Overview

You may increase your chance of suffering a shin splint if you have any of these risk factors:

• improper stretching or failure to warm up before exercising
• activities that involve repeated pounding of the legs on hard surfaces, such as running, basketball, or tennis
• increasing intensity of exercise or mileage of running without proper preparation and conditioning
• worn-out or ill-fitting footwear
• improper running technique or problems with the way the foot hits the ground when running
• a strength imbalance between two opposing muscle groups in the leg

Diagnosis

Symptoms include:

• pain on the inner side of the shin, described as aching or throbbing with local tenderness
• swelling or redness of the shin (possible, but not common)

If you have the symptoms of shin splints you may not need to see a doctor. If the injury does not respond to self-treatment after two to four weeks, see your doctor. You may have a more serious injury.

The doctor will examine your lower leg and look for areas of tenderness and swelling. In addition the doctor will look for foot problems such as over-pronation. Tests may include x-rays to check for a stress fracture, which has similar symptoms.

Treatment Options

You can treat your shin splint using RICE therapy:

• rest
  Take a break from the activity that caused the pain. This is often enough to clear up the shin splint within a 10-day period.
• ice
  Apply ice in 15-minute periods during the first 24 hours after the injury and for several days after if needed. This helps reduce swelling, inflammation, and pain.
• compression
  Wrap the shin in an elastic bandage. This will help stop swelling and provide support for the shin and nearby soft tissues.
• elevation
  Keep the injured leg raised for the first 24 hours, including during sleep. If there is local swelling, this may help.

In addition to RICE therapy, you may take anti-inflammatory medications to relieve pain. If over-pronation is causing your shin splints, you can get custom-made arch supports (called orthotics), which help correct the over-pronation.

Prevention

• Warm up gradually first and then do progressive stretching.
• Slowly increase intensity and duration of exercise.
• Cool down after exercise with light stretching.
• Run on a softer surface, such as grass, dirt, or certain outdoor tracks.
• Do not suddenly change from a softer running surface to a hard one.
• Carefully select footwear. Different shoes have different degrees of support and motion control.
• Avoid over-striding, which can put more stress on your shin.
• Wear orthotics if your doctor recommends them.

How can I prevent shin splints?

Shin splints are best prevented by stretching and strengthening the muscles of the lower leg before and after doing your activities. If you have tight calf muscles, it is a good idea to stretch these twice a day whether or not you are doing any sports activities that day.

Here are some more steps to reduce your risk of shin splints:

• Avoid sudden increases of training volume or intensity. If you have had a lay-off of more than 5 days, return to full training should be done in gradual increments.
• Be sure that running surfaces and courses used in training are amenable to the training regimen. Some athletes thrive on hard surfaces, others on resilient ones. You need to decide what surface is best, based on experience.
• A training diary can be a valuable in helping you remember what aspects of your training were beneficial.
• Choose your running shoes carefully. They should provide sufficient cushion for the heel strike. Also replace worn out shoes regularly.
• In addition to custom-fitted orthotics, all runners should be encouraged to wear well-designed shoes that provide good stability. This helps to prevent shin splint problems and is especially important in athletes running more than a few miles at a time.
• Increase your running distance and your speed gradually, in increments no greater than 10 percent a week.
• Avoid unaccustomed strenuous sprinting, such as hill running.
• Cool down properly by stretching after exercise.

Improving sports performance

The key to improving sports performance after a diagnosis of shin splints is a proper rehabilitation program, and adhering to some of those same principles after the injury is gone.

The single most important aspect of improving performance is stretching before and after training.

Benefits derived from stretching include:

• increased physical efficiency and performance
• decreased risk of injury
• increased blood supply and nutrients to joint structures
• increased coordination
• improved muscular balance and postural awareness
• reduced stress
• enhanced enjoyment

Shin splint rehabilitation

As an athlete, your number one concern is getting back to full strength as soon as possible so that you can return to training and competition. That is why appropriate rehabilitation is extremely important. Rehabilitation for shin splints often includes the following:

• reduce activity during the acute phase
• ice injury multiple times per day
• use anti-inflammatory medications such as ibuprofen to reduce inflammation and speed up recovery
• begin stretching exercises when acute pain subsides

Rehabilitation exercises

The major objectives of rehabilitation from shin splints are to improve the elasticity of the calf muscle and to gradually increase pain-free range of motion at the ankle. Use these exercises during routine pre-exercise warm-up. We highly recommend that the muscles of both legs be stretched and strengthened, not just the affected side. Here are some exercises for stretching the muscles of the lower leg:

• Extended calf stretch
  Face a wall, standing an arm's length away. Place both palms on the wall. Bend your elbows so that your forehead lightly touches the wall; keep knees and back straight. You should feel a deep stretch in the back of the lower leg. Hold this position for 10 to 15 seconds. Extend the elbows and then rest for 10 seconds. Repeat 15 to 20 times two to three times daily.
• Flexed calf stretch
  Assume the position described in the extended calf stretch. Allowing the knees to bend slightly, bend your elbows such that the forehead lightly touches the wall. Hold this position for from 10 to 15 seconds. Extend the elbows. Rest for 10 seconds. Repeat 15 to 20 times three times daily.
• Seated leg grasps
  Sitting on the floor or ground, reach forward and grasp your lower legs or toes, bending your knees as necessary. Hold this position for five to 10 seconds. Return to the seated position with arms at sides. Rest for five seconds. Repeat five to 10 times at least twice daily.
• Double toe raises
  Stand facing a chair back or other supporting structure. Rest fingertips lightly on the chair back for balance. Press down with the toes and raise heels fully from the floor. Maintain this position for 10 to 15 seconds, then relax for 10 seconds. Repeat 15 to 20 times at least twice daily.
• Single toe raises
  When double toe raises can be easily and painlessly performed 20 consecutive times, it's time to try single toe raises. Stand beside a chair back or other supporting structure, resting fingertips of the hand closest to the chair back lightly on the chair for balance. Flex the knee of the leg farthest from the chair back so that the foot rises from the floor. Press down with the toes of the opposite foot, raising the heel fully from the floor. Hold this position for 10 to 15 seconds, then relax for 10 seconds. Repeat 15 to 20 times at least twice daily. Reverse positions of the legs and perform single toe raises with the opposite leg.

Alternative exercises

During the period when normal training should be avoided, alternative exercises may be used. These activities should not require any actions that create or intensify pain at the site of injury. They include:

• swimming
• water running
• stationary bicycle (add resistance gradually from one session to the next, as pain allows)

When can I return to my sport or activity?

The goal of rehabilitation is to return you to your sport or activity as soon as is safely possible. If you return too soon you may worsen your injury, which could lead to permanent damage. Everyone recovers from injury at a different rate. Return to your activity is determined by how soon your shin area recovers, not by how many days or weeks it has been since your injury occurred.

You may safely return to your sport or activity when, starting from the top of the list and progressing to the end, each of the following is true:

• You have full range of motion in the injured leg compared to the uninjured leg.
• You have full strength of the injured leg compared to the uninjured leg.
• You can jog straight ahead without pain or limping.
• You can sprint straight ahead without pain or limping.
• You can do 45-degree cuts, first at half-speed, then at full-speed.
• You can do 20-yard figures-of-eight, first at half-speed, then at full-speed.
• You can do 90-degree cuts, first at half-speed, then at full-speed.
• You can do 10-yard figures-of-eight, first at half-speed, then at full-speed.
• You can jump on both legs without pain and you can jump on the injured leg without pain.

How long will the effects of the injury last?

With proper rehabilitation, a first occurrence of shin splints diagnosed and treated in its early stages usually lasts two weeks. If the injury has recurred several times, full recovery may take as long as two months. In any case, you should not return to training until the pain is gone, both at rest and during weight-bearing activities.