What Are Shin Splints?

What are shin splints?

Shin splints, also known as medial tibial stress syndrome, refer to an overuse injury that causes pain and inflammation of the muscles, tendons, and bone tissue in the front of your lower leg. The pain is usually located on the inside portion of your lower leg between your knee and ankle. Such pain can be dull or severe and can resolve when resting in acute stages. When symptoms are prolonged, however, swelling of the lower leg and a worsening prognosis can occur. 

Shin splints often develop after increasing running intensity without proper training, seen commonly in athletes who play tennis, soccer, or basketball. But primarily, running on uneven surfaces, using poor training techniques, wearing worn-out shoes, starting and stopping suddenly while playing sports, or frequently running downhill can all lead to shin splints. Having flat feet, as well as medical conditions such as weakness of the hip, core, and ankles, can also be contributing factors. Women are more likely than men to get shin splints. A proper examination by your doctor is crucial to ensure achieving the correct diagnosis for shin splints.  

Due to the intensity of the pain caused by shin splints the body cannot repair itself with continued stress on the tibia. Stress fracture, tendonitis, or compartment syndrome are other possible differential diagnoses if patients do not respond to treatment for shin splints. A stress fracture is a small crack in the tibia. It usually occurs from overuse or possible injury. Tendonitis, due to inflammation in the tendon, if severe enough, can cause partial or full tearing of the tendon. Acute compartment syndrome leads to elevated pressure within the muscle and decreased blood flow to the area. This is considered a surgical emergency requiring a fasciotomy. An intra-compartmental pressure monitor device can be used to measure pressure. An MRI can be commonly used to diagnose stress fractures or tendonitis. X-rays should be performed as a baseline to rule out stress fractures.  

Patients who with to remain physically active must learn how to prevent shin splints from occurring. To prevent shin splints, patients should generally avoid running on hills or rocky surfaces. They should also stretch properly with adequate warm-up time, perform strength training of the hip and core muscles, wear properly fitted shoes, and take a break when pain intensity increases. Patients often overlook wearing shoes that are in good condition. This is important to prevent overuse injuries and instability. Furthermore, using a resistance band around the knees and rotating the hip outward, as well as foam rolling can reduce tension and decrease the risk of shin splints. Also, using a stationary bike and swimming are good alternatives to running that will prevent shin splints. 

If suffering from shin splints, treatment options include rest, stretching, custom orthotics, taping, icing, physical therapy, EPAT,, and possibly taking anti-inflammatory medications. Stretching of both the Achilles tendon and calf muscles are advised. Patients should be pain-free for at least two weeks before resuming physical activity and running. More severe forms of shin splints may require surgery, but this is very rare. A fasciotomy involves cutting the thin fascia of the lower leg to alleviate pressure. Another surgical technique called periosteal stripping removes a thin strip of the tissue overlying the tibia called the periosteum to reduce inflammation. However, conservative treatment methods that are less invasive than surgery should be the first line of defense.  


Dr. Reema Dua works in our Rockville, MD (North Bethesda) office for your convenience.

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