Shin Splints

Inflammation and swelling of the tissues in the lower leg is what produces the only symptom of shin splints, but the type of pain can vary:

• Pain in one leg or both legs, along the front of the shin or on the inner side

• Sharp or dull, aching pain

• Pain that worsens when you press on your shin

• Pain that worsens during exercise

• Pain that decreases with rest

Experts consider shin splints a repetitive strain injury, or RSI. Overuse of your lower leg, especially with high-impact exercises, is what causes shin splints, also known as tibial stress syndrome. Actions that require you to move quickly and stop and start suddenly may also cause shin splints, particularly if you are doing so on uneven terrain.

Imaging tests of athletes with shin splints and tibial stress fractures show changes in bone density. The thought is that repeated stress on the tibia decreases bone density without allowing time for bone to repair and rebuild bone mass. Changes in bone density increase the potential for a stress injury, including shin splints and stress fractures. Bone injury could result from a combination of direct stress on the bone itself and indirect stress from inflammation of the surrounding muscles. 

People who participate in activities that put a lot of stress on their lower leg are at higher risk for developing shin splints. Activities include:

• Dancing

• Gymnastics

• Running more than 20 miles per week

• Sports that require intense bursts of running such as soccer

• Running up and down hills

You may be at even higher risk of developing shin splints if you:

• Have flat feet (low arches)

• Run or work out on hard, concrete surfaces

• Wear inappropriate shoes (shoes without enough shock-absorbing material)

• Are in military training

• Have a narrow tibia

You may be able to lower your risk by:

• Cross-training or changing your routines so your legs aren’t subjected to repetitive or overuse

• Switching to an activity that focuses on other parts of the body as well, such as cycling or swimming

• Wearing proper footwear for the activity

• Wearing arch supports if you have low arches

• Working out on softer surfaces

• Exercising to strengthen the muscles in your legs

If you have risk factors for shin splints and would like to work on prevention techniques, a physical therapist or a foot doctor (podiatrist) can help. A therapist can assess your body movement and suggest ways that may help you reduce your risk.

It can take several months for shin splints to heal completely. Rushing will likely result in worsening of the condition and a longer time to shin splint relief. The most important thing is to stop the activity that triggered the pain for at least two weeks. You can continue being physically active in other ways, but avoid putting stress on your lower legs. Once your legs have rested, resume your activity slowly, allowing your legs a chance to build up to your previous levels of activity. Other measures you can take include:

• Applying ice to your shins for 20 minutes at a time, every few hours for several days

• Stretching your legs gently

• Wearing a compression bandage around your lower leg. Make it snug but not tight.

• Taking nonsteroidal anti-inflammatories, such as ibuprofen or naproxen, to help relieve the swelling and pain

• Wearing shoes with good support or using orthotics

Surgery is very rarely necessary for shin splints, although fasciotomy may be an option should the shin splints be very severe or lead to complications. A surgeon makes an incision into the fascia, which is a connective tissue covering muscles. Cutting the inflamed fascia releases pressure on muscle and bone.

Shin splints don’t usually lead to any potential complications, although severe shin splints can limit your activity and affect your quality of life. It is possible for severe shin splints to lead to a condition called compartment syndrome. As pressure from the swelling in your leg builds up, it can decrease the blood flow to the rest of your lower leg and foot. This prevents the tissues from getting the nutrients and oxygen they need to keep functioning.

Signs and symptoms of compartment syndrome include swelling and numbness in the lower leg and foot. It may also feel cold to touch. This can be a medical emergency and may require surgery to reestablish proper blood flow.