Shin splints – also known as medial tibial stress syndrome (MTSS) – are the catch-all term for lower leg pain that occurs below your knee, either on the front outside part of your leg (anterior shin splints) or the inside of your leg (medial shin splints).

While they’re the bane of many athletes (like tennis players and dancers), shin splints often plague runners who do not build their mileage gradually enough, or who abruptly change their workout regimen – suddenly adding too much mileage, for example, or switching from running on flat surfaces to running on hills.

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But what exactly is a shin splint? There’s no end-all consensus among sports scientists, and theories have included small tears in the muscle that’s pulled off the bone, an inflammation of the periosteum – a thin sheath of tissue that wraps around the tibia, or shin bone – an inflammation of the muscle, or some combination of all of these. Regardless, the nature of shin splints most often can be captured in four words: too much, too soon.

Identifying Symptoms of Shin Splints

Shin pain doesn’t always mean you have shin splints. It might be a sign of some other problem. The following are two conditions that are sometimes mistakenly diagnosed as shin splints.

Pain on the anterior (outside) part of the lower leg may be what’s called compartment syndrome – a swelling of muscles within a closed compartment – which creates pressure. To diagnose this condition, special techniques are used to measure the amount of pressure. Sometimes surgical “decompression” is required. The symptoms of compartment syndrome include leg pain, unusual nerve sensations, and eventually muscle weakness.

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Pain in the lower leg could also be a stress fracture (an incomplete crack in the bone), which is a far more serious injury than shin splints. A bone scan is the definitive tool for diagnosing a stress fracture. However, there are clues you can look for that will signal whether or not you should get a bone scan.

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The pain of shin splints is usually more generalised than that of a stress fracture. Press your fingertips along your shin, and if you can find a definite spot of sharp pain, that’s more commonly a sign of a stress fracture. Additionally, stress fractures often feel better in the morning because the bone has rested all night; shin splints often feel worse in the morning because the soft tissue tightens overnight. Shin splints are also at their most painful when you flex your ankle or bring your toes toward your shin.

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Common Causes of Shin Splints

There can be a number of factors at work, such as over-pronation (a frequent cause of medial shin splints), inadequate stretching, worn shoes, or excessive stress placed on one leg or one hip from running on cambered roads or always running in the same direction on a track. Typically, one leg is involved, and it is almost always the runner’s dominant one. If you’re right-handed, you’re usually right-footed as well, and that’s the leg that’s likely to hurt.

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The most common site for shin splints is the medial area, which is the inside of your shin. Anterior shin splints, which are located toward the outside of your leg, usually result from an imbalance between your calf muscles and the muscles along the front of your leg, and often afflict beginners who either have not yet adjusted to the stresses of running or are not stretching enough.

Treating Shin Splints

Experts agree that when shin splints strike, you should stop running completely or decrease your training depending on the extent and duration of pain. Then, as a first step, ice your shin to reduce inflammation, says Jordan Metzl, a sports medicine physician. Here are some other treatments you can try:

• Gently stretch your Achilles if you have medial shin splints, and your calves if you have anterior shin splints. Try this stretch for your shins: Kneel on a carpeted floor or exercise mat, legs and feet together and toes pointed directly back. Then slowly sit back onto your calves and heels, pushing your ankles into the floor until you feel tension in the muscles of your shin. Hold for 10 to 12 seconds, relax and repeat.
• Start in a seated position, then trace the alphabet on the floor with your toes. Do this with each leg.
• Or alternate walking on your heels for 30 seconds with 30 seconds of regular walking. Repeat four times. These exercises are good for both recovery and prevention. Try to do them three times a day.
• If you continue running, wrap your leg before you go out. Use tape starting just above the ankle and wrapping to just below the knee. Continue wrapping your leg until the pain goes away, which usually takes three to six weeks. “What you’re doing is binding the tendons up against the shaft of the shin to prevent stress,” Metzl says.
• Consider cross-training for a while to let your shin heal. Swim, run in the pool, or ride a bike.
• Foam roll your shins to loosen up the muscles, says Metzl.
• When you return to running, increase your mileage slowly, no more than 10 percent increase in distance each week.
• Avoid hills and excessively hard surfaces until shin pain goes away completely, then re-introduce them gradually to prevent a recurrence.

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Preventing Shin Splints

There are numerous things you can do to lessen your chances of getting shin splints:

• Make sure you wear the correct running shoes for your foot type. If you’re unsure, visit your local running store to get a professional fit or analysis.
• Have two pairs of shoes and alternate wearing them to vary the stresses on your legs.
• If you frequently run on roads with an obvious camber, run out and back on the same side of the road. Likewise, when running on a track – switch directions.
• Strength train. “Good strength will keep you running in proper form and alignment, and that will help a lot,” Metzl says. He recommends exercises like jump squats, split squats, and single-leg toe touches.
• If you know you are prone to developing shin splints, stretch your calves and Achilles regularly as a preventive measure.
• Take in foods that are high in calcium and Vitamin D, which will improve bone density, Metzl adds.
• This is especially true if you are a woman with a family history of osteoporosis.
• Shorten your stride and quicken cadence. Metzl suggests keeping your cadence between about 85 to 90 steps per minute (with one foot) to put less load on your feet.

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