Shin Splints 101 – The What, Why & How


If you have ever suffered from shin splints, you would know how annoying they can be. As we always say, understanding your condition is the first step to treatment and recovery which is the inspiration behind this guide: What it is, its causes and how to treat it!

Shin splint is a general term used to describe pain in the anterior portion of the leg which is caused by one or more of a range of conditions. The most common conditions are Medial Tibial Stress Syndrome, Compartment Syndrome, and Stress Fractures.

They are a common injury that most athletes experience from time to time, including runners, tennis players & even military personnel.

What are Shin Splints exactly?

Since shin splints are a very general term, we will consider pain in the shin area as three different but interrelated injuries namely:

  1. Medial Tibial Stress Syndrome
  2. Compartment Syndromes (whichh can maifest as acute or acute Exertional)
  3. Stress Fractures

 
The causes for each of these syndromes are different but most of the time the causation behavior and treatments are the same.

Identifying your Type of Shin Splint Syndrome

Knowing which syndrome you are suffering from is key to your treatment and rehabilitation process. Below we break down the 3 main types of shin splints syndromes and how they are caused!

1. Medial Tibial Stress Syndrome (MTSS)

Medial Tibial Stress Syndrome or MTSS is the official name of shin splints. It’s pain that occurs in the posteromedial border of the tibia (the inner aspect of the leg).

This syndrome usually manifests due to extreme stress placed on the tibia bone and the surrounding muscles. If left untreated, MTSS can become a stress fracture which will ultimately impact the progress of your training.

The stress on the tibial bone and musculature can result in:

  • Periostitis (inflammation of the periosteum) of the tibial bone
  • Microdamage of the tibial bone
  • The muscle pulling away from the bone

 
All of these factors cause pain that occurs during activity. In the initial stages, the pain may cease or reduce after activity but as it worsens, pain is experienced after exercise.
 

What causes Medial Tibial Stress Syndrome?

There are various causal factors that result in undue stress on the tibial bone and surrounding musculature. These factors can be due to training changes, equipment or incorrect technique. Factors include:

  • Sudden increase in training intensity
  • Abrupt changes in training regimen
  • Sudden increase in training frequency
  • Increased mileage (especially for runners) over a short period of time
  • Muscle weakness
  • Improper shoes
  • Training on very hard surfaces
  • Overpronatation
  • Decreased stretching

 

How do you treat or manage Medial Tibial Stress Syndrome?

Firstly, it is important to see your physician in order to ensure that you actually have MTSS. X-rays would be able to rule out the possibility of a stress fracture.

Rehabilitation of MTSS would depend on why your injury occurred. It is therefore essential to establish the cause of injury in order to treat MTSS effectively. Physiotherapists and Biokineticists would be able to ensure proper recovery methods are being used.

Some Self-help tips to aid rehabilitaton:

  • Rest (it is a stress related injury, rest is absolutely essential)
  • Ice (to reduce inflammation)
  • Modify your training programme by cross training in order to maintain your cardiovascular fitness. Cycling on a stationary bike or swimming are appropriate Achilles tendon and calf stretches and mobility exercises
  • Excessive Overpronation could be corrected depending on its cause.
  • Running technique (gait) may have to be modified and orthotics may be used.
  • Strength training
  • Kinesiotaping

 

2. Compartment Syndrome

Compartment syndrome is an injury that causes increased compression and pressure of muscle compartments which are comprised of muscular and neurovascular structures.

The lower leg muscles are organised into compartments and are separated from each other by fascia that wraps around each compartment. These compartments include the Anterior compartment (injured most commonly), Lateral compartment, Deep and superficial posterior compartments.

If the muscles expand faster than the fascia due to exercise or trauma, there is increased pressure in the compartment. This increase in pressure causes a reduction in blood flow which results in reduced oxygen and nutrients to the area and reduced metabolic waste removal and this causes pain and in some cases paraesthesia i.e. numbness and a feeling of ‘pins & needles.’ The affected muscles become very tight and in severe cases the muscle tissue can become damaged.
 

What Causes Compartment Syndromes?

There are 2 types of Compartment syndromes; Acute Exertional Compartment Syndrome and Acute Compartment Syndrome.

Acute Exertional Compartment Syndrome is an overuse injury that occurs due to physical activity. The causes as you will notice are very similar to Medial Tibial Stress Sydrome. They include:

  • Sudden increase in training intensity
  • Abrupt changes in training regimen
  • Sudden increase in training frequency
  • Increased mileage (especially for runners) over a short period of time
  • Change in training surface (especially hard surfaces)
  • Undue stress on the tibialis anterior due to probable muscle imbalances

 
Acute compartment syndrome is caused by direct trauma to the muscle compartment (usually the anterior compartment). Trauma can be due to a car accident or by being hit or kicked there.
 

How do you treat Compartment Syndromes?

Acute Compartment Syndrome: Seek medical attention immediately as often a fasciotomoy (surgery to the compartment) has to take place to prevent further damage.

Exertional Compartment Syndrome: As Exertional Compartment Syndrome is due to physical activity, it is important to find out the main cause in order to treat it appropriately and to avoid reoccurrence.

The following modalities can be used as part of treatment:

  • Rest from activity
  • Activity modification – reduction in frequency and intensity
  • Cross training to take pressure off the area
  • Icing
  • Massage to the leg muscles to reduce tension (this must be done by a qualified physiotherapist only as there is an underlying pathology)
  • Stretching the specific muscles in the affected compartment.

 

3. Stress Fractures

Stress fractures are damage and breakage (micro-fractures) of the tibial bone.
 

What causes Stress Fractures?

Stress fractures are caused by too much stress on the tibia that can be due to:

  • Training errors
  • Muscle imbalances
  • Nutritional deficiencies
  • Progression of untreated Medial Tibial Stress Syndrome
  • Sudden increase in training intensity and frequency
  • Change in training surface (to a hard surface)
  • Worn or incorrect shoes

 

How do you treat and manage stress fractures?

Consult your physician as soon as possible in order for the correct procedures to be followed.

Rehabilitation should be carried out under the guidance of physiotherapists and biokineticists as different case of stress fractures can have different causal factors.

Contact Us

If you suffering from shin splints or would like a more personal injury analysis get in touch with us or book a consultation!

Disclaimer:
The content on this website is purely informational. It is not a replacement for any diagnosis, treatment or advice from a qualified medical professional.
Should you be unsure about a certain injury/niggle, please contact a qualified medical professional (biokineticist, physiotherapist, general practitioner) before applying any self-treatments.

REFERENCES
ARNHEIM, D. D. and PRENTICE, W. E.(1993). Principles of athletic training. St. Louis, Mosby Year Book.
NORRIS, C. (2011). The Complete Guide To Sports Injuries. London: A&C Black Publishers Ltd, pp 69-73.
RESHEF N, and GUELICH DR. (2012). Medial tibial stress syndrome. Clinics in Sports Medicine. 31, 273-90.
WINTERS, M., ESKES, M., WEIR, A., MOEN, M.H., BACKX, F.J., and BAKKER, E.W. (2013). Treatment of medial tibial stress syndrome: a systematic review. Sports Medicine (Auckland, N.Z.). 43, 1315-33.

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