Shin Pain (Shin Splints)

What is shin pain?

Shin pain is pain on the front of your lower leg between the knee and the ankle. It can hurt directly over your shinbone (tibia) or over the muscles that are on the inner or outer side of the tibia. Shin pain has often been called shin splints.

How does it occur?

Shin pain generally occurs from overuse. This problem can come from irritation of the muscles or other tissues in the lower leg or from a stress fracture. This injury is most common in runners who increase their mileage or the intensity of their running, or who change the surface on which they are running.

When you walk or run your foot normally flattens out a small amount when it strikes the ground. If your foot flattens out more than normal it is called over-pronation. Over-pronation can contribute to shin pain.

Some specific conditions that cause shin pain include:

• Stress fracture: This is a hairline crack in one of the lower leg bones, the tibia or fibula.
• Medial tibial stress syndrome: This is when the muscles that attach to the inner side of your tibia are inflamed.
• Compartment syndrome: Your anterior compartment is an area in your leg that contains the muscles that point your foot and toes toward your body. Your lateral compartment contains muscles that move your foot and ankle away from your body. Your posterior compartment contains the calf muscles which point your foot downwards. When a compartment is overused the muscles will become painful.

What are the symptoms?

You have pain over the front part of your lower leg. You may have pain during exercise, at rest, or both. Stress fractures of the tibia cause pain directly over your shinbone. It will hurt to touch the part of the bone that is fractured. Stress fractures of the fibula cause pain on the outer side of your lower leg. With medial tibial stress syndrome, you will have pain and tenderness along the edge of the shinbone, especially along the muscles. With compartment syndrome the muscles in that area will be painful. Blood vessels and nerves are also in the anterior compartment. If the muscles in this compartment become swollen during exercise they may irritate these nerves or blood vessels and your foot may become weak, numb, or cold.

How is it diagnosed?

Your healthcare provider will examine your lower leg. He or she will decide which part of your shin is the source of the pain. Your provider may watch you walk or run to see if you have problems with over-pronation. You may need an X-ray, MRI, or a bone scan to check for stress fractures. If your provider thinks you have compartment syndrome you may need a test that measures the pressure in your lower leg compartments. This is done using a needle attached to a measuring device. The test is done at rest and then again after exercise.

How is it treated?

Treatment may include:

To treat this condition:

• Put an ice pack, gel pack, or package of frozen vegetables, wrapped in a cloth on the area every 3 to 4 hours, for up to 20 minutes at a time.
• You could also do ice massage. To do this, first freeze water in a Styrofoam cup, then peel the top of the cup away to expose the ice. Hold the bottom of the cup and rub the ice over the area for 5 to 10 minutes. Do this several times a day while you have pain.
• Raise your legs on a pillow when you sit or lie down.
• Take an anti-inflammatory medicine such as ibuprofen, or other medicine as directed by your provider. Nonsteroidal anti-inflammatory medicines (NSAIDs) may cause stomach bleeding and other problems. These risks increase with age. Read the label and take as directed. Unless recommended by your healthcare provider, do not take for more than 10 days.
• Your healthcare provider may recommend arch supports, called orthotics. You can buy orthotics at a pharmacy or athletic shoe store or they can be custom-made. Arch supports (orthotics) help correct over-pronation.
• Follow your provider’s instructions for doing exercises to help you recover.

Surgery is sometimes needed for compartment syndrome or some types of stress fractures.

While you are recovering from your injury, you will need to change your sport or activity to one that does not make your condition worse. For example, you may need to bicycle or swim instead of run. When you begin to run again, you should wear good shoes and run on soft surfaces.

When can I return to my normal activities?

Everyone recovers from an injury at a different rate. Return to your activities depends on how soon your leg recovers, not by how many days or weeks it has been since your injury has occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better. The goal is to return to your normal activities as soon as is safely possible. If you return too soon you may worsen your injury.

You may safely return to your activities when, starting from the top of the list and progressing to the end, each of the following is true:

• You have full range of motion in the injured leg compared to the uninjured leg.
• You have full strength of the injured leg compared to the uninjured leg.
• You can walk straight ahead without pain or limping.

How can I prevent shin pain?

• Since shin pain usually occurs from overuse, be sure to start your activities gradually.
• Wear shoes with proper padding and support.
• Run on softer surfaces.
• Warm up properly and stretch the muscles in the front of your leg and in your calf.
• Do not keep running while you have shin pain or it will take longer for the pain to go away.
• Try cross training to limit the stress on your shins. Do an exercise that does not place stress on the injured tissue, such as swimming. This will allow you to keep exercising while your injury heals.