Shin splints is not a specific injury itself but is a general term often used to describe chronic pain on the lower, inside of the shin. A number of injuries may cause 'shin splints' type pain, but medial tibial stress syndrome probably the most common.
On this page:
- Symptoms & diagnosis
- Causes & anatomy
- Shin splints taping
- Sports massage for shin pain
The main symptom of 'shin splints' or medail tibial stress syndrome is pain on the lower inside of the shin. Symptoms usually develop gradually over time with the athlete continuing to train through the pain initially. Pain is often worse at the beginning of a training session but eases as the session progresses and the athlete warms up, only to return again later in the session or the following day.
When pressing in (palpating) along the inside of the shin, the area will feel painful and tender. In long term, chronic cases, lumps and bumps may be felt along the inside of the tibia bone from new bone growth in response to repeated trauma. Occasionally in severe cases reddening of the skin over the inside of the leg from acute inflammation may be seen.
Other causes of shin splints
It is important to get an accurate diagnosis so effective treatment can be applied. Other injuries which may also cause shin pain include:
Stress fracture of the tibia - Symptoms of a tibia stress fracture are similar to medial tibial stress syndrome. A stress fracture will only show up on an X-ray once the healing process has begun.
Chronic compartment syndrome - A compartment syndrome occurs when the muscle becomes too large for the sheath that surrounds it causing increased pressure and pain. Typically symptoms consist of an aching type of pain which becomes progressively worse with exercise, but eases with rest.
Popliteal artery entrapment - Symptoms of popliteal artery entrapment consist of pain mostly in the calf muscles at the back of the shin bone. The pain gets worse with exercise, especially going up on your toes or jumping. Blood flow to the area is restricted causing the athlete's pulse to be diminished when plantar flexing the foot (pointing the foot downwards).
The lower leg consists of tibia and fibula bones. The tibia is the larger weight-bearing bone and the fibula is the thinner one to the outside of it. The function of the smaller fibula bones is mostly for muscles attachment to aid movement. The tibia or shin bone bears the bodies weight when running and jumping. Large forces are transmitted through the tibia bone and the soft tissues attached to it.
The tibia bone has a thin sheath surrounding the bone called the periosteum. Medial tibial stress syndrome or medial tibial traction periostitis occurs when the soft tissues (muscles and tendons) pull on the periosteum resulting in pain and inflammation.
What causes shin splints?
Medial tibial stress syndrome is primarily an overuse injury. Overtraining, especially running or jumping without giving your body time to recover will result in repetitive strain and as a result, injury. However, there are a number of factors which can increase the likelihood of developing chronic shin pain. These include:
- Increasing running mileage too quickly, especially on hard surfaces or running on your toes such as in sprint training.
- 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. 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. Overpronators may require a running shoe with a firmer midsole on the inside to reduce the amount of rolling in (known as a stability shoe or motion control shoe). Supinators usually require a neutral shoe with plenty of cushioning. A specialist running shop can advise.
- Poor flexibility, in particular tight calf muscles and tibialis posterior muscle can cause increased stress on the soft tissues, muscles, and tendons of the lower leg when running.
Shin splints treatment
Treating shin splints involves reducing pain and inflammation, identifying and correcting training errors and biomechanical problems and restoring muscles to their original condition through stretching, exercises, and massage. The full rehabilitation process may take anywhere from 3 weeks to 12 weeks.
Self-help treatment for shin splints
Apply the PRICE principles of protection, rest, ice, compression and elevation to reduce initial pain and inflammation. Apply a cold therapy and compression wrap for 10 minutes every hour initially for the first 24 to 48 hours, reducing frequency to 3 or 4 times a day as symptoms improve. Do not apply ice directly to the skin as it may burn. Either wrap ice in a wet tea towel or use a commercially available cold pack.
Rest is important and often overlooked. This may mean reducing normal training volume and running on soft surfaces. More severe injuries will require complete rest for a few days and then replacing running and jumping type activities with non weight bearing activities such as cycling or swimming.
Protect and support the area with a shin splint sleeve or compression support. This will help keep the muscles warm and supple as well as providing support to the inflamed tissues. Wearing shock absorbing insoles in shoes will help reduce the stresses on the lower leg, or wear softer training shoes/sneakers all the time until symptoms have gone.
Stretching exercises for the calf muscles in particular should begin as soon as pain allows. Keep a training diary so you can look back and assess if the training load is too high.
Shin splints taping
A simple taping technique can often instantly relieve symptoms by supporting the muscles of the lower leg. Tape is applied in a spiral pattern and works by pulling muscle towards the bone, therefore reducing traction forces on the shin and allowing the tissues to heal.
What can a professional do?
A professional therapist can diagnose and identify possible causes of your shin pain. It is a common complaint that a patient will rest until their shin pain is gone, only for it to return once normal training resumes. This is often because the underlying causes are not addressed.
A full biomechanical assessment will identify any biomechanical problems such as overpronation of the feet, which may increase the risk of injury.
Expert interview (play video): Sports Physiotherapist Neal Reynolds explains professional approach to treating shin splints.
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 for shin splints
Sports massage & myofascial release (play video) may be beneficial after the first 3 days or so. Massage will reduce tension in the muscles which may be causing excessive traction forces on the bone, as well as increasing blood flow and therefore, aiding the healing process. Techniques should initially be light, being careful to avoid the inflamed periosteum along the bone as this can make symptoms worse.
If all conservative treatment fails then surgery is an option, although this is rare.
Shin splints exercises
Exercises to stretch the muscles of the lower leg, in particular, the tibialis posterior, which is often associated with shin pain are important. Stretching exercises should be done both with the knee straight and bent to target both the gastrocnemius muscle and the deeper soleus muscle.
Straight leg calf stretch (play video)
This is one of the most important shin splints exercises and stretches the larger gastrocnemius muscle as well as the tibialis posterior. Lean against a wall with the back leg straight keeping the heel pushed into the floor. A stretch should be felt at the back of the lower leg. If a stretch cannot be felt then move the heel further back. Hold for 20 seconds then relax and repeat 3 times. If the athlete has particularly flexible calf muscles then a more advanced version of the calf stretch can be done on a step.
Bent leg calf stretch (play video)
To stretch the deeper soleus muscle the knee must be bent to relax the larger gastrocnemius muscle which attaches above the knee. The patient faces a wall with the foot of the calf to be stretched at the back. The knee of the back leg should be bent towards the wall, keeping the heel on the floor. A stretch should be felt in the lower part of the back of the calf. Hold this position for 30 seconds and repeat 3 times. A more advanced version of this stretching exercise is to place the forefoot or the front leg on the wall keeping the heel on the floor and gently push the front knee towards the wall.
Strengthening exercises may also be required although being an overuse injury it is rest and stretching which should be the priority. A gradual return to full fitness is important. Calf raises and toe raise exercises can help get the muscles of the lower leg working again.
When can I start training again?
When walking has been pain-free for 2 weeks, you can begin running, but build up gradually. Apply tape to the shin to support it for the first few runs and ice afterward to prevent/reduce inflammation. Stretch properly before and after each training session.
Expert interview (play video): Preventing shin splints
- Detmer DE. Chronic shin splints. Classification and management of medial tibial stress syndrome. Sports Med 1986;3(6):436-46
- Moen MH, Tol JL, Weir A et al. Medial tibial stress syndrome: a critical review. Sports Med 2009;39(7):523-46
- Tweed JL, Avil SJ, Campbell JA et al. Etiological factors in the development of medial tibial stress syndrome: a review of the literature, J Am Podiatr Med Assoc 2008;98(2):107-11
- Bennett JE, Reinking MF, Pluemer B et al. Factors contributing to the development of medial tibial stress syndrome in high school runners. J Orthop Sports Phys Ther 2001;31(9):504-10
- Griebert MC, Needle AR et al. Lower-leg Kinesio tape reduces the rate of loading in participants with medial tibial stress syndrome. Phys Ther Sport. 2016 Mar;18:62-67