Shin splints, also known as medial tibial stress syndrome (MTSS), is a common term that describes pain along the front of the shin bone in the lower leg. The condition generally occurs with physical activity due to excessive force or pull on the tibia (shin bone) and the connective tissue attaching the muscles to this bone. This then leads to inflammation and irritation of the tibia causing pain on the inside of the lower leg. In more severe cases, stress fractures or compartment syndrome can occur.
Causes of Injury
Shin splints is generally an exercise induced injury caused by overuse of the lower leg muscles. It is more common in high impact sports or those involving a lot of running and jumping, such as basketball, netball, football. There are a number of factors which can increase a person’s risk of developing shin splints, including:
- Abnormal biomechanics, such as overpronation or malalignment of the lower leg
- Poor flexibility in the calf muscles and Achilles tendon
- Insufficient warm up, fatigue
- Recent increase in the intensity, duration, frequency or type of exercise
- Inappropriate training surfaces- hard or uneven ground
- High impact sports, such as running, netball, tennis, dancing or athletics
- Poor running technique
- Inappropriate footwear or worn out shoes
- Pain along the inside of the shin bone (tibia)
- Worsening pain with continued activity, generally easing with rest
- Tenderness when touching the front of the shin
- The calf muscles may throb or ache
The aim of treatment initially is to reduce inflammation and relieve pain. This can be achieved by:
- Rest. In less severe cases reducing normal exercise may suffice, however in many cases full rest from impact exercises will be required. Swimming or cycling are examples of non-impact exercises.
- Icing after activity
- Correction of abnormal biomechanics, using orthotics, taping, strengthening or stretching
- Physiotherapy treatment may include ultrasound, massage, education and a specific home exercise programme aimed at stretching and strengthening muscles of the lower limb including a gradual return to activity as appropriate
Return to Sport/Activity
Shin splints generally respond well to rest and treatment. Provided sufficient rest is allowed, six weeks would be the average time frame for return to sport and normal activity. It is essential that any biomechanical or training issues are addressed to prevent recurrence of the injury. It is also important to ensure adequate rest and appropriate treatment is provided to avoid ongoing complications, such as stress fractures.
Surgery is considered only if conservative treatment and rest has not been successful or in persistent and recurrent cases. It is very uncommon. In this instance surgery would involve releasing the connective tissue where the muscle attaches to the tibia.