Shin splints (medial tibial stress syndrome) are an exercise-related
pain. Shin splints occur along or just behind the inner (medial) edge of
the shin (tibia). The pain usually involves a span measuring about 3
inches to 4 inches. Shin splints result from exercise of the involved
leg(s). The pain recurs if you try to go back to doing the same kind of
exercise before healing is established. Studies show that medial tibial
stress syndrome (MTSS) commonly affects runners, aerobic dancers and
people in the military.
Shin splints are an inflammation of the thin layer of tissue that
covers the bone (periosteum). The bone tissue itself is also involved.
This can be seen on bone scan examinations. The muscles that attach to
the shinbone through the periosteum are the part of the shin that hurts.
These are the soleus muscle (an ankle flexor important in pushing off
the foot) and the deeper of the two toe flexors (flexor digitorum longus).
Certain factors seem to contribute to the onset of MTSS.
Circumstances can result in abnormal tension at the site of the bony
attachment. The tension causes microscopic tissue injury. Training such
as running, walking and aerobic dancing can cause tissue damage that
must heal and adapt to the increased level of tension. When training
causes damage more quickly than the area can heal, a more chronic
inflammatory state seems to occur. Some factors can help cause tension
and microdamage more quickly than the area can heal and adapt. You may
be more likely to get MTSS if there are abnormal stresses from:
|Flatfoot or abnormally rigid arch (foot/ankle
|Knock knee or bow legs (knee mal-alignment) |
|Runners: As many as 13.2 to 17.3 percent of all running
injuries have been attributed to MTSS. Shin splints are among the five
most common running injuries. |
|Aerobic dancers: In a group of aerobic dancers, 22 percent
of dance related injuries were MTSS. |
|Military personnel: Naval recruits who were followed
through their first 11 to 12 weeks of training showed a 6.4 percent
incidence of MTSS. |
Circumstances that contribute to MTSS include relatively sudden
|Training regimens, such as running longer distances or on
hills, increasing the length of time spent aerobic dancing or
increasing the number of days you exercise each week |
|Surfaces, such as running on concrete rather than cinders
Wearing shoes that have lost their shock absorbing capacity can also
be a factor.
Symptoms of shin splints include pain during increased activity. The
pain is felt along or just behind the inner edge of the shin. It
measures a distance of several inches. It is centered about two-thirds
of the way down from the knee.
See your doctor to diagnose MTSS. Tell him or her your complete
medical history and describe how the condition started. The doctor will
examine you and recommend treatment.
Treatment for shin splints involves several weeks of rest from the
activity that caused it. You may substitute other forms of conditioning.
The doctor may recommend that you take anti-inflammatory medications, or
use cold packs and mild compression to feel better. Most often the pain
is not so bad with just ordinary walking. After several weeks of rest,
training begins at a level much lower than what you were doing before.
Increase training slowly. If you start to feel the same pain, quit
exercising immediately for the rest of the day. Use a cold pack and rest
for a day or two. Return to training again at a lower level of
intensity. Increase training even more slowly than before. Use pain as
|Severe pain is avoided.
|Mild pain is a sign that you have reached or even passed
your maximum level for the session. |
Most people eventually get back to their prior level of
Treatment Options: Surgical
Very few people need surgery for MTSS. For severe MTSS that does not
respond to the usual treatment, surgery has been described. It is not
clear how effective it is.
The accuracy of the diagnosis is a concern. When shin splints are not
responsive to treatment or there is great time pressure to return to
conditioning, a bone scan and MRI (magnetic resonance imaging) can often
show if there is a stress fracture. MRI can also help the doctor
diagnose tendonitis, especially if there is a partial tear of the
involved tendon. An uncommon condition called chronic exertional
compartment syndrome involves swelling of muscle with exertion. This
happens within the muscle's usually tight compartment in the leg. These
compartments are non-yielding. Swelling can raise pressure within the
compartment to levels so high that blood will not flow into the muscle.
This causes severe pain and is best treated surgically. Diagnostic tests
required for chronic exertional compartment syndrome are highly
specialized, and not easily available. They involve pressure
measurements within the compartments immediately after exercise.
The diagnostic tests, causes of shin splints, and treatment regimens
all bear a similarity and relationship to stress fractures. It is
possible that there is a relationship between MTSS and stress fracture
at the tissue level, but this has not been clearly identified.