Shin Splints

Everything you should know:

I find that most people are familiar with the term “shin splints,” but not a lot of people know exactly what they are or why they occur.

The medical term for shin splints is medial tibial stress syndrome (MTSS).  When people refer to shin splints, they are generally referring to one of two locations: the inside (medial) or the front/outside (anterolateral) portion of the shin bone (tibia).  True shin splints are the medial portion (the hard, flat, inner surface of your shin).

The pathoanatomical cause of MTSS is not totally clear, but there are several different theories.  One is an irritation of something called the periosteum (a sheath overlying the tibia).  Another is small tearing of muscles that attach directly to the shin bone.  The cause of the anterolateral aspect of shin pain is usually a muscle called the anterior tibialis being overworked.

Although the structural pathology of shin splints may not be proven, the cause is well known.  Shin splints are an “overuse injury,” meaning something is being over-worked.  For example, a runner that significantly increases their milage within a short amount of time.  Military recruits tend to get shin splints because of their high activity levels as well.  Other causes include new shoes, overpronation (collapsing of your foot arch), over striding, running on different terrains, or a combination of several factors together.

Stress fractures (a small break in the shin bone) can present like shin splints. Although much much rarer than shin splints, stress fractures are common in the right population, specifically “the female athlete triad.”  The female athlete triad is a syndrome itself that describes young women who may or may not have an eating disorder (predisposing themselves to low energy levels), amenorrhoea/oligomenorrhoea (abnormal menstruation), and decreased bone mineral density (osteoporosis and osteopenia).

Something called compartment syndrome can also present similar to shin splints.  Like stress fractures, this is also rarer than shin splints.  Compartment syndrome is when swelling gets stuck in our fascia (a lining on muscles).  It causes intense pain that is usually immediately resolved with rest.  Generally, you will feel a “throbbing” sensation and sometimes you can see visible bulging in your shin.

Treating shin splints can be simple, or a little more complicated depending on the case.  Usually activity modification and icing can decrease the pain, but when the pain lingers for weeks, the solution is likely more involved.  That’s when I can come into play as a physical therapist, looking at shoe wear, flexibility, structural things, running form, along with various other things.

If you have shin splints that you can’t kick, you could need help finding out exactly what the cause of them is.  Talk to your physical therapist to look into your specific cause(s) of your shin splints.