What are shin splints?
Shin splints tend to be the name given to exercise
induced pain in the lower leg, specifically along the front of the leg
between the knee and the ankle, the area known as the shin.
Shin
splints are really a symptom rather than a specific diagnosis because
they are probably caused by a number of different problems. Shin
splints are one of the most common problems in the lower leg in people
who exercise or play sports.
In typical shin splints, pain is
felt more over the medial (inner) part of your shin. Pain felt over the
lateral (outer) part of your shin may not be due to shin splints and
may be due to a compartment syndrome in your leg.
Shin splints are sometimes called medial tibial stress syndrome.
What causes shin splints?
Experts do not all
agree on the cause of shin splints and the exact cause is not known.
They are thought to be caused by overuse or overactivity and typically
occur in runners. There are certain things that have been suggested
that may make shin splints more likely. These include:
- A sudden increase in training frequency or intensity.
- A lack of calcium.
- Hard running surfaces.
- Running up an incline
- Previous leg injury.
- Poorly fitted or inadequate running shoes that do not support the foot and ankle.
- Various problems with muscles in the lower leg and foot position, including over-pronation of the foot.
(The foot (and ankle) normally roll slightly inward when we
move. Over-pronation is where the foot rolls inward more than normal.)
Some
experts suggest that shin splints are caused by small tears in the
membrane structure between the two bones of the leg below the knee (the
tibia and fibula). This structure is called the interosseous membrane.
Others suggest that they may also be caused by inflammation of tendons
(tendonitis), muscle sprains, or inflammation of the membrane
surrounding the tibia and fibula bones (periostitis). Tiny fractures
(microfractures) in the surface of the tibia bone have also been
suggested as a cause.
What are the symptoms of shin splints?
The
main symptom is pain in the shin area. The pain tends to be in the
middle and lower shin and on the medial (inner) half. Pain first comes
on after running or exercising. However, over time, the pain can come
on during running or exercising. If severe, it may also come on when
climbing stairs.
What else could the pain be?
Stress
fractures of the tibia (one of the two bones in the leg below the knee)
can also cause shin splint-type pain. A stress fracture is a type of
incomplete fracture in a bone. Stress fractures tend to occur as a
result of overuse and are known as 'overuse injuries'.
Do I need any investigations for shin splints?
X-rays
are usually normal in people with shin splints. The main reason that
your doctor may suggest an X-ray of your leg below the knee is to rule
out a stress fracture in one of the bones. However, not all stress
fractures show up on X-rays.
In some cases, your doctor may
refer you for a bone scan of your lower leg. This can help to
differentiate between shin splints and a stress fracture. A bone scan
involves an injection of a very small amount of radioactive material,
usually into your arm. A gamma camera is then used that can detect the
radiation emitted by the injected material. This can show up a stress
fracture or changes that can occur in the bones in shin splints. An MRI
scan is also sometimes used to help to tell the difference between shin
splints and stress fractures.
What is the treatment for shin splints?
Rest.
This is the main treatment for shin splints. This means avoiding any
activity, such as running, that may have lead to the shin splints.
Ice.
Applying ice to your shin and raising your leg may also help to relieve
pain from shin splints. You can make an ice pack by wrapping ice cubes
in a plastic bag or towel. (Do not put ice directly next to skin as it
may 'ice-burn'.) A bag of frozen peas is an alternative. Gently press
the ice pack onto the injured part. The cold from the ice is thought to
reduce blood flow to the damaged ligament. This may limit pain and
inflammation. After the first application, some doctors recommend
re-applying for 10 minutes every two hours (during day time) for the
first 48 hours.
Elevation of the leg aims to limit and
reduce any swelling. Keep the foot up on a chair to at least hip level
when you are sitting. (It may be easier to lie on a sofa and to put
your foot on some cushions.) When you are in bed, put your foot on a
pillow.
Painkillers such as paracetamol are useful to
ease pain. It is best to take these regularly initially.
Anti-inflammatory painkillers are an alternative. There are many types
and brands. They relieve pain and may also limit inflammation and
swelling. Side-effects sometimes occur with anti-inflammatory
painkillers. Stomach pain, and bleeding from the stomach, are the most
serious. Some people with asthma, high blood pressure, kidney failure,
and heart failure may not be able to take anti-inflammatory painkillers.
What is the prognosis (outlook) for shin splints?
With
rest and treatment, you can fully recover from shin splints. However,
they may recur if you do not look at the underlying cause of your shin
splints.
When you have recovered from your shin splints, you
may benefit from seeing a specialist such as a sports physiotherapist
or a podiatrist. They may be able to help you to modify your exercise
programme and may also be able to assess your legs, feet and shoes.
This may show up some problems that may have caused your shin splints
such as over-pronation of your foot or poorly fitting training shoes.
They may suggest the insertion of an insole inside your shoes.
Can shin splints be prevented?
Studies and
trials have been done to look at preventing shin splints. No single
prevention method has been found to be consistently effective and
further trials are needed. However, one of the things that does show
some promise is the use of shock-absorbent insoles inside shoes while
you are exercising. Special insoles to correct over-pronation of your
foot (if you have this) may also be helpful. You should also regularly
replace your running shoes. Graduated running programmes that build in
rest days may also help.
Disclaimer: This article is for information only and should not
be used for the diagnosis or treatment of medical conditions. EMIS and
PiP have used all reasonable care in compiling the information but make
no warranty as to its accuracy. Consult a doctor or other health care
professional for diagnosis and treatment of medical conditions.
© EMIS and PiP 2008 Reviewed: 9 Sep 2008
