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Shin Splints - Medial Tibial Stress Syndrome

Painful But Treatable

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Updated May 16, 2014

What Are Shin Splints?

Long ago, the term shin splints was used to describe general pain in the lower leg, because lower leg pain was all lumped together and called shin splints -- regardless of what or where the pain was located.

Today, we know that shin splints occur in a particular area and are a separate diagnosis from other problems, such as stress fractures or compartment syndromes. Researchers and doctors are now more knowledgeable and are trying to be more specific in naming causes of lower leg pain. They also are trying to base the name of the diagnosis on where the pain is located and by what is actually causing the pain. Typically, the pain associated with shin splints is felt on the medial-posterior (inside-back) tibia. Therefore, shin splints are now called medial tibial stress syndrome.

There is still much debate on what actually causes the pain. Possible causes of the pain are: periostitis (inflammation of the covering around the bone), traction periostaligia (pain of the covering around the bone due to muscle pulling on it), tendinopathy (problems with the tendons), periosteal reaction (formation of new bone due to injury) and fatigue failure of the connective tissue connecting muscle to bone.

The term "shin" is a common name for the large, lower leg bone called the tibia. If you take your hand and touch the front of your lower leg, the hard bone you feel is your tibia. Shin splints frequently affect people who run.

Causes

    • Running on uneven surfaces
    • Weak muscles in the front of the leg (stronger muscles in the back of your leg)
    • Over-pronation (when your foot rolls to the inside and your arch flattens)
    • Wearing inappropriate shoes (worn-out or incorrect for your foot type)
    • Training too hard too soon (not increasing your activity gradually), because muscles that fatigue quickly lose their ability to absorb shock and therefore more stress is placed on the bones
    • Resuming activity (exercise) after a period of no or reduced activity

Signs and Symptoms

    • Tenderness over the inside shin area (may start as a dull ache and progress to a sharp pain)
    • Pain starts with activity and then seems to disappear, but may return at the end of activity, as shin splints get worse the pain may last longer
    • Lower leg swelling
    • May see lower leg redness (rubor)
    • May feel a lump or bump on the lower leg
    • Pain with toes or ankle pointed downwards

Diagnosis

The diagnosis is usually made from your history and physical examination. Pain is usually located 3-12 cm above the tip of the inside ankle bone (medial malleolus) and is "vertically oriented" (runs up and down) as opposed to pain with a stress fracture, which is horizontal (across or side to side). Your podiatrist or doctor should perform a biomechanical exam to see if your foot type is contributing to your shin splints. If the diagnosis is still unclear, your doctor may order an x-ray, MRI or bone scan. An MRI is able to show a difference between shin splints and stress fractures: A stress fracture will show a "wide signal abnormality" whereas shin splints will show a "linear signal abnormality."

However, an MRI is usually not needed if the physical exam findings are obvious. Sometimes, a bone scan may be done, which can show a linear (long line) of increased signal uptake, highlighting the difference between shin splints and stress fractures.

Treatment

    • Rest (no exercise)
    • Ice/ice massage
    • Appropriate shoes
    • Arch supports
    • Orthoses (orthotics)
    • Taping/bracing
    • Anti-inflammatories (NSAIDs)
    • Cross training (swimming, biking, walking)
    • Train on softer surface (soft grass, smooth dirt, asphalt, concrete)
    • Relative rest (lengthening the time between work-outs, decreasing the amount and intensity of the work-outs)

Other Causes of Lower leg Pain:

    • Stress fracture
    • Bone tumor
    • Lipoma
    • Vascular disease
    • Spinal stenosis
    • Cellulitis
    • Infection
    • Nerve entrapment

Sources:

Aoki Y, Yasuda K, Tohyama H, Ito H, Minami A. Magnetic resonance imaging in stress fractures and shin splints. Clin Orthop Relat Res. 2004 Apr;(421):260-7.

Bates P. Shin splints--a literature review. Br J Sports Med. 1985 Sep;19(3):132-7.

Holder LE, Michael RH. The specific scintigraphic pattern of "shin splints in the lower leg": concise communication. J Nucl Med. 1984 Aug;25(8):865-9.

Pribut S. The top five running injuries seen in the office. Podiatry Management. 2008 Apr/May;27(4):117-30.

Story J, Cymet TC. Shin splints: painful to have and to treat. Compr Ther. 2006 Fall;32(3):192-5.

Thacker SB, Gilchrist J, Stroup DF, Kimsey CD. The prevention of shin splints in sports: a systematic review of literature. Med Sci Sports Exer. 2002 Jan;34(1):32-40.

Tweed JL, Avil SJ, Campbell JA, Barnes MR. Etiologic factors in the development of medial tibial stress syndrome: a review of the literature. J Am Podiatr Med Assoc. 2008 Mar-Apr;98(2):107-11.

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