Written by Tom Bradley, Head Athletic Trainer at Castle View High School
The nature of shin splints, also known as medial tibial stress syndrome (MTSS), most often can be captured in four words: too much, too soon.
Shin splints are defined by the American Academy of Orthopaedic Surgeons as "pain along the inner edge of the shinbone (tibia). It accounts for 10 -15% of all running injuries and up to 60% of all conditions that cause pain in athletes’ lower leg. It is seen commonly in running, basketball, gymnastics, and military personnel .”
- Over pronation of the foot (flat foot), see picture 2
- Tight Achilles
- Weak soleus and tibialis posterior muscles
- Weak toe flexors muscles
- Worn out shoes that do not absorb the ground reaction force anymore
- Undertaking high-impact exercises on hard, non-compliant surfaces (ex: running on asphalt or concrete)
There are 4 levels of shin splints:
- Grade 1: pain in the shin occurring after athletic activity
- Grade 2: pain in the shin before and after activity but not affecting performance
- Grade 3: pain in the shin before, during, and after athletic activity and affecting performance
- Grade 4: pain so severe that performance is impossible
Wear a proper fitting athletic shoe: To get the right fit, determine the shape of your foot using the "wet test." Step out of the shower onto a surface that will show your footprint, like a brown paper bag. If you have a flat foot, you will see an impression of your whole foot on the paper. If you have a high arch, you will only see the ball and heel of your foot. When shopping, look for athletic shoes that match your particular foot pattern.
In addition, make sure you wear shoes designed for your sport. Running long distances in court-type sneakers can contribute to shin splints.
Slowly build your fitness level: Increase the duration, intensity, and frequency of your exercise regimen gradually.
Cross train: Alternate jogging with lower impact sports like swimming or cycling.
Rest: Because shin splints are typically caused by overuse, standard treatment includes several weeks of rest from the activity that caused the pain. Lower impact types of aerobic activity can be substituted during your recovery, such as swimming, using a stationary bike, or an elliptical trainer.
Ice: Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly to the skin .
Compression: Wearing an elastic compression bandage may prevent additional swelling.
Non-steroidal anti-inflammatory medicines: Drugs like ibuprofen and naproxen reduce pain and swelling.
Stretching of Achilles: With leg straight and with the knee bent
Strengthening of toes flexors muscles: Towel curls with the toes or picking up marbles with the toes
Strengthening of soleus muscle: Using a Thera-Band, sit with the knee bent and Thera-Band around the toes, push down with the foot into plantarflexion (pointing toes down).
Strengthening of tibialis posterior: Using a Thera-Band, sit with leg straight and Thera-Band around the toes, pull the ankle inward holding the Thera-Band to the outside of the ankle.
Orthotics: People who have flat feet or recurrent problems with shin splints may benefit from orthotics. Shoe inserts can help align and stabilize your foot and ankle, taking stress off of your lower leg. Orthotics can be custom-made for your foot or purchased "off the shelf."
When to see a Doctor
Management of shin splints should include physician exam to rule out stress fractures via x-ray or bone scan if pain is affecting your athletic activity. Compartment syndrome and tendinitis are other injuries that can cause shin pain that should be seen by an orthopedic doctor.
Prentice, WE. (2003). Arnheim’s Principles of Athletic Training. 555.