Shin Splints

What are ‘shin splints’?

In the past, ‘shin splints’ has been somewhat misused as an umbrella term to cover pain arising in the lower leg. However, 'true' shin splints is most commonly a disorder affecting the muscular attachments of the tibialis posterior and/or soleus muscles where they attach on the inner (medial) border of the shinbone (or tibia). A second type is seen in anterior tibial muscles at the front of the lower leg. It is most common in poorly conditioned people who start a new running program, but also in fitter athletes who rapidly increase the intensity or distance of their existing program. Changes in footwear, running terrain and the development of ‘flat’ (pronated) feet are common contributing factors.

Shin splints is an old term that has been gradually replaced by more technical names such as Medial Tibial Stress Syndrome (MTSS) and Medial Tibial Traction Periostitis (MTTP) which more accurately describe the nature of the problem. A number of factors contribute to a cycle of tractional strain, micro-trauma and inflammation of the muscular attachments, leading to periostitis and acute pain with loading.

The soleus and tibialis posterior muscles are forceful plantarflexors and invertors of the foot which also resist foot pronation. Running heightens the impact stress on these muscles, and forces are amplified if the position of the foot and ankle are suboptimal, or if the training surface is hard and unyielding. Local tenderness and thickened areas of soft tissue adjacent to the medial tibia are commonly felt and signify areas of localised sub-periosteal inflammation.

Characteristics of Shin Splints

• Dull ache over the lower two thirds of the medial tibial border that becomes sharper with rapid walking and running. This can also occur at the front of the leg in the anterior tibial compartment.
• Pain may decrease after a few minutes of ‘warm up’ exercise, and typically eases with rest
• Pain is worse with repetitive loading and resistance, and is frequently associated with overuse.
• Often coincides with a recent return to training, or a large increase in a regular training volume.
• Pain is often felt diffusely over the lower tibia, with focal areas of sharp pain where periosteal traction has been the greatest. If poorly managed, tibial stress fractures can result.