Shin Splints

What are shin splints?

Shin splints refers to pain in the front part of your lower legs (shins). This pain occurs when the muscles, tendons and tissue around your shin bone (tibia) become inflamed. Athletes often have shin pain because they put repeated stress on their shin bones, muscles and connective tissues. Healthcare providers sometimes call shin splints medial tibial stress syndrome.

Shin splints are a very common overuse injury. With rest and ice, most people recover from shin splints without any long-term health problems. However, if left untreated, shin splints do have the potential to develop into a tibial stress fracture.

What are shin splints symptoms?

The most common symptom of shin splints is lower leg pain. The pain can range from mild to severe, and your shin bone may be tender to the touch. Mild swelling may occur, as well.

What do shin splints feel like?

Pain from shin splints can:

• Commonly be felt on the inner lower part of your leg or front of your shin bone.
• Start off as come-and-go discomfort with activity and progress to a steady and persistent pain even after the activity has ended.
• Be sharp or a dull ache.
• Get worse after activity.

What causes shin splints?

Shin splints develop from repeated stress to your shin bone by the pulling and tugging of the muscles and connective tissues in your lower leg. Frequent, repetitive pressure from running and jumping can cause your shin bone to become inflamed (swollen or irritated) and weakened. When the bone doesn’t have time to heal, the damage can get worse and cause severe pain. Such repeated stress can happen for many reasons, including starting a new exercise routine or increasing your level of physical activity too quickly.

Who is affected by shin splints?

Although anyone can get shin splints, certain people have a higher chance of developing the condition. Groups with a higher risk of shin splints include:

• Runners, especially those who run on uneven surfaces or suddenly increase their running program.
• Athletes who play high-impact sports that put stress on their legs.
• Dancers.
• People who have flat feet, high arches or very rigid arches. In these situations, your muscles and bones may not absorb or distribute force from impact and loading activities, as well.
• Members of the military and people who march or walk a lot.
• People who wear unsupportive shoes when exercising.
• People who walk extreme distances.
• Anyone with underlying vitamin D deficiency, an eating disorder or loss of normal menses (periods).
• People with osteopenia or osteoporosis who may already have weaker bones.

What are the complications of shin splits?

Complications from shin splints are rare. If you continue to run or play sports without letting your legs heal, shin splints can progress into a stress fracture. A stress fracture occurs when little cracks form in your bone. To treat a stress fracture, healthcare providers often recommend using crutches or wearing a walking boot until the bones heal.

How are shin splints diagnosed?

Healthcare providers diagnose shin splints by learning your medical history and doing a physical exam. Your provider will look at how you walk and examine your lower leg, ankle and foot. A complete exam will involve moving your ankle and foot around and feeling for tenderness along the bone. Standing on the painful leg or hopping on that leg may help to diagnose shin splints or a stress fracture.

To rule out a stress fracture, your provider will first order an X-ray, although stress fractures aren’t seen in about two-thirds of plain X-rays. Therefore, if your provider is concerned, they may then order a magnetic resonance imaging (MRI) scan or bone scan. These tests allow your provider to see if the shin splint has become a stress fracture because they pick up the injury before an X-ray

How do you treat shin splints?

To relieve your symptoms, you need to give your bones and muscles time to heal. Shin splints treatment usually includes a combination of:

• Rest: Take a break from sports, running and other activities to give your muscles and bones a chance to recover. You may need to rest and take it easy for a few weeks or longer.
• Ice: Apply a cold compress to your shins every 10 to 20 minutes, three to four times a day, for a few days. Ice helps relieve the swelling and pain of shin splints.
• Pain relievers: Over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) can ease pain and swelling.
• Supplements: A vitamin D3 supplement (1000 to 2000 IU daily) may help. Discuss supplements with your healthcare provider.
• Shin splint stretches: Gently stretching and flexing your lower leg muscles may be helpful.
• Slow increase in activity level: When you do become active again, start slowly. Increase your activities gradually to reduce the risk of shin splints returning.
• Supportive shoes and shoe inserts: For people who have flat feet, shoe inserts (orthotics) can be effective at relieving the pain of shin splints. Orthotics support your arches and reduce stress on the muscles and bones in your lower legs.
• Physical therapy: Physical therapy can help you get moving again by strengthening your legs and reducing your chance of repeated injury.

What are the side effects of the treatment for shin splints?

Side effects from NSAIDs are rare but can occur. They usually happen only after you’ve taken the medication for a long time. You should use the lowest dose for the shortest time to minimize side effects.

Side effects of NSAIDs can include:

• Heartburn, stomach pain and (rarely) stomach ulcers.
• Headaches, dizziness and lightheadedness.
• High blood pressure (hypertension).

How do you prevent shin splints?

While you may not always be able to prevent shin splints, you can reduce your risk of developing the condition or making it worse. To lower your risk, you can:

• Wear supportive shoes when exercising. Running shoes should be replaced every 300 miles. Consider wearing orthotic inserts that support your arches. Stop in and chat with someone at a running shoe store where they can help match your foot type with a proper running shoe or orthotic. You may also consider speaking with a pedorthist. A pedorthist is a specialist in using shoes and other footwear to solve problems related to your lower legs and feet.
• Start slowly and increase your activity level and intensity over time. Avoid sudden increases in activity. Stick to the 10% rule — don’t increase more than 10% per week in activity. For example, if you run 5 miles (8 kilometers) total in one week, you should only add a half mile to your total mileage the following week (5.5 miles or 8.85 kilometers total).
• Stretch your muscles before exercising to warm them up.
• Avoid surfaces that are hard, uneven or hilly when you’re running. If you run often, consider adding low-impact exercises (like swimming) to your exercise program to give your legs a break from the stress of running. Consider cross-training and taking days off.
• Rest between activities to allow your muscles and bones time to heal.
• Use pain as your guide. If you’re noticing shin pain, reduce your activity level until this improves. Don’t try to push through pain.

What is the outlook for people who have shin splints?

Most people who have shin splints recover after taking time off from sports and activities. Shin splints often go away once your legs have had time to heal, usually in three to four weeks. Most people can resume an exercise program after their legs have healed. It takes longer to recover from a stress fracture, so it’s best to treat shin splints early.

How long do shin splints last?

Shin splints aren’t permanent. You should be able to ease pain from shin splints with rest, changing the amount of exercise you’re doing and making sure to wear supportive footwear. If your shin splints don’t go away over a long period of time, see your healthcare provider. You may need to be tested for stress fractures or other conditions that could be causing the pain. Preventing shin splints from returning may require an evaluation of your footwear, stretching and flexibility.

When should I see my healthcare provider?

You should call your healthcare provider if your shin pain is severe or doesn’t go away after a few weeks of rest. Call your provider if your legs are very swollen, red or painful. These symptoms could mean you have an infection or another condition.

What questions should I ask my healthcare provider?

Questions you may want to ask your provider include:

• How did I get shin splints?
• How can I get rid of shin splints?
• How long will they last?
• Is it OK to walk with shin splints?
• How can I prevent shin splints in the future?

A note from Cleveland Clinic

You’re running along the tree-lined path in the park as you always do. Wind in your hair, tunes in your ears, pushing yourself to go just a little bit further. Suddenly, you feel a sharp pain in your leg — you may have a shin splint. While inconvenient, shin splints usually aren’t serious. But you should take it easy for a while until they heal. To rule out the possibility of a stress fracture, see your healthcare provider if the pain continues.