Specializing in Spine, Sports & Physical Medicine

Shin Splints

Shin splints or medial tibial stress syndrome (MTSS) refers to pain along or just behind the tibia (shinbone), the large bone in the front of the lower leg. Shin splints occur during physical activity and result from too much force on the shinbone and connective tissue attaching muscles to it. Shin splints are common in runners and in those who participate in activities with sudden stops and starts, such as football, basketball, soccer or tennis. This is a common injury in runners and can be caused by increasing activity, intensity and duration of the sport too quickly and not allowing the tendons and bone to become strong enough to handle the forces. The is made worse by running on uneven terrain, uphill, downhill, or hard surfaces when one primarily trains on soft ground. Improper footwear, including worn-out shoes can also contribute to shin splints.Symptoms of shin splints

  • Pain over the inside lower half of the shin
  • Pain at the start of exercise which often eases as the session continues. However, in more chronic cases it can last the entire exercise bout.
  • Pain often returns after activity and may be at its worse the next morning
  • Sometimes some swelling on the inside of the lower shin

Potential Risk Factors for MTSS

  • Being female
  • Excessive pronation of the foot
  • Excessively tight calf muscles (which can cause excessive pronation)
  • Using the medial leg muscle in excessive amounts of eccentric muscle activity. Muscles work eccentrically (lengthening contraction) when they slow or decelerate the motion of a joint. At foot strike in a runner, the quadricep muscle contracts eccentrically to slow the rate of knee flexion. If the quadricep did not contract in this manner, the runner’s knee would collapse.
  • Undertaking high-impact exercises on hard, noncompliant surfaces (ex: running on asphalt or concrete), especially when
  • someone has trained primarily on soft surfaces.


Shin splints can be caused by a number of factors which are mainly biomechanical and training errors. Some of the most common causes include:

  • Overpronation of the feet
  • Oversupination of the feet
  • Worn out running shoes
  • Increasing training too quickly
  • Running on hard surfaces when one has primarily run on soft ground
  • Decreased flexibility at the ankle joint

Treatment for shin splints is as simple as reducing pain and inflammation. Identifying errors in training and biomechanics issues can sometimes be more challenging. Fully rehabilitation and injured athlete always involves improving muscle flexibility, strength and endurance and gradually returning to pain free training.

In an acute situation rest is probably the most important thing an athlete can do. Healing times can vary from a few weeks to months depending how long the pain has persisted. In addition, ice can help reduce pain and inflammation.

If you are not getting better or the pain is worsening, you should consult with a healthcare provider that is familiar with the proper diagnosis and treatment of shin splints.

Treatments your doctor may prescribe:

  • Prescribe anti-inflammatory medication e.g. ibuprofen (always consult a doctor before taking medication)
  • Perform gait analysis to determine if you overpronate or oversupinate
  • Use of corrective or shock absorbing insoles
  • Physical therapy to reduce pain and inflammation, stretch and strengthen the muscles of the leg and trunk

In order to properly treat shin splints and prevent them recurring, the factors causing them must be identified and corrected if possible. Regardless of how much rest, ice, anti-inflammatories and other modalities are used, without correcting the cause of the injury, the symptoms will continue to return.

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