Shin splints, often medically known as medial tibial stress syndrome, cause pain along the shin bone. Shin splints are common in runners, military recruits, and anyone regularly engaged in activities involving repetitive lower leg impacts. Knowing the possible causes of shin splints, how to treat them, and how to prevent them can ensure that they cause minimal disruption to your training programme. This guide is designed to help runners stay informed, recover swiftly, and run pain-free.
What are shin splints?
It’s a term that gets used frequently, but the interesting thing about shin splints is that it’s not really a diagnosis. It has to be one of the most poorly defined and, therefore, most misunderstood running injuries we regularly treat. The first thing to understand is that shin splints are effectively an umbrella term for many potential underlying causes.
This can include acute tendinopathy, enthesopathy, periostitis, bone stress responses, chronic stress reactions, stress fractures, compartment syndrome, or referred pain from neuropathies. It is therefore important to see a Physiotherapist or Sports Medicine Doctor for an accurate diagnosis and treatment advice.
“Shin Splints” as a Tendinopathy
A tendinopathy is the preferred term for persistent tendon pain and loss of function related to mechanical loading of a tendon (1). The key difference here is that the issue lies within the tendon itself. This could involve the tibialis anterior tendons for anterior shin splints and the tibialis posterior, soleus, or flexor hallucis longus for posterior shin splints.
“Shin Splints” as a Enthesopahty
An enthesopathy is a pathology associated with where the tendon attaches to the bone. The surface of contact between the tendon and bone is called the enthesis. Enthesis problems are mainly linked to spondyloarthropathies (2), but can also result from direct trauma to the site. In the case of shin splints, it is usually the enthesis of the tendons listed above for tendinopathy. Enthesopathy is also often called an insertional tendinopathy.
“Shin Splints” as a Periostitis
Periostitis is the inflammation of the periosteum, a dense sheath of fibrous connective tissue that surrounds a bone. This layer is crucial for bone growth and repair, and with its dense supply of nerve endings, it can be a source of severe pain. Periostitis is usually a result of overuse. However, again, direct trauma to the area or an infection can also be the cause.
“Shin Splints” as a Stress Fracture
A stress fracture is where the repeated stress on a bone, results in eventually a crack in that bone. In the case of shin splints, it is the tibial bone that develops the cracks. The incidence of stress fractures have been linked to tibial bone shape and greater bending moments with different running mechanics (3).
“Shin Splints” as Compartment Syndrome
Compartment syndrome is characterised by an increase in pressure inside a muscle, resulting in impaired blood flow. Acute cases are typically caused by trauma (4), while shin splints is a result of a gradual issue known as ‘Chronic Exertional Compartment Syndrome’ (CECS). In this case, the pain is a result of reversible changes in blood flow, caused by repetitive exercise such as running. The symptoms in CECS typically resolve quickly post-exercise. An acute episode, however, can be serious and needs urgent medical attention (5).
“Shin Splints” as Peripheral Neuropathy
A peripheral neuropathy refers to a disturbance of function or pathological change to nerves outside of the central nervous system (i.e. outside of the brain and spinal cord) (6). This can include sensory, motor, or autonomic nerves. Symptoms can include numbness and tingling, burning, stabbing or shooting pains, and weakness in the muscles affected. In the case of ‘shin splints’, this usually involves, the muscles on the front of the shin: tibialis anterior. This can stem from changes at L4, L5 or S1 nerve root levels (7) or through changes to the nerves that supply the front of your lower leg, such as the common peroneal nerve or the deep peroneal nerve.
Is it safe to run with shin pain?
This will depend largely on what the specific diagnosis is. Running through shin splint pain can aggravate the condition.
At worst, it could lead to stress fractures or chronic exertional compartment syndrome. If you experience mild shin pain, it’s crucial to assess it carefully. Mild soreness may ease with gentle warm-up exercises; however, persistent or severe shin pain necessitates rest and recovery. Continuing to run, without a specific diagnosis, could exacerbate the injury and prolong recovery time.
What causes shin splints in runners?
Shin splints occur due to repetitive stress on the shinbone and connective tissues that attach muscles to the bone. Commonly, shin splints are caused by increasing running mileage too quickly, inappropriate footwear, poor running technique, or running frequently on hard surfaces. You are more at risk, especially if you have flat feet or poor arch support, since your feet can’t absorb shock well, leading to extra stress on the lower leg muscles, tendons, and shinbone.
While the term “shin splints” might have seem straightforward, it represents a complex array of potential issues affecting runners and active individuals. Understanding shin pain and where it stems from is the first step to manage and recover. It’s important to listen to your body, seek an accurate diagnosis from a healthcare professional such as a Physiotherapist so you can get back to running and doing what you enjoy.
Book an appointment
References:
- Scott A, Squier K, Alfredson H, et al ICON 2019: International Scientific Tendinopathy Symposium Consensus: Clinical Terminology, British Journal of Sports Medicine, 2020;54:260-262. https://doi.org/10.1136/bjsports-2019-100885
- Alito, A.; Talotta, R.; D’Amico, V.; et al The Effect of Therapeutic Exercise and Local Cryotherapy on Lower Limb Enthesitis in Non-Radiographic Axial Spondyloarthritis: A Case Report. J. Personalized Medicine. 2024, 14, 1035. https:// doi.org/10.3390/jpm14101035
- Meardon, S.A., Willson, J.D., Gries, S.R., et al Bone stress in runners with tibial stress fracture, Clinical Biomechanics. 2015, 30(9):895-902, https://doi.org/10.1016/j.clinbiomech.2015.07.012.
- Garner MR, Taylor SA, Gausden E, Lyden JP. Compartment Syndrome: Diagnosis, Management, and Unique Concerns in the Twenty-First Century. HSS Journal®. 2014;10(2):143-152. doi:10.1007/s11420-014-9386-8
- George, Christopher A. et al. Chronic Exertional Compartment Syndrome Clinics in Sports Medicine, Volume 31, Issue 2, 307 – 319
- Merskey, H., Bogduk, N. Classification of Chronic Pain. Seattle: IASP Press,. 1994.
- Bove GM. Partial mixed neuropathy of the fourth lumbar spinal nerve misdiagnosed as “shin splints.”. J Can Chiropr Assoc. 2023 Aug;67(2):186-193. PMID: 37840581; PMCID: PMC10575327.