Q&A: Shin Splints

What are shin splints?

A shin splint is the term used to describe general lower leg pain. The shin is the tibia, the bigger bone that is located in the inner side of your lower leg. The pain can either be felt on the front part of the tibia (anterior) or more commonly the inside part of the tibia (medial).  

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What causes shin splints?

The cause can be described in a few words: too much too soon. Shin splints most commonly, but not exclusively, occur with athletes who do not GRADUALLY build up their workout plan. For example, runners who abruptly build up their mileage are more at risk for shin splints due to excessive demands on the foot/leg that they are not quite ready for.

Causes include:

  • Excessive pronation: Pronation includes the motions of plantar flexion (foot points down), eversion (foot points out to the side) and external rotation (foot rotates or turns out to the side). While running, pronation normally occurs in order to allow the arch to absorb shock. However, with excessive pronation, the arch collapses and creates more contact between the foot and the ground, increasing the force up the tibia bone of the lower leg. 
  • Flat foot: This follows the same concept with excessive pronation. Flat footed people have weaker muscles in their foot that would usually keep their arch upright. As mentioned, the arch's role is to absorb shock between the foot and the ground. Therefore, without a strong arch, there will be more force going up into the leg.
  • Worn out shoes
  • Tight lower leg muscles
  • Increased dominance of one side over another: If you are right handed, you most likely favor your right leg when you are running. Therefore, your right leg will be receiving more force from the ground than the left leg and will become the leg that gets the shin splints.
  • Muscle strength imbalance between lower leg muscles

How do I know that I do not have a stress fracture?

Symptoms of shin splints and stress fractures can seem similar, however there are common characteristics that distinguish the two conditions:

Shin splints:

  • Felt throughout the tibia, no matter where pressure is placed
  • Worse in the morning because overnight, the muscles and other soft tissue tighten up
  • Worse with excessive dorsiflexion (pointing foot up) and plantarflexion (pointing foot down)

Stress fracture:

  • Felt in a specific spot when pressure is applied to it
  • Better in the morning because overnight, the bone has time to heal without any weight bearing
  • The direction of pain, in regards to the ankle, depends on the location of the stress fracture
  • Pain with weight bearing
  • An X-ray is required to diagnose stress fractures.
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How do I treat shin splints?

Here are some recommendations to manage the pain:

  • RICE: Rest, Ice, Compress, Elevate
  • Stretch the muscles of your lower leg: Below are some stretches you can perform easily at home
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  • Update your current running shoes if they are worn out.

Below are treatments that a physical therapist can provide to treat your shin splints:

  • Manual therapy techniques:
    • Soft tissue mobilization including Graston technique
    • Passive range of motion stretching
    • Joint mobilization of the ankle
  • Individualized program to strengthen intrinsic foot muscles, as well as proper body mechanics for return to sport.

Moral of the story: Remember to GRADUALLY increase your workload when starting a new exercise program or returning to a particular sport.