Ask the Expert: How Do I Treat and Prevent Shin Splints?

Shin splints are common for runners, dancers, and military personel. Female Runner Tibia photo via Shutterstock.

Most of the athletes we know have experienced shin splints at some time or another. Shin splints, or medial tibial stress syndrome, is a common injury that affects all types of athletes and involves pain along the middle of the tibia, or shin bone.

But even though we’d experienced the pain of shin splints ourselves, we still weren’t sure what caused it or how to fix it, so we sat down with Dr. Jeffrey R. Jockel, an orthopedic surgeon and foot and ankle specialist at New England Baptist Hospital, to get the low down.

Why do athletes get shin splints?

Shin splints usually occur during exercise or shortly afterwards. The pain is usually at the center of the tibia (shin bone) or more towards the ankle. There is disagreement among doctors about the cause, but there are a few different theories. You probably get them because of traction, or pulling on the bone, by the calf muscles, and also because of repetitive bending forces or loads across the shin bone. All this can lead to painful changes in the bone itself. Essentially, shin splints is an overuse injury that happens when you do too much, too soon.

What kind of activities cause shin splints?

The people that we see who have shin splints are most often runners, military personel, and dancers. But I would say about 30 percent of athletes will experience shin splints at some time in their lives. Usually shin splints is an overuse injury, so any athlete who does something that causes repetitive stress will likely experience it. Impact activities make the condition worse, which is why running is one of the biggest culprits.

Are certain people more likely to get shin splints than others?

People who have flat feet and people who pronate are more at risk for shin splints because of the pressure that those conditions can put on shin bone. Women also more commonly experience shin splints — they are four to five times more likely to have the condition than men. We don’t know why women get them more often, but researchers are working on that.

People who are inexperienced runners or people who have trained for shorter periods of time also tend to be at a higher risk for developing shin splints because of the changes in their training regiment and because of not being conditioned. Their bones and muscles are often not conditioned enough to handle the new training load and exertion.

How can athletes get rid of their shin splints?

If you’re experiencing mild shin pain after exercising, do the classic rest, ice, elevation routine. Then if it’s still bothering you after a few weeks, you should go see a doctor.

When people come in with shin splints, I have them modify and decrease their activities. Then I start some conservative measures, like physical therapy for stretching. If they have flat feet, I get them orthotics. Then, after the symptoms resolve to some extent, I have them increase their activities slowly. It’s non-impact activities first, like swimming. Then I have them do low impact activities, like walking and using the elliptical machine and the exercise bike. The last thing is that I get them back to running and other high impact activities. This can take a few weeks to a few months, depending on the severity of the symptoms and the duration of the symptoms before the person came into my office.

What happens if you have shin splints but don’t see a doctor?

Over time, the symptoms can become more severe until the athlete deals with it. The other things that we worry about are that the pain could be a stress fracture or exertional compartment syndrome. Shin splints are localized in terms of tenderness and you might have a little bit of swelling. When you have a stress fracture, there’s more tenderness on the bone. When you have compartment syndrome, patients describe the pain as an exercise-related tightness over the muscle compartments. People with compartment syndrome often have neurologic symptoms as well.

We don’t know if one of these conditions is a precursor to the other, but we do know that there’s a spectrum of shin injuries. We don’t know if shin splints become stress fractures, but heading to the doctor is a good idea.

Can you prevent shin splints?

The biggest thing that athletes can do to prevent shin splints is to gradually increase their training levels over time. Athletes should also cross train with different types of impact activities. Shin splints is an overuse injury, so repetitive force tends to be the culprit. Dancers do the same motions over and over, and runners do too, so cross training helps to mix it up.