Information From Your Health Care Provider

SHIN SPLINTS

(Medial Tibia Stress Syndrome)

Basic information

description

Shin splints is a common term that has been used to describe a variety of different leg injuries and it is generally being replaced by more specific diagnostic terms. The most common shin pain is caused by medial tibia stress syndrome (MTSS). The tibia (shin bone) is the larger of the two bones between the knee and the ankle. Medial refers to the inside part of the tibia (the most common injury site).

FREQUENT SIGNS & SYMPTOMS

Pain, dull ache, or tenderness, and, sometimes, swelling, redness, and warmth in inner side (medial), back side (posterior), or outer side (anterior) of the lower leg. At first, the pain decreases with exercise and increases with rest. Later, it becomes continuous.

causes

It is an overuse condition that can be caused by several factors. This shin problem usually develops gradually over weeks to months or could occur after a single excessive or intense training session. The problem is exercise-induced, but the specific cause of the pain is difficult to pinpoint. It may be periostitis (inflammation of the outer layer of the bone), myositis (muscle inflammation), tendinitis (inflammation of the muscle-tendon complex), or a combination of two of these. Faulty foot mechanics contribute to the injury.

risk increases with

Sports involving running (e.g., runners and sprinters, football, basketball, soccer, and rugby players); jumping activities such as gymnastics or figure skating.
Running on uneven surfaces. Climbing hills.
Training too quickly, too hard, and for too long.
Training that involves switching from one type of sport to another (e.g., a triathlon).
High impact aerobics or aerobic dancing.
Poorly fitting or worn-out running shoes.
Foot arches that are flat (pronated) or high (supinated), or muscle imbalance in leg muscles.

PREVENTIVE MEASURES

Stretch and strengthen the muscles in the lower leg.
Stretch before and after running.
Slowly increase intensity/duration of a new exercise.
Avoid hard and uneven surfaces. Use soft surfaces, such as dirt or grass, for jogging, running, and walking.
Warm up before the activity and avoid overtraining.
Shoes with good fit, cushioning, and arch support.
Try sports activities, such as swimming or biking, that have less impact on the shins.

expected outcomes

Healing takes a few days, to two weeks, to two months.

possible complications

May progress to stress fracture.
Shin splints may recur.

diagnosis & treatment

general measures

Use ice massage over the painful area (in a circle about the size of a softball). Do this for 15 minutes at a time 3 or 4 times a day.
After a few days, apply heat if you want. Use hot soaks, hot showers, or heating pads.
Massage area gently and often to provide comfort and decrease swelling. Stretch the calf and foot frequently.
See your health care provider if self-care does not help. A physical exam and x-ray or bone scan may be done to rule out a stress fracture. Physical therapy may be recommended.

medications

For minor discomfort, use nonprescription antiinflammatory drugs such as aspirin (not for children) or ibuprofen.
Other nonsteroidal anti-inflammatory drugs may be prescribed.

activity

Discontinue sports or exercise until the pain is gone. Return to pre-injury activity level slowly.
In some cases, severe pain may require the use of crutches for a short period of time.
If foot mechanics are a problem, such as excessive pronation, special shoes, heel lifts, or orthotics (inserts for the shoes) may be prescribed. Orthotics can be nonprescription products. In some cases, custom-made orthotics are recommended.
Try different exercises (cross-training) such as swimming or walking in water, bicycle riding, or regular walking.