The term shin splints refers to nonspecific pain that occurs in the lower legs during running sports.

Repetitive impact forces during jogging, running, or vigorous walking (eg, hiking) can overload the musculotendinous unit and cause shin pain. Such pain sometimes results from a specific injury (eg, tibial stress fracture, exercise-induced compartment syndrome, tibial periostitis, excessive foot pronation), but often an exact cause cannot be identified. In such cases, the term shin splints is used.

Symptoms and Signs

Shin pain can occur in the anterior or posterior aspect of the leg and typically begins at the start of activity but then lessens as activity continues. Pain that persists during rest suggests another cause, such as stress fracture of the tibia.

Diagnosis

• Usually clinical

On examination, severe localized tenderness is usually present over the anterior compartment muscles, and sometimes there is palpable bone pain.

X-ray findings are usually unremarkable, regardless of the cause. If a stress fracture is suspected, a bone scan may be necessary.

Exercise-induced compartment syndrome is diagnosed by using a specialized manometer to document increased intra-compartmental pressure during exercise.

Treatment

• Modification of activity
• Stretches, NSAIDs

Running must be stopped until it causes no pain. Early treatment is ice, NSAIDs, and stretching of the anterior and posterior calf muscles (see Sidebar 4: Sports Injury: Strengthening the Calf and Shin Muscles). During the rest phase of treatment, deconditioning can be minimized by encouraging cross-training techniques that do not require repetitive weight-bearing activity, such as swimming.

Once symptoms have resolved, it is advised that a return to running be gradual. Wearing supportive shoes with rigid heel counters and arch supports helps support the foot and ankle during running and can aid recovery and prevent further symptoms. Avoiding running on hard surfaces (eg, cement roads) can also help. Exercising the front of the calves by dorsiflexing the ankle against resistance (eg, rubber bands or a dorsiflexion machine) increases leg muscle strength and can help prevent shin pain.

Sidebar 4
Strengthening the Calf and Shin Muscles
Calf Toe raises Stand up. Slowly rise up on the toes, then slowly lower the heels to the floor. Do 3 sets of 10 repetitions with 1 min of rest between repetitions. When this exercise becomes easy, do it while holding progressively heavier weights. Shin Heel raises Stand on the heels and walk 3 to 4.5 m (10 to 15 ft). Do this exercise 3 times.

Last full review/revision April 2009 by Brian D. Johnston; Paul L. Liebert, MD