Shin Splints: What are they and What are the symptoms?

Anatomy

Shin Splints or Medial Tibial Stress Syndrome affects the inner (medial) aspect of the tibial bone, generally in the lower 1/3. There are slight anatomical differences in each person, but primarily the Soleus muscle, Posterior Tibialis muscle and the Flexor Hallucius Longus muscle attach to the medial aspect of the tibia. It is believed that if stress is applied to the area where these muscles attach to the bone (periosteum), it causes inflammation and irritation, leading to Shin Splints. This is a progressive condition; the bone can become compromised if it deteriorates, leading to a stress fracture.

Shin Splints Diagram

Shin Splints Symptoms

Shin Splint pain is felt along the inner aspect of the shinbone. If you run your hand along the bone, there may be visible bumps, lumps or swelling. It is painful when walking or running, especially uphill or on hard surfaces and in mild cases, it is not unusual for the pain to ease and go away during a run before returning when you stop. As the condition deteriorates, it becomes constantly painful with impact activities.

The symptoms of Shin Splints can appear on both sides and should improve with rest. Activities such as Basketball, Jump Rope Skipping and Running are likely to worsen symptoms. There may be some night pain if you have aggravated the shin bone during the day.

Shin Splints Causes

A sudden change in activity levels is the most common cause of Shin Splints. This can vary from walking to running, but increased volume, speed or intensity of impact activity can cause Shin Splints.

If there is no change in activity levels, then a biomechanical cause such as flat feet or poor foot control can alter where the force is applied to the shinbone leading to more pressure on the medial aspect of the Shin.

Currently, there is no evidence to suggest that having tight calves is a risk factor for Shin Splints, but clinically, it can be rationalised. Other causes to consider are poor footwear selection; this can be inadequate support or that they have become too worn. Poor hip control can overload the shin, and females are more likely than males to get medial tibial stress syndrome, according to Newman et al., 2013.

How to Avoid Shin Splints

Avoid sudden changes in exercise levels
Regularly replace footwear
Stretch Calf muscles and Anterior Tibialis muscles regularly
Avoid consistently running on hard surfaces
Vary between impact and non-impact exercises

How To Diagnose Shin Splints

A clinical assessment by a Physical Therapist of a Sports Doctor is the Gold Standard form of diagnosis for Shin Splints. A clinical interview is followed by a physical assessment of a patient’s foot control, strength and mobility. The tibia is palpated for pain along the medial line, and a hop test is performed. A tapping test may be carried out to rule in or out a potential stress fracture.

An x-ray cannot diagnose Shin Splints; if imaging is required, this is in the form of an MRI Scan. There may be evidence of periosteum or bone marrow oedema on an MRI, but the specificity varies between 33-100%.

Home Treatment for Shin Splints:

Ice your Shins for 15 minutes 3-4 times daily
Rest from impact activity
Stretch Calf muscles and Anterior Tibialis muscles regularly
Swim for cardiovascular exercise
Wear cushioned trainers
Take anti-inflammatories such as ibuprofen

Treatment for Shin Splints

Shin Splints treatment should be multifaceted as one intervention is unlikely to resolve the symptoms. Treatment should be under the guidance of a Physical Therapist.

In the initial phase, identifying the causes of pain are essential so that they can be limited or altered to help control your pain levels. Following assessment stretches, strengthening and stability exercises are often recommended. Taping may be applied to help reduce the pain levels; this can be with rigid zinc oxide or KT Tape. Other forms of pain relief that can be recommended are ice sleeves or compression socks.

Picture of Shin Splint Ice Pack

Running gait analysis is beneficial for identifying factors contributing to the cause of your shin splints, such as poor hip control and rapid pronation moments of the foot. These can be addressed with running re-training strategies, insoles, stability trainers and strengthening exercises.

In very irritable cases, a walker boot may be required for 2 weeks before recommencing rehabilitation. Surgery is rarely recommended due to poor outcomes, but periosteal stripping or a fasciotomy is the most common.

Physiotherapy with James McCormack

This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.