How to Care for Your "Shin Splints" and Avoid Them in the Future

Pain in the shins, often referred to as “shin splints,” can be debilitating. But what exactly are “shin splints”? Medically speaking, “shin splints” don’t exist – the phrase is not a medical diagnosis.

The term is actually a catchall for any number of conditions that cause pain and inflammation in the lower leg, including tendinitis, muscle strains, stress fractures in the lower leg, medial tibial stress syndrome (MTSS), recurrent chronic anterior compartment syndrome, and inflammation of the connective tissue around and between the bones in the lower leg (called periosteitis and inflammation of the interosseous membrane, respectively).

The muscles and tendons involved with “shin splints” dorsiflex the foot (pull the foot up toward the rest of the body) and provide support to the foot’s main arch. People with “shin splints” can also have – or be at a higher risk of developing – plantar fasciitis, metatarsal stress fractures, FHL tendinitis (which can present with pain in the big toe, foot, ankle, and/or lower leg) or other foot and ankle pain and injuries. Early intervention (medical treatment and activity modification/reduction) is critical, since “shin splints” can indicate the presence of – or be a precursor to – a stress fracture of the lower leg.

Causes

Despite “shin splints” referring to a range of injuries to a variety of tissues, there are some common factors that cause the pain and inflammation associated with these injuries. Most of the conditions included under the umbrella of “shin splints” are overuse injuries caused by any combination of:

• Pounding activities like jumping, running or sprinting, or choreography that involves stomping
• Decelerating or quickly changing directions while running or sprinting, especially when done over a very short period of time
• Poor technique/mechanics, especially while running/sprinting or jumping
• A sudden increase in physical activity, especially activities that include running or sprinting, stairs, running hills, or jumping
• Worn-out, poorly fitting, and/or unsupportive footwear
• Hypermobile or pronated feet
• Weak leg muscles
• Inflexible leg muscles

When shin pain is caused by a muscle strain, muscle soreness, or tendinitis, the affected muscles typically have been overworked eccentrically (the muscle has had to work while being lengthened). Remember, an eccentric muscle contraction leads to the most intense cases of delayed-onset muscle soreness (DOMS). This is the type of muscle contraction that occurs in the anterior tibailis (muscle on the front of the shin) when the forefoot is lowered to the ground while walking or running. This muscle can easily become fatigued and injured while running or walking downhill for an extended period.

Performers who must wear character shoes (or other shoes with an elevated heel) while jumping are at an elevated risk of developing injuries, including shin pain, since the shoe’s heel interferes with proper jump-landing mechanics.

Care

• Relative rest or RICE
• Avoid activities that provoke symptoms.
• Identify cause of injury and stop or correct it.
• Ice massage
• Anti-inflammatory or analgesic medication, if needed.
• Stretch, especially after activity, focusing on both calf muscles (gastrocnemius and soleus), hamstrings, and arches of the feet.
• Use orthotics (follow a break-in schedule when you begin wearing new orthotics), if necessary to correct structural causes of shin pain (like pronation).
• Change to more supportive/better-fitting shoes (reduce your activities while you transition to your new shoes so that these shoes do not cause additional pain and injuries).
• See a doctor to rule-out a stress fracture. Refresh your memory on the signs and symptoms of a stress fracture, since stress fractures will not appear on an x-ray when symptoms first appear.

Once symptoms have resolved, a daily strengthening program for weakened and/or overworked muscles can help the muscles recover and avoid a recurrence of this injury in the future (but other activities still need to be modified for continued healing). The specific muscles to be targeted by this exercise program will depend on the specific injury causing the shin pain.

Avoid Shin Pain Next Time

Thankfully, the injuries collectively referred to as “shin splints” are relatively easy to avoid. The most important steps to take are:

• Gradually start new workouts or gradually increase the amount or intensity of your current workout.
• Do not run loudly, especially during deceleration. Give yourself plenty of room to slow down after a sprint.
• When jumping, use correct and complete landing mechanics and land softly.
• Stretch, especially after activity, focusing on both calf muscles (gastrocnemius and soleus), the hamstrings, and the arches of the feet.
• Wear supportive shoes that fit your feet.
• Wear orthotics, if appropriate, and follow the break-in schedule if they are new or radically different from the previous orthotic used.
• Perform a simple daily strengthening program for the muscles in the foot, ankle, and lower leg.