Medial tibial stress syndrome or Shin splints is a term commonly given to pain at the front of the lower leg. The term does not imply a specific diagnosis, rather it is a symptom of pain over the front of the tibia (shin bone). The pain can be due to either problems of the muscles, the bone, or the attachment of the muscle to the bone.

Shin splints are most commonly due to overuse, where repetitive traction forces of the tendon (tibialis posterior) cause inflammation of the sheath that surrounds the tibia (known as the periostium). This condition is called medial tibial stress syndrome and it is usually what people are talking about when they use shin splints as a diagnosis. It is most commonly the result of athletes who suddenly increase their duration or intensity of training, such as marathon runners.

The tibialis posterior muscle can be strained more if the person overpronates, meaning that the foot becomes too flattened out causing the foot to roll inwards. As a result of this overpronation it causes an increase demand on the muscle and furthermore causing stress of the attachment muscle onto the tibia leading to inflammation of the periostium. The tibialis posterior is the key stabilizing muscle of the lower leg.

Patients with medial tibial stress syndrome typically have a dull, aching type of pain on the inside of their tibia. On examination, patients will often be tender over the inside of the tibia. Patients may or may not have a small amount of detectible swelling over this part of the tibia. Some specific maneuvers, especially resisted plantar flexion (pushing down of the foot against resistance), typically causes an increase of symptoms.

If symptoms persists an x-ray or even a bone scan can be a good idea to detect any stress fractures or ‘hot’ areas that indicate stress fractures or other bone problems. Patients with medial tibial stress syndrome may also have an abnormal bone scan, but there is usually a difference that can be detected to differentiate medial tibial stress syndrome and stress fractures.

Treatment of Shin Splints

The following can help with the recovery of shin splints:

  • Applying ice packs or performs ice massage for up to 20 minutes, three times a day.
  • Make sure that you have the correct footware. See your podiatrist as orthotics may need to be prescribed, especially if you overpronate your feet.
  • Adjust your training accordingly, by avoiding weight-bearing or excessive impact activity. Swimming and cycling are excellent activities.
  • See your local osteopath to correct pelvic alignment, improve ankle and foot mobility, and loosen the muscles in the lower leg and foot.
  • Taping the lower leg can help ease the pressure of the muscle pulling on the bone.
  • Shockwave Therapy can be helpful for those really stubborn shin splints


Shin Splints Prevention

Shin splints are usually as a result of increasing your training by too much too soon. Be smart with your training and have it planned out. Stick to the rule of increasing your training by only a maximum of 10% per week. You may also want to mix up your training with some low impact activity. Make sure that you have the proper footware and make sure that your runners are not too old and overused. If you are training daily you may need to replace your runners every six months. Most running shoes have a life span of about 800km.  Running on softer ground such as grass or gravel travels will be less impact on the legs compared to running on a concrete sidewalk.

Below is an exercise which can help strengthen the muscles in your lower leg and it can help in the prevention of shin splints, especially if you are considering an event like a marathon.

Pole pulls
Set up a pulley or resistance band about waist-high. Stand barefoot on one foot next to the band, with a slight bend in your knee and your core muscles tight. Pull the band so that your hands are in front of your belly button and the band is parallel with the floor. Move the band slowly from side to side, in and out or in small circles. If you’re on the outside foot (away from the pole), the tibialis posterior muscle along the inside of your shin works, balancing you against the upper-body resistance. To strengthen the peroneal muscles on the outside of the shin, switch feet and stand on the inside leg.