Q: What exactly are shin splints? What causes them and how do you treat them?

Q: What exactly are shin splints? What causes them and how do you treat them?


A: The tibia is the large bone in the lower part of the leg (the shin bone). The tibia bears the weight and stress from the bending, twisting and pounding forces generated from running and from many other physical activities.


“Shin splints” is the colloquial term for medial tibial stress syndrome, a condition manifested by pain along or behind the tibia. MTSS is thought to be caused by inflammation and/or swelling of the tibia and/or the tissues that connect the tibia to the leg muscles; it is brought on by mechanical stress and overuse. It most commonly affects the lower half of the tibia, but any part of the shin can be involved.


The pain from MTSS may be mild and occur only during physical activity, or it can be so severe that it impairs or even prevents involvement in the activity. There may also be swelling and/or tenderness of the affected area.


It is estimated that up to 80 percent of the 40 million regular runners in America will experience some running-related injury, with MTSS accounting for over 10 percent of these. Thankfully, the overwhelming majority of these injuries are minor and self-limited.


MTSS is more likely to occur in people starting or ramping up their running/exercise program, running or playing sports on hard or uneven surfaces, participating in activities with lots of starting and stopping, and in those with flat feet or very high/rigid arches. Inappropriate footwear (shoes that are worn out, are poorly supportive or do not fit the shape of the athlete’s foot properly) also contribute to developing MTSS.


MTSS is diagnosed based on the history and physical exam. X-rays are not usually required but may be considered if other conditions, such as a stress fracture, are suspected.


The initial treatments for MTSS are conservative measures, including rest from the contributing activity, ice and elevation of the leg to minimize inflammation and swelling and compression, such as an ace wrap or neoprene sleeve. NSAID pain medications, such as ibuprofen or naproxen, may help alleviate symptoms. Correcting contributing factors, such as replacing worn out or poorly supportive shoes or modifying the workout routine, is also indicated.


One key question that always arises is when and how best to return to your exercise routine. You will know that your MTSS is improved when you no longer have pain, and when both your legs are essentially symmetric with regards to strength and flexibility; and at this point it is reasonable to consider restarting your workouts.


Since abrupt changes in an exercise routine can contribute to developing MTSS, it makes sense that “gradual” should be a key concept; gradually restart your workouts, slowly increasing their duration and intensity. Adding strengthening exercises and varying your workout routine (such as cross-training) may also be beneficial. This may include adding less impactful aspects to your workout, such as swimming or using an elliptical.


Think of pain during your resumed workout as a warning sign that you are redeveloping or exacerbating your injury. The old adage of “no pain no gain” too often translates to “you are hurting yourself, and it will get worse if you ignore it.”


I have often been asked about whether there is true benefit from stretching before exercise. It is interesting that studies on this topic have had somewhat inconsistent results, with most showing no real benefit in terms of preventing injuries (although stretching at the end of your workout does have benefit in terms of increasing flexibility). However, many athletes, coaches and trainers still recommend pre-workout stretching and warm ups. I have not seen any evidence at all that this causes harm or increases injuries, so my best advice on this is to do what seems to work for you.


Appropriate exercise has many health benefits, and of course avoiding injuries is better than treating them once they occur. So always wear supportive (including arch and heel support for those that require these) and well-fitting shoes. Modify or temporarily halt your workout as needed if you start to develop pain or other symptoms suggestive of a developing injury.


Jeff Hersh, Ph.D., M.D., F.A.A.P., F.A.C.P., F.A.A.E.P., can be reached at DrHersh@juno.co