What is the best treatment for shin splints?

Treatment of Shin Splints

The optimal treatment for shin splints (medial tibial stress syndrome) involves a combination of rest, ice application, NSAIDs for pain control, and early progressive exercise therapy, with a gradual return to activity guided by pain levels. 1

Initial Management

Pain Control and Inflammation Reduction

• Apply cold therapy (ice) for 20-30 minutes, 3-4 times daily to reduce pain and inflammation
• Use NSAIDs for pain relief and to reduce swelling
  • Topical NSAIDs can provide localized relief with fewer systemic side effects
  • Avoid direct ice contact with skin to prevent cold injury
• Compression with an elastic bandage or sleeve may help reduce swelling

Rest and Activity Modification

• Implement the PRICE protocol (Protection, Rest, Ice, Compression, Elevation) for the first 72 hours 2
• Rest from activities that cause pain
• Gradually return to low-impact activities (swimming, cycling) before progressing to higher-impact activities
• Increase duration and intensity by no more than 10% per week 1

Rehabilitation Phase

Exercise Therapy

• Begin exercises within 48-72 hours of injury to restore motion and strength 2
• Focus on:
  • Strengthening exercises for calf muscles, quadriceps, hamstrings, and hip muscles
  • Proprioceptive and balance training
  • Core stability exercises
  • Progress from isometric to dynamic exercises 1

Functional Support

• Use of functional support (brace or tape) is preferred over immobilization 2
• Ankle braces show greater effects compared to other types of functional support
• Use functional support for 4-6 weeks to facilitate return to activity 2

Return to Activity

Progressive Loading

• Implement a walk/run interval training program for safe return to running 1
• Gradually increase training intensity (no more than 10% per week)
• Return to sports-specific drills only after basic exercises are well-tolerated 2

Biomechanical Considerations

• Address any biomechanical abnormalities that may have contributed to the injury
• Consider prefabricated foot orthoses or taping techniques to improve proprioceptive feedback 1
• Ensure proper footwear with adequate shock absorption

Prevention of Recurrence

Maintenance Program

• Continue strengthening and proprioceptive exercises even after return to full activity
• Implement proper warm-up and cool-down routines
• Monitor training intensity and avoid sudden increases in volume or intensity
• Educate on early recognition of symptoms and self-management strategies 1

When to Consider Additional Evaluation

Red Flags

• Persistent pain despite 2-3 weeks of conservative treatment
• Severe pain that doesn't improve with rest
• Night pain or pain at rest
• Consider imaging to rule out stress fractures if symptoms persist 1

Special Considerations

• Patients with hypermobility require additional emphasis on proprioceptive training 1
• Individuals with high BMI (>30) may be at increased risk and may need more gradual progression 3
• Address any muscular imbalances at the ankle or overtight/weak triceps surae muscles 3

Functional treatment has been shown to result in faster return to work and daily activities compared to immobilization, making it the preferred approach for shin splints 2.