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Shin splints is the common name often given to pain at the front of the lower leg. The most common symptoms occur at the front inside of the shin bone and can arise from a number of causes.
We explain the symptoms, treatment and rehabilitation to cure shin splints and prevent it recurring.
- Pain over the inside lower part of the tibia or shin bone.
- There may be pain at the start of exercise which often eases as the session continues only to come back worse later in the training session or afterwards.
- Symptoms are often worse the next morning.
- Swelling or lumps and bumps felt along the inside of the bone.
- Pain may also be triggered when the toes and foot are bent downwards.
- Occasionally in severe cases reddening of the skin over the inside of the leg from inflammation may be seen.
What is shin splints?
Shin splints is a common term which can include a number of diagnosis or causes and is not an actual injury or diagnosis in itself. One of the most common causes is inflammation of the periostium or sheath that surrounds the shin bone. Traction forces from the muscles of the lower leg pull on the periosteum causing pain and inflammation. This has lead to a more accurate name or diagnosis of medial tibial traction periostitis.
Is it a stress fracture?
A stress fracture is a hairline fracture of the tibia bone. Symptoms are similar but pain is often more acute or sharp along the inside of the shin and does not ease off with exercise but gets worse. Other causes of shin pain include a stress fracture, chronic compartment syndrome and popliteal artery entrapment.
See more detail on shin pain diagnosis.
Over training or overuse is the most likely cause, however a number of factors can increase the likelihood of this occuring:
- Biomechanical factors such as overpronation and over supination of the feet. Overpronation occurs when the foot rolls inwards too much flattening the arch of the foot and causing the lower leg to rotate inwards. This in turn increases the stress on the soft tissues of the lower leg resulting in pain and inflammation. Over supination is where the foot rolls outwards too much during the time the foot is in contact with the ground. If you think you have suspected biomechanical issues then a professional can do gait analysis tests either with a treadmill or using force plates to determine this and whether corrective orthotic inserts for your shoes are needed.
- Inadequate footwear such as the wrong type of shoe for your running style or running shoes that are just too old and have lost their support and cushioning can cause injury. Over pronators may require a running shoe with a firmer midsole on the inside to reduce the amount of rolling in. Supinators usually require a neutral shoe with plenty of cushioning. A specialist running shop can advise.
- Increasing training too quickly, running on hard surfaces, on your toes as in sprinting and generally doing too much too soon will increase the risk of injury.
- Poor flexibility at the ankle can cause increased stress on the soft tissues, muscles and tendons of the lower leg when running.
Treatment for shin splints involves reducing pain and inflammation, identifying and correcting training and biomechanical problems and restoring muscles to their original condition. See rehabilitation program for how and when the following are best applied.
Rest & Ice
Rest is important to allow the injury to heal. If you continue to run on painful shins they will not get better. Avoid activities which make symptoms worse such as running and jumping but try to maintain fitness with other non weight bearing exercises such as swimming, cycling or running in water. Apply ice or cold therapy in the early stages, particularly when it is very painful to reduce pain and inflammation. This can be done for 10 minutes every hour for the first few hours then at least 4 times a day after and particularly after training sessions.
Taping & Supports
Shin splints taping can instantly relieve symptoms in most patients. The simple taping technique supports the muscles of the lower leg by pulling them towards the shin bone reducing traction forces at the most painful part. A calf sleeve or shin support may also help relieve pain by providing support and compression to the muscles of the lower leg.
Stretching exercises should be done to stretch the muscles of the lower leg. In particular calf stretching exercises will stretch the tibialis posterior muscle which is often associated with shin splints. In the long term strengthening exercises may help prevent shin splints from recurring by strengthening the muscles of the lower leg but it is important not to over stress the leg whilst it is healing.
Applying heat and using a heat retainer or shin and calf support after the initial acute stage and particularly during training can provide support and compression to the lower leg helping to reduce the strain on the muscles. It will also retain the natural heat which causes blood vessels to dilate and increases the flow of blood to the tissues to aid healing. As a rule of thumb, heat to warm up before exercise and cold therapy after exercise to reduce pain and inflammation.
Wearing shock absorbing insoles in shoes particularly if you run or walk on hard surfaces in poorly cushioned shoes will help reduce the shock on the lower leg. However, if you do have a biomechanical problem with the foot then a firmer orthotic type insole may be more beneficial. A professional practitioner or podiatrist can perform gait analysis to determine if you overpronate or oversupinate and prescribe orthotic inserts to correct any biomechanical problems.
A doctor may prescribe anti-inflammatory medication e.g. ibuprofen to help reduce pain and inflammation. Although this should not be relied on as a long term solution or excuse not to rest. Asthmatics should not take Ibuprofen.
Sports massage techniques to the deep muscles at the back of the lower leg may help by reducing the strain applied by tight muscles but avoid the inflamed periostium close to the bone.
If all conservative treatment fails then surgery is an option, although this is rare.
See more about shin splints rehabilitation.
Test yourself flash cards
First aid for any acute muscle strain including hamstring pulls is PRICE which stands for.....
The hamstrings consist of which three muscles?
- Biceps femoris
Which type of activity is more likely to result in a strain high at the back of the thigh?
A stretch related muscle strain.
Which type of activity causes a strain lower in the muscle?
How soon should strengthening exercises begin after a hamstring strain?
As soon as pain allows!
Which type of strengthening exercises should be done first for a recent hamstring strain?
Isometric or static exercises which involve squeezing the muscle but no movement.
What type of stretching is dynamic stretching?
Stretching which involves movement or gentle swinging of the leg to stretch the muscle at speed.
Is heat a useful form of treatment? If so, when?
Yes! After the acute stage heat and ice can be alternated or later on just heat.