The catch-all term "shin splints" refers to a family of overuse injuries causing inflammation of muscles and tendons of the lower legusually the tissues surrounding the tibia, or shin bone. Characterized by pain in the lower leg, this condition, also referred to as medial tibial stress syndrome, is the most common overuse injury among runners.
During exercise, the muscles in the lower leg enlarge and press against the compartment formed by the two bones of the lower leg (the tibia and fibula). Repeated stress and pressure can cause irritation of the muscles, tendons, ligaments, or bones. Most commonly, the result is tendinitis. Initially, the pain often starts during exercise, then after days or even weeks it may disappear during exercise but occur later and then continue during daily activities.
Shin splints are referred to as "posterior" or "anterior," depending on the location of the injury. A posterior shin splint is characterized by aching pain on the inner side of the calf due to inflammation of the muscles that roll the foot inward and support the arch. People with flat feet are the likeliest candidates for posterior shin splints. An anterior shin splint causes pain along the outer side of the calf.
Symptoms of Shin Splints
- Persistent pain—from mild tenderness to severe achingin the front or side of the lower leg. The pain generally starts during exercise, but sometimes begins several hours later.
- Redness inside of the shin
- Bumps and lumps over the bone
- Sometimes swelling occurs
What Causes Shin Splints?
The pain from shin splints is caused by damage to the soft tissue that typically results from repeatedly pounding the feet on hard surfaces while running or jumping. Seasoned athletes as well as beginners can develop the problem, and the shin splints can be compounded by such factors as running on concrete (rather than a softer surface such as grass) and wearing poorly cushioned shoes. Poor posture and gait can also contribute to shin splints.
What If You Do Nothing?
At the very least, you will probably need to stop the activity and rest the muscles and connective tissue in the lower leg. Otherwise, the condition is likely to grow progressively worse.
Home Remedies for Shin Splints
For mild cases of shin splints, self-treatment measures can usually alleviate the problem. But if you haven’t had this type of pain before, it’s a good idea to consult a physician to get an exact diagnosis, since the cause could also be a stress fracture.
- Rest is essential. Refraining from running and/or jumping for three to six weeks will allow the damaged tissue to heal.
- For pain, use ice and NSAIDs. Applying ice 3 or 4 times a dayfor no more than 20-minute intervalscan help reduce pain and inflammation. A good way to ice shin splints is to use a paper or Styrofoam cup that has been filled with water and then frozen. Place the open end of the ice cup directly on the skin over the sore areas and gently massage with circular or back-and-forth movements. As the ice melts, peel away a strip of the cup to expose more ice. Over-the-counter anti-inflammatories such as aspirin, ibuprofen, or naproxen can also help relieve pain and swelling.
- Wear shoes that are well cushioned. The shoes should provide good support and have plenty of impact-absorbing material to cushion the ball and heel areas of your feet.
- Massage gently to decrease swelling and provide comfort.
These precautions can help you safely return to a full complement of activitiesand lessen your risk of re-injury.
- Switch to low-impact activities. Engage in activities such as bicycling, swimming, and pool running until you can resume running or jumping without pain.
- Don’t run in worn-out shoes. If you run regularly, consider replacing shoes every three to six months. Studies have shown that regardless of brand, price, or construction, running shoes lose about 30 percent of their ability to absorb shock after approximately 500 miles of use.
- Don’t run on hard surfaces. Try to avoid cement and concrete, and instead run on grass, school tracks, well-cleared paths, or boardwalks.
- Take it easy. Keep in mind that running more than 20 miles a week doesn’t greatly increase your fitness, but it does increase your chance of injury. Don’t suddenly increase the intensity of your workout. Also avoid excessive downhill running, which places additional stress on the front part of the lower leg. And be sure to warm up carefully before you work out.
- Stretch and strengthen your calf muscles. Do toe raises and foot rolls several times a day; lie on your back and flex your feet; sit on the edge of a table and flex your foot with a weight attached to it. Also, be sure to stretch your calf muscles thoroughly when you warm up before running.
Beyond Home Remedies: When To Call Your Doctor
For a first case of shin splints, especially if the pain grows worse or the shin muscles are inflamed and swollen, call your doctor. You should also get medical evaluation if the pain is concentrated in a small area along the inside part of the tibia, rather than extending to the surrounding tissue. This may mean you have a stress fracture—a microscopic break in the shin bone itself. An x-ray or bone scan may be used to diagnose a stress fracture.
Also, see your doctor if symptoms persist for more than seven days after self-treatment measures or if pain occurs when you resume running or jumping. You may have tendon or muscle damage that needs additional treatment.
What Your Doctor Will Do
In diagnosing the problem, your doctor will exam your feet and legs to see if an anatomical problem, such as flat feet, might be a factor. You may be referred to a podiatrist, who can see if an orthotic device (a specially fitted shoe insert) would improve your posture and gait. If so, you should wear it in all your shoes.
In persistent cases, a physical therapist may help alleviate the problem by strengthening any affected muscles.
The Complete Home Wellness Handbook
John Edward Swartzberg, M.D., F.A.C.P., Sheldon Margen, M.D., and the editors of the UC Berkeley Wellness Letter
Updated by Remedy Health Media