Shin splints

Answer 1

Definition

Shin splints are pains in the front of the lower legs caused by exercise. They usually appear after a period of inactivity.

Alternative Names

Lower leg pain; Pain - shins; Anterior tibial pain

Common Causes

Shin splints can be caused by any of four types of problems, which are only occasionally serious.

Tibial shin splints are very common. They can affect both recreational and trained athletes, including runners. There are two types of tibial shin splints: tibial periostitis and posterior tibial shin splints. In tibial periostitis, the bone itself is tender.

Anterior compartment syndrome affects the outer side of the front of the leg.

Stress fractures usually cause sharp pain and tenderness 1 or 2 inches below the knee. A stress fracture is likely to occur 2 or 3 weeks into a new training program or after beginning a harder training program.

Home Care

Most shin splints can be treated with rest.

Healing from posterior tibial and tibial periostitis shin splints usually involves a week of rest. Use ice for 20 minutes, twice a day. Over-the-counter pain medications will also help. Do not start running again for another 2 - 4 weeks.

For anterior compartment syndrome, pain will usually go away as the muscles gradually get used to the intense exercise. Complete rest is probably not necessary.

For a stress fracture, rest for at least 1 month. Complete healing takes 4 - 6 weeks. You can use crutches, but they are typically not necessary.

Call your health care provider if

Although shin splints are seldom serious, you may need to call your health care provider if:

• The pain continues and is persistent, even with rest
• You are not sure whether your pain is caused by shin splints
• You don't improve with home treatment after several weeks

What to expect at your health care provider's office

The health care provider will perform a physical examination and take a medical history.

Medical history questions may include:

• Time pattern
  • When did the pain start?
  • Is it present all of the time?
• Quality
  • Describe the pain.
  • Is it a sharp pain?
• Location
  • Are both legs affected?
  • Where exactly on the leg is the pain?
• Aggravating factors
  • Have you recently begun exercising?
  • Have you recently increased the amount that you exercise?
  • Have you recently changed the type of exercise that you do?
• Relieving factors
  • What have you done for the pain?
  • How well did it work?
• Other: What other symptoms do you have?

The physical examination may include an examination of the legs.

Home treatment will be prescribed for any of the different types of shin splints. Surgery may be needed in rare cases when shin splints caused by an anterior compartment syndrome do not go away over time.

The pressure can be relieved by splitting the tough, fibrous tissue that surrounds the muscles. Surgery may also be necessary for stress fractures that do not heal.

References

Carr K, Sevetson E, Aukerman D. Clinical inquiries. How can you help athletes prevent and treat shin splints? J Fam Pract. 2008;57:406-408.

Answer 2

Definition

Shin splints refers to pain in the front of the lower legs. The pain is located along the inside edge of the tibia, the large bone in the lower part of the leg.

Pain most often occurs during or right after a change in activity level, such as running more often or increasing the number of miles.

Although the term shin splints is often used, it is not a defined medical diagnosis.

Alternative Names

Lower leg pain; Pain - shins; Anterior tibial pain; Medial tibial stress syndrome; MTSS; Exercise-induced leg pain; Tibial periostitis; Posterior tibial shin splints

Common Causes

Tibial shin splints are very common. They can affect both recreational and trained athletes.

The pain of shin splints is caused by swelling or inflammation of the muscles, tendons, and the thin layer of tissue that covers the shin bone.

The common cause is overuse from too much activity or training, and then not enough time to allow the tissues to heal or recover.

Often a sudden change in activity may be the cause, such as:

• Aerobic dancing
• Military training
• Running more often, longer distances, or up hills

Flat feet or a very rigid arch may place more stress on the lower leg and also cause shin splints.

Other causes of pain in the shin bone:

• Chronic anterior compartment syndromeaffects the outer side of the front of the leg. It can cause numbness and clumsiness of the foot while exercising.
• Stress fractures usually cause sharp pain and tenderness 1 or 2 inches below the knee.

Home Care

Begin the healing process with 2 - 4 weeks of rest.

• Rest completely (other than walking for daily activities) for at least 2 weeks.
• You can try other training activities, such as swimming or biking.

After 2 - 4 weeks, and when the pain is gone, you can start running again. Increase your activity level slowly. If the pain returns, stop exercising right away. Warm-up and stretch before and after any exercise.

Use ice or a cold pack over the area for 20 minutes, twice a day. Over-the-counter pain medications will also help.

Talk with your health care provider or a physical therapist about wearing the proper shoes, getting orthotics for your shoes, and running on the right types of surfaces.

For anterior compartment syndrome, your doctor will recommend treatment.

For a stress fracture, see your health care provider. Most patients will need to be on crutches and avoid activities.

Call your health care provider if

Although shin splints are seldom serious, you may need to call your health care provider if:

• The pain continues and is persistent, even with rest
• You are not sure whether your pain is caused by shin splints
• You don't improve with home treatment after several weeks
• You have a stress fracture

What to expect at your health care provider's office

The health care provider will perform a physical examination and take a medical history.

Medical history questions may include:

• Time pattern
  • When did the pain start?
  • Is it present all of the time?
• Quality
  • Describe the pain.
  • Is it a sharp pain?
  • Do you have any numbness and tingling in your foot?
  • Does your leg become clumsy while exercising?
• Location
  • Are both legs affected?
  • Where exactly on the leg is the pain?
• Aggravating factors
  • Have you recently begun exercising?
  • Have you recently increased the amount that you exercise?
  • Have you recently changed the type of exercise that you do?
• Relieving factors
  • What have you done for the pain?
  • How well did it work?
• Other: What other symptoms do you have?

The physical examination may include an examination of the legs.

Home treatment will be prescribed for any of the different types of shin splints. Surgery may be needed in rare cases when shin splints caused by an anterior compartment syndrome do not go away over time.

The pressure can be relieved by splitting the tough, fibrous tissue that surrounds the muscles. Surgery may also be needed for stress fractures.

References

Carr K, Sevetson E, Aukerman D. Clinical inquiries. How can you help athletes prevent and treat shin splints? J Fam Pract. 2008;57:406-408.

Bederka B, Amendola A. Leg pain and exertional compartment syndromes. In: DeLee JC, Drez D, Jr., Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa. Saunders Elsevier;2009:chap 24.

Reviewed By

Review Date: 07/28/2010

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Department of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.