Shin Splints: Pain in the Front of the Leg and When to Have It Checked

What it involves

MedlinePlus describes shin splints as pain in the front of the lower leg from inflammation of the muscles, tendons and bone tissue around the shin. It calls them an overuse problem, caused by overloading the leg muscles, tendons or shin bone, and common in runners, gymnasts, dancers and military recruits.

Who this is for

• New runners and anyone who suddenly increased mileage, speed or training days
• Walkers, dancers and court-sport players with an aching shin that worsens during exercise
• Patients with flat feet or very rigid arches, or who train on hard surfaces
• Patients unsure whether their shin pain is shin splints or something more serious

What to expect

• Questions about your training, shoes, surfaces and when the pain began
• An exam of the lower leg, feet and arches
• A plan for rest, icing, stretching and a gradual return to activity
• An x-ray or other testing through referral if a stress fracture or another shin problem is a concern

How the problem builds

MedlinePlus says the activity that causes shin splints is usually high impact and repetitive exercise of the lower legs. Common triggers it lists are a sudden change in activity level, whether in intensity or duration; running, particularly on hills; adding training days; and going harder or farther. Sports with frequent stops and starts, such as dancing, basketball or military training, can produce the same overload. The pattern is nearly always the same: more load arrives than the leg has adapted to, and the shin complains.

Risk factors you can change, and some you cannot

MedlinePlus lists flat feet or very rigid arches, hard surfaces such as streets or hard courts, the wrong shoes, and worn-out shoes as raising your chances. It points out that running shoes lose over half of their shock-absorbing ability after about 250 miles of use, which is easier to track than most people think. Being a new runner also raises the risk. Arch type is something you cannot change, but shoes, surfaces and the way you ramp up your training are all within your control.

What the pain is like

The symptoms MedlinePlus describes are pain in one or both legs, sharp or dull aching in the front of the shin, tenderness when you press on the shin, pain that gets worse during and after exercise, and pain that gets better with rest. In more severe cases the legs may hurt even when you are not walking. That last detail is a useful yardstick: pain at rest suggests the leg needs more than a few easy days.

Rest, ice and a slow return

MedlinePlus advises expecting at least two to four weeks of rest from the sport or exercise that caused the problem, and avoiding repetitive lower-leg exercise for one to two weeks, keeping to everyday walking. Low-impact options such as swimming, an elliptical machine or biking are fine as long as nothing hurts. Ice several times a day for the first three days or until the pain is gone, stretch the shin and calf muscles, and ask a provider about anti-inflammatory medicine, which has side effects of its own. Full healing, MedlinePlus says, can take three to six months.

Shoes, supports and prevention

MedlinePlus suggests talking with your provider or a physical therapist about proper shoes and, where appropriate, arch supports or shock-absorbing insoles. To keep shin splints from coming back it recommends being pain-free for at least two weeks before returning to a routine, restarting slower and shorter than before, warming up and stretching, icing after exercise, avoiding hard surfaces, and cross training with swimming or biking. Pain along the heel or foot after training may be a neighbouring problem, covered in the heel pain guide.

When to call the office

MedlinePlus says shin splints are most often not serious, but advises contact if pain persists after several weeks despite rest, icing and pain relievers, if you are not sure the pain is shin splints, if swelling in the lower legs is getting worse, or if the shin is red and hot to the touch. A provider may order an x-ray or other tests to make sure there is not a stress fracture and to rule out other shin problems such as tendinitis or compartment syndrome. Sudden severe pain after an injury needs prompt care.

Sources

• MedlinePlus — Shin splints, self-care