Introduction

The two types of shin splints include the anterolateral shin splint - a type of shin splint that affects the front and outer part of the muscles of the shin and is caused by a congenital (present at birth) imbalance in the size of opposite muscles and posteromedial shin splint - a type of shin splint that affects the back and inner part of the muscles of the shin and is caused by running and/or by wearing inappropriate footwear. 

Shin splints cause pain in the front of the outer leg below the knee. The pain of shin splints is most often located on the outer edge of the mid region of the leg next to the shin bone (tibia). An area of discomfort measuring 4-6 inches (10-15 cm) in length is frequently present. Pain is often noted at the early portion of the workout, then lessens only to reappear near the end of the training session. Shin splint discomfort is often described as dull at first. However, with continuing trauma, the pain may become so extreme as to cause the athlete to stop workouts altogether. Shin splints may also be caused by standing for a long time or repetitive stress to the lower leg.

Anatomy

Anterolateral shin splints
With this type of shin splint, pain is felt on the front and outside of the shin, which is first felt when the heel touches the ground during running. Pain eventually becomes constant and the shin is painful to the touch.

Posteromedial shin splints
With this type of shin splint, pain starts on the inside of the lower leg above the ankle. Pain becomes worse when standing on the toes or rolling the ankle inward. As the shin splint progresses, the severity of pain will increase, leading to inflammation.

Causes

They can be caused by running or jumping on hard surfaces or simply overuse. They occur most often in people unaccustomed to training, although they can also plague experienced athletes who switch to lighter shoes, harder surfaces or more concentrated speed work. The cause could be one of three overuse injury conditions that develop gradually during excessive sports activity:

Muscle Irritation - The muscles that cover the shinbone become irritated and may cause swelling. In extreme cases pain is felt before, during, and after exercise. This is caused by repetitive pounding of the feet during running and sports like cross country track, aerobics, basketball, and volleyball.

Muscle Swelling - During exercise, the muscles of some people swell with blood more than is normal. This puts pressure on surrounding nerves and the blood supply. Tightness, numbness, and tingling in the lower leg are signals that a medical emergency has developed. If left untreated, long-term loss of mobility in the leg may result.

Stress Fractures - Tiny cracks in the lower leg bones. They may occur when muscle strength is exceeded, or when muscle contractions bend the bones. Stress fractures are common in distance runners and ballet dancers. People with thin bones are at greater risk. This is the most serious and can take 6 months or more of care.

Treatment

Use the following general treatment guidelines if you are diagnosed with shin splints. It is important to note that the treatment of a stress fracture is not the same, and persistent shin pain should be evaluated by your doctor before you begin treatment. Specialized (and costly) tests (e.g., bone scans) are generally only necessary if the diagnosis is unclear. Bone scanning in this setting is helpful to detect stress fracture of the tibia bone.

Treat minor problems with RICE therapy: Rest, Ice, Compression, and Elevation. 

Apply ice packs or perform ice massage for up to 20 minutes, three times a day. 

• Get the ice on quickly. Icing is most effective in the immediate period following an injury. The effect of icing diminishes significantly after about 48 hours.

• Perform an 'ice massage'. Apply ice directly to the injury. Move the ice frequently, not allowing it to sit in one spot.

• Don't forget to elevate. Keep the injured body part elevated above the heart while icing. This will further help reduce swelling. A few pillows under your leg should suffice.

• Watch to clock! Ice for 15-20 minutes, never longer. You can do more damage to the tissues, including frostbite, by icing for too long.

• Allow at least 45 minutes or an hour time between treatments to allow the area to warm before beginning the icing routine again.

Take an anti-inflammatory medication prescribed by your doctor.

If symptoms do not improve, get a medical examination.  Early and proper diagnosis is important for treatment and recovery. Specific treatment for shin splints will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the condition
• type of shin splint
• your tolerance for specific medications, procedures, and therapies
• expectation for the course of the condition
• your opinion or preference

Perform rehabilitation exercises (low-impact) regularly. Swimming and cycling are excellent activities for an individual with shin splints.

Prevention

To lessen the risk of shin splints:

• wear well-cushioned, quality running shoes

• run on soft surfaces like grass, dirt, or exercise mats

• increase the intensity of your workout gradually

• warm up before exercise and cool down after with light stretching.

• stretch the calf muscles before and after a workout -- some research, though, is showing that this does not help. 1

• Avoid over-striding, which can put more stress on your shin.

• check with a healthcare provider to see if you need orthotic inserts for your shoes (mixed results).

After all your symptoms have improved, do leg-strengthening exercises.

1 POPE, R. P., R. HERBERT, J. D. KIRWAN, and B. J. GRAHAM. A randomized trial of pre-exercise stretching for prevention of lower-limb injury. Med. Sci. Sports Exerc. 32:271–277, 2000.