What are Shin Splints?
Shin splints is a term to describe pain around the shin (tibia) bone. There are three common forms of shin splints-compartment syndrome, medial tibial stress syndrome (MTSS), or tibial stress fracture. MTSS is the most commonly known and diagnosed; however, it is not the only cause of shin pain.
Shin splints are a common occurrence in runners, in fact, up to 70% of runners can experience shin pain. You don’t have to be a runner to get shin splints, though if you overdo any activity too quickly which requires the use of your lower leg muscles and joints, you too can develop shin pain. Here is how it all works.
In the lower leg, you have two bones the tibia and fibula. These are the bones that help form the joints at both the knee and ankle. The large bone in the front of your lower leg is the tibia, and the smaller of the two is the fibula which is on the outside of the lower leg.
The tibia is the second strongest bone in the body and can withstand great forces as well as absorb our body weight. At the top of the bone where the bone forms the knee, exists a flat surface called the tibial plateau, which is where the femur bone sits in with the tibia to help form the knee. Unlike the tibia, the fibula is a small bone whose main purpose is to provide support to the ankle as it joins up with the talus bone in the foot.
The main muscles in the lower leg are:
- Tibialis Anterior (TA) – the lateral side (away from midline) of the tibia; it is the strongest dorsiflexor (lifting the foot upward) of the foot
- Extensor Digitorum Longus (EDL) – lays deep within the lower leg on the lateral side; extends the four lateral toes (not the big toe)
- Extensor Hallicus Longus (EHL) – lays deep within the lower leg and under the TA and EDL muscles; extends the great toe and assist with dorsiflexion
- Posterior Tibialis – runs down the back of the leg and in between the tibia and fibula bones through to the foot; plays a major role in supporting the arch of the foot and prevents the foot from pronating
- Soleus – runs down from the back of the knee down the leg to form the Achilles tendon; primarily used for pushing the foot off the ground
- Flexor Digitorum Longus – runs down the middle of the leg following the tibia to the ankle and foot; responsible for flexing or curling of the toes (except the greater toe)
Understanding this anatomy is important to understanding where and how shin splints develop. Although not common, acute compartment syndrome is a very serious condition. In fact, it is a dangerous condition, a medical emergency.
Acute compartment syndrome typically starts due to trauma (e.g. fracture or contusion) to the lower leg. Between the space of the tibia and fibula, there are muscles, nerves, and capillaries for blood supply. Muscles are covered by a tough tissue called the fascia which helps hold muscles in place. When trauma occurs, the fascia does not stretch which causes increased pressure in the compartment and causes trauma to the muscles, nerves, and capillaries.
This increased pressure in the compartment is dangerous because there is virtually no room for the swelling or bleeding within that compartment, which causes extreme stress on the tissue which if it goes untreated, can cause permanent damage and disability. The swelling reduces the amount of oxygen to the tissue which can cause nerve damage and muscles atrophy. It can be as serious as the tissue death for which there is no recovery.
Chronic compartment syndrome is not a serious condition. Its onset is from overdoing exercises, like running, biking, or swimming. Once the activity stops, or the area is rested, the symptoms subside.
There are a couple of key differences between acute vs. chronic compartment syndrome. Chronic compartment syndrome, activities cause tissue irritation and not because of a traumatic event. Chronic also has a slower onset. With acute, a traumatic event builds pressure quickly from swelling, and there is no place for that swelling to go.
Medial tibial stress syndrome (MTSS) is a more common form of shin splint. It is caused by introducing too much activity, like running, too quickly. Micro tears occur in the muscles, tendons, and bones when too much stress occurs, which is not a dangerous condition; however, it can be painful and debilitating if not taken care of properly.
A tibia stress fracture is also a form of shin splint. The stress fracture develops when the muscles in the lower leg become irritated and fatigued from activity like running which causes altered stress distribution of the lower leg. Without proper rest, the tibia can develop small cracks or fractures which become more irritated and painful over time. The most common site for a tibia stress fracture is about 2 to 3 inches above the ankle.
What causes a shin splint?
The onset of shin pain typically occurs due to either doing too much too soon or repetitive exposure to wear and tear activities. Beyond those causes, the most common causes for shin splints are:
- Excessive hip range of motion
- Flat feet (over pronated)
- Improper stretching or warm-up before activity
- Poor low back function (strength and range of motion)
- Poor shoe wear or overworn shoes
- Smaller calf muscles in men
- Trauma (tibia fracture or contusion)
- Weak hip muscles
Symptoms of Shin Splints
Symptoms for shin splints are typically in the lower half of the lower leg and can range from a dull ache to a severe sharp, stabbing pain. Typically, the area is tender and can be painful during and after activities.
With acute compartment syndrome (ACS), the symptoms tend to be more severe. Not only is there pain, but also swelling, numbness, and even paralysis of the muscles in the area with the most severe cases.
Do not run through shin splints, especially with a recent trauma to the lower leg, which could be a serious condition like an acute compartment syndrome. Even if it is not a serious condition, shin splints occur from overuse and taking a break from stressful activities like running is advised.
How are shin splints diagnosed?
If you suspect ACS, seek immediate medical attention. The sooner the confirmed diagnosis and treatment begins, the less permanent damage may occur.
Most shin splints are not medical emergencies, but more or less a nuisance or annoyance is hindering you from doing the activities you love and need to do. If you are a runner, chances are you’ve experienced shin splints before. They can be self-diagnosed; however, it is recommended you visit with your health care provider to rule out any other possible diagnoses, especially with those stubborn cases.
Either your physical therapist (PT) or physician can diagnosis the condition through a medical history review and physical exam. If there is suspect of a fracture or another medical condition, your doctor may order an X-Ray or MRI (magnetic resonance imaging) to assess the health of the bones and tissue in the culprit area.
Treatment of Shin Splints
For the most common types of shin splints, resting and applying ice is the key. The body needs time to heal, so resting for several weeks is best advised. Introducing low impact exercises like swimming can be done during the resting and healing phase.
From the onset of symptoms, apply ice to the area for approximately 15 mins 2-3 times per day over the next 2-3 days. Others have also reported finding some relief with gentle compression to the area of pain by wearing a compression sleeve during activities.
If symptoms don’t subside during this healing phase, or if you have symptoms that keep returning, then medical intervention is recommended. Your PT will work with you on establishing goals to prevent reoccurrence or worsening of the condition.
Your PT will focus on managing symptoms and instruct you on proper exercises that will help reduce the stress causing the shin splint. Treatment interventions such as manual work, strengthening, stretching, education on proper footwear, and even possibly provide you with a customized orthotic.
The goal of PT is to get to the primary cause of what caused the shin splint and work with you on correcting the biomechanical issue. Treatment will depend on the injury and state of symptoms you are experiencing. In the more advanced stage of a shin splint, PT alone may not help. In rare cases, your physician may prescribe non-steroidal medications to help with pain and swelling.
If a stress fracture is suspected and diagnosed, resting the leg for about eight weeks is recommended. The bone and surrounding tissue need time to heal. During this time, however, you can continue to be active at lower levels. No weight bearing exercises, such as running, are recommended. Focus on swimming, running in water, and gentle range of motion stretches during this time. Returning to aggressive activities too soon will only prolong the recovery process.
Early intervention to shin splints is important because the sooner you address your symptoms, the more likely conservative care will work for you. PT is advised for shin splints because there is commonly a biomechanical issue that caused the flare-up in the first place. If not addressed, shin splints can become chronic.
Most states have direct access to a physical therapist, meaning you can go directly to a physical therapist without a physician order. To determine if your state has direct access, please visit the American Physical Therapy Association’s website Physical Therapy Direct Access By State.
As a consumer of health care, you have a choice in finding the right provider for you. Do your homework and search for a health care provider, like a physical therapist, with excellent outcomes, great customer reviews, and can provide you the care you need for a reasonable cost.
To get started with conservative care today, you can find a highly qualified PT in your area. There are many qualified PTs, so to find one near you, please click on Find A Clinic. This link will help you find a PT that has top national rankings for treating conditions such as shin splints.