the tibialis muscles, the doctor can locate the point at which the muscle attaches to the tibia and thus determine the source of the pain.


    X-rays or bone scans may be taken so to eliminate stress fractures as the source of pain.Bone scans involve injecting tracers into the blood stream; tracers accumulate in areas of additional stress to bone tissue and show up on x-rays.

  • Magnetic resonance imaging (MRI) scan may also be undertaken in the diagnosis of shin splints.MRI is primarily a medical imaging technique used to visualize the function and hence internal structure of the body. An MRI scan differentiates between the soft tissues, and therefore scar tissue and abnormal swelling as a result of shin splints.


The best treatment for shin splints is rest. It is not one of those leg pains that recovers faster with physical activity. In the majority of cases the doctor will recommend two weeks' rest. This means no running or taking part in any kind of sport linked to higher shin splint risk. However, gentle activities, such as cycling, swimming or walking are probably acceptable (check with your doctor or physical therapist).

Raising the leg and applying an ice pack to the affected area can help reduce the swelling.

To alleviate pain, an OTC (over-the-counter) analgesic, such as paracetamol (acetaminophen, Tylenol) or ibuprofen may help. Check with your doctor first.

Other Preventive Measures:

    Use proper fitting shoes with good support.

  • Make sure the insoles are shock-absorbing. If you have flat feet, good insoles are vital.

  • Avoid hard surfaces, uneven terrain, or slanted slopes.

  • Increase your intensity gradually.

  • Make sure you warmed up properly before doing exercise.

NOTE: The above information is for processing purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.


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