From the Guidelines
Shin splints, or medial tibial stress syndrome, should be treated with a gradual return to running, prioritizing pain-free progression, and individualized based on the risk and grade of the tibial bone stress injury, as well as the level of the athlete 1.
Treatment and Prevention
The treatment of shin splints involves rest, ice, and over-the-counter pain medications like ibuprofen (400-600mg every 6-8 hours) or naproxen (220-440mg twice daily) for 7-10 days.
- Reduce or modify activities that cause pain for 2-3 weeks
- Apply ice to the painful area for 15-20 minutes several times daily
- Use compression sleeves and proper footwear with good arch support
- Gradually return to activity once pain subsides
- Stretching the calf muscles and strengthening exercises for lower legs can prevent recurrence Shin splints occur when repetitive stress causes inflammation of the muscles, tendons, and bone tissue around the tibia.
Return to Running
When returning to running, it is essential to monitor for the presence of pain, either during or following running, and guide running progressions accordingly 1.
- Running distance should be progressed before speed following a tibial BSI
- The rate of progression should be individualized based on risk and grade of the tibial BSI as well as the level of the athlete
- Females may benefit from a slower progression of running due to higher tibial bone stresses across a range of running speeds, compared with males 1 Most cases resolve with these conservative measures within 2-4 weeks, but persistent pain lasting more than a month should prompt medical evaluation to rule out stress fractures or other conditions.
Prevention
Proper warm-up before exercise and avoiding sudden increases in training intensity can help prevent shin splints from developing.
- Individualized progression of running load, taking into account the pre-injury training status and the severity of the injury, can help reduce the recurrence rate of tibial BSIs 1.
From the Research
Definition and Causes of Shin Splints
- Shin splints, also known as medial tibial stress syndrome (MTSS), is a common overuse injury of the lower extremities affecting a large percentage of athletes 2.
- The term "shin splints" is not a specific diagnosis, but rather a descriptive term that describes chronic exertional shin pain in an athlete, with various causes and anatomical variations 3.
- Biomechanical abnormalities, training errors, and mechanical overload of the musculoskeletal system of the leg are likely to be major factors in predisposing certain persons to shin splints 4.
Symptoms and Diagnosis
- Shin splints present with diffuse palpable pain, often described as a dull ache following exercise, and tenderness along the posteromedial edge of the tibia 2.
- The pain is often alleviated by resting, and athletes may complain of pain along the middle to distal third of the posteromedial border of the tibia following an exercise session 2.
- Diagnosis can be made by history alone in a majority of cases, but if the diagnosis is unclear, an X-ray and magnetic resonance imaging should be considered 5.
Treatment and Prevention
- The main objectives of shin splint treatment are to relieve pain and to enable the patient to return to normal activities without pain 2.
- Rest is the most important aspect of treatment, and locally applied cold and anti-inflammatory medication have also been felt to be beneficial 5.
- To prevent shin splints, repetitive stress should be avoided, and measures to reduce inflammation and pain, as well as identifying possible biomechanical factors, should be taken 2, 4.