Shin Splints

March 13, 2014

Shin Splints

By: Daniel P. Bouvier, MD

What Are They?

Otherwise known as “medial tibial stress syndrome”, shin splints refers to pain at the inside back edge of the tibia, or shin bone. Usually the pain is located in the lower 1/3 of the bone, but may occur along a longer length of the bone.

Shin splints occur when too much stress is placed on the muscles and tissues that connect to that area of the bone.


The hallmark of shin splints is pain in the area of the shin mentioned above which begins during prolonged or intensive activity, but can gradually worsen to the point of being constant.

Initially the pain may go away with rest, but it might progress to the point where it lingers even after activity has ended. There may also be swelling in the lower leg that is tender to the touch.

A sudden, traumatic event is NOT how shin splints begin.


As with many of the so called “overuse” syndromes, shin splints often begin with an increase in duration, intensity, and repetition of an athletic activity.

Shin splints can occur while doing endurance activities such as running, or during activities requiring cutting, pivoting, jumping and landing like lacrosse, basketball and soccer.

Other causes include:

  • Running downhill
  • Running on slanted surfaces
  • Poorly fit or worn-out shoes that don’t provide good support for the foot and ankle

Risk Factors

Both boys and girls are at risk. Beginners or people who have not prepared adequately for increased intensity are at greater risk. Other risk factors include:

  • Sudden increases in mileage
  • Sudden increases in the duration of an activity
  • Hard surfaces
  • Flat feet


As is common with soft tissue conditions, the diagnosis is often a clinical one after careful questioning and a physical examination by a trained sports medicine specialist. However, a stress fracture of the shin bone (tibia) needs to be ruled out by an X-ray and often an MRI scan depending on how suspicious the clinician is and the duration of symptoms.


REST, REST, REST. You may recognize rest as the same treatment for many overuse problems and it is the most difficult for many people.

Rest doesn’t mean do nothing. It means move to low or no impact activities like riding a stationary bike and swimming when you are comfortable enough. As your pain decreases, you can start light impact cross training.

Ice and anti-inflammatory medications can be very helpful to control pain and swelling when it is present.

Wear proper shoes and get evaluated for orthotics, or shoe inserts. They can help prevent the inward turning of the foot and ankle, which quite often contributes to stress on the lower leg.


This overlaps with treatment and includes:

  • Wear proper shoes and change them frequently. Runners should change shoes every 350-400 miles.
  • Use orthotics, either off-the-shelf or custom fit by an orthotist, physical therapist, or podiatrist. They should be semi-rigid – not floppy gel pads.
  • Cross train with lower impact exercises.
  • Add core stability and strength training to increase your durability.