Shin splints

By Joseph M. Harris, PT, ATC, CEAS - President/Clinical Director - Physical Therapy Solutions, PSC


Shin splints are a generalized term for lower leg pain. It commonly occurs after running or prolonged standing.

The causes of this shin pain can be many. They can occur as a result of inflammation in the lower leg due to muscle strain or can be from stress fracture of the tibia, the large bone in the leg.

Symptoms of shin splints are typically pain in the front of the lower leg. Tenderness may also be present, especially if the condition has been going on for some time. The pain may begin at first as a dull ache that comes on with activities and may progressively worsen to constant pain that is worse with activity.

Most people experience shin splints when activity is increased, particularly distance or intensity of running. This may occur at the beginning of a sports season or when mileage is increased for a runner. This may also occur when biomechanics change. Biomechanics may change due to an injury or as shoes begin to wear.

A common cause of shin splints is strain of the posterior tibialis. This occurs as a result of excessive pronation of the foot and ankle. The posterior tibialis is a small muscle on the inside of the lower leg that is stressed with excessive pronation. This is when the foot rolls in too far as the foot hits the ground.

Another cause can be due to strain of the anterior tibialis. Here, the muscles in the front and outside of the lower leg become inflamed from lifting the foot while running. Weak ankle muscles can also strain as they stabilize the ankle while running.

Another more severe cause of shin splints is stress fracture of the tibia. This is due to breakdown of the bone from repetitive pounding, such as in running on hard surfaces.

Shin splints are diagnosed after carful physical exam. A healthcare professional such as a physician, physical therapist, or athletic trainer will examine the patient making note of the location and cause of the pain as well as the history of the onset of the condition. X-ray, MRI, or bone scan may be indicated to rule out more severe causes of the shin pain.

By accurately determining the cause of the shin pain, appropriate treatment and rehabilitation can begin to alleviate the symptoms. Reducing, but not eliminating the contributing activity will allow the area to rest without deconditioning the injured area or athlete. This is called “relative rest” and is a strategy used with many sports injuries. Stress fractures require more rest and shoes should be modified on return, using a shock-absorbing insole.

Also, return to running should be on a softer surface and concrete should absolutely be avoided. If the shin splints are due to biomechanics, particularly over pronation, an orthotic that helps to control pronation can mean very rapid and effective relief of symptoms, allowing quicker return to full activity.

Bandages and taping also help reduce pain. Icing the area helps decrease immediate pain and inflammation. Anti-inflammatories are often used to decrease pain and inflammation. Stretching and graded strengthening exercises will improve tolerance to the activity and decrease abnormal stresses.

Finally, gradual return to full workouts and competition will allow the athlete to return to activity without flare up of the condition.

A physical therapist or athletic trainer is a good resource to help someone assess the cause of their shin pain and to establish a rehabilitation program to return them back to their sport.


By Joseph M. Harris, PT, ATC, CEAS

President/Clinical Director

Physical Therapy Solutions, PSC

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