Shin Splints -
Prevention and Treatment

by Brad Walker

Although the term shin splints is commonly used to describe most lower leg pain, it is only one of several conditions that affect the lower leg. The most common causes of lower leg pain are general shin soreness, shin splints, and stress fractures. For the purpose of this article, I'll only be addressing the first two.



First, I want to quickly cover the topic of general shin soreness. Shin soreness is simply a muscular overuse problem. By using the R.I.C.E.R. regime, you'll be able to overcome 95 percent of all general shin soreness within about 72 hours.

For lower leg pain that goes beyond general shin soreness, you need a more aggressive approach. Let's now look at shin splints in more detail.

What are Shin Splints?

Although the term shin splints is often used to describe a variety of lower leg problems, it actually refers specifically to a condition called Medial Tibial Stress Syndrome (MTSS). To better understand shin splints, or MTSS, lets have a look at the muscles, tendons, and bones involved.

As you can see from the diagram to the right, the lower leg, or calf region, is made up of many muscles and tendons. It's a complex formation of inter-weaving and over-crossing muscles and tendons.

The main components of the lower leg affected by shin splint pain are

• The tibia and fibula. These are the two bones in the lower leg. The tibia is located on the medial, or inside, of the lower leg, and the fibula is located on the lateral, or outside, of the lower leg.
• A large number of the muscles attach to the tibia and fibula. It's these muscles, when overworked, that pull on the tibia and fibula and cause the pain associated with shin splints.

Specifically, the pain is a result of fatigue and trauma to the muscles' tendons where they attach to the tibia. In an effort to keep the foot, ankle, and lower leg stable, the muscles exert a great force on the tibia. This excessive force can result in the tendons being partially torn away from the bone.

What Causes Shin Splints?

While there are many causes of shin splints, they can all be categorized into two main groups: overload (or training errors) and biomechanical inefficiencies.

Overload (or training errors): Shin splints are commonly associated with sports that require a lot of running or weight bearing activity. However, it is not necessarily the added weight or force applied to the muscles and tendons of the lower leg that cause the problem, but rather the impact force of running and weight bearing activities.

In other words, it's not the running itself, but the sudden shock force of repeated landings and change of direction that causes the problem. When the muscles and tendons become fatigued and overloaded, they lose their ability to adequately absorb the damaging shock force.

Other overload causes include

• exercising on hard surfaces, such as concrete;
• exercising on uneven ground;
• beginning an exercise program after a long lay-off period;
• increasing exercise intensity or duration too quickly;
• exercising in worn out or ill fitting shoes; and
• excessive uphill or downhill running.

Over-pronation occurs when the foot and ankle continue to roll excessively inward. This excessive inward rolling causes the tibia to twist, which in turn, over stretches the muscles of the lower leg.

Other biomechanical causes include

• poor running mechanics;
• tight, stiff muscles in the lower leg;
• running with excessive forward lean;
• running with excessive backwards lean;
• landing on the balls of your foot; and
• running with your toes pointed outwards.

How to Prevent Shin Splints

Prevention, rather than cure, should always be your first aim. Even before any sign of shin soreness appears, you can use a number of simple preventative measures.

Since about half of all lower leg problems are caused by inefficient biomechanics, it makes sense to get the right advice on footwear. Your feet are the one area you should not "skimp" on. The best advice I can give you concerning footwear is to go and see a qualified podiatrist for a complete foot-strike, or gait, analysis. The podiatrist will be able to tell you if there are any concerns regarding the way your foot-strike or gait is functioning.

After your foot-strike has been analyzed, ask your podiatrist, or competent sports footwear sales person, to recommend a number of shoes that suit your requirements. Good quality footwear will go a long way in helping to prevent many lower leg problems.

Apart from good footwear, what else can you do? I believe the following three preventative measures are not only effective but crucial.

First, a thorough and correct warm up helps prepare the muscles and tendons for any activity to come. Without a proper warm up, the muscles and tendons are tight and stiff, with limited blood flow to the lower legs, resulting in a lack of oxygen and nutrients for those muscles. For a detailed explanation of how, why, and when to perform your warm up, click here.

Second, flexible muscles are important in the prevention of most lower leg injuries. When muscles and tendons are flexible and supple, they are able to move and perform without being over stretched. If however, your muscles and tendons are tight and stiff, it is easy to push those muscles and tendons beyond their natural range of movement. To keep your muscles and tendons flexible and supple, it is important to undertake a structured stretching routine.

Stretching is one of the most under-used techniques for improving athletic performance, preventing sports injury and properly rehabilitating sprain and strain injury. Don't make the mistake of thinking that something as simple as stretching won't be effective.

For an easy-to-use, quick reference guide of 135 clear photographs of every possible stretching exercise for every major muscle group in your body, get a copy of The Stretching Handbook. You'll also learn the benefits of flexibility, the rules for safe stretching, and how to stretch properly.

Third, strengthening and conditioning the muscles of the lower leg help prevent shin pain. You can do a number of specific strengthening exercises for these muscles, but instead of me going into the details here, I have simply found another web site that has already done all the hard work. It explains a number of exercises you can do for preventing shin splints.

The above-mentioned article is the only other article I found that included a comprehensive section on shin splint prevention. If you're only interested in the strengthening exercises, you'll find them towards the end of the article. If however, you suffer from shin splints or you're looking for more information on shin splints, I recommend you read the entire article.

Treatment of Shin Splints

First, be sure to remove the cause of the problem, whether it's a biomechanical problem or an overload problem.

The basics of healing shin splints is the same as for most other soft tissue injuries. Immediately following the onset of any shin pain, use the R.I.C.E.R. regime. This involves Rest, Ice, Compression, Elevation, and Referral to an appropriate professional for an accurate diagnosis. It is critical that the R.I.C.E.R. regime be implemented for at least the first 48 to 72 hours. Doing this will give you the best possible chance of a complete and full recovery.

The next phase of treatment (after the first 48 to 72 hours) involves a number of physiotherapy techniques. The application of heat and massage are the most effective treatments for speeding up the healing process of the muscles and tendons.

I have found, both from personal experience and from working with many clients, that this form of treatment is the most effective. The application of heat and skilled, professional deep tissue massage on the affected area seems to bring the best results. Also, if you have shin pain, be sure to spend at least a few minutes massaging the affected area both before and after you exercise.

Once most of the pain has been reduced, it is time to move onto the rehabilitation phase of your treatment. The main aim of this phase is to regain the strength, power, endurance, and flexibility of the muscle and tendons that have been injured.