Springtime is here and so are spring sports. As young athletes embark on increasing training regimens, especially more running, some will experience shin splints. If you’ve ever suffered from shin splints, you know just how miserable they can be.

What are shin splints?

The official medical term is medial tibial stress syndrome. (We like these fancy names, it makes us feel smart.) Shin splints are pain that happens along the shins (the flat bone on the front of the lower leg). In short, shin splints are an overuse injury. The phrase shin splint is essentially a catch-all phrase that encompasses most of the lower leg pain along the bones. They can be little, tiny micro tears in muscles or micro stress fractures (little breaks) along the bone. Technically, stress fractures are different from shin splints (they can happen as a result of untreated shin splints).

What causes shin splints?

1. Overuse: This can be from increasing too fast or simply doing too much.
2. Weak bones/muscles: If the bones (or muscles) are weak, they are more apt to have problems. It is very common for people to have low vitamin D and calcium levels, which are the nutritional components needed for strong bones.
3. Body mechanics: If the body moves in such a way to cause extra stress on the bones/shins, they will be subject to problems. For example, if a runner’s foot rolls slightly (e.g., pronation) when striking the ground, he/she is more likely to develop shin splints.
4. Training circumstances: Certain training situations increase the likelihood of developing shin splints (again, getting at things that cause undue stress on lower legs). For example, running on uneven surfaces (going from paved streets to uneven dirt roads while running), particularly hard surfaces, training on hills, worn/uneven footwear, etc.

What are the symptoms of shin splints?

Shin splints present with pain along the shins. Depending on the overuse injury, the pain may very slightly.

1. Muscle-related pain:
   1. Muscle soreness
   2. Pain with running, better after
   3. No pain along the bone
   4. Pressure along the bone with running
   5. Can cause symptoms in the feet (e.g., numbness, tingling)
2. Bone-related pain:
   1. Worse during and after running
   2. Very localized pain along the bone (which can also be a sign of progression from a shin splint to a full on stress fracture)
   3. Pain gets worse over time/with continued use

How are shin splints diagnosed?

Typically a doctor will get a good history and do a thorough physical exam. Based on those two factors alone, a diagnosis can usually be made clinically. If there is question, x-rays can be done. Typically, x-rays will light up the reaction of healing (after shin splints have been there for a few weeks). If the injury is brand new, x-rays may not show the stress fractures and a more extensive MRI may have to be done. On occasion, bone scans can also be done.

How are shin splints treated?

Unfortunately, there isn’t a magic pill to make shin splints better and the solution is not usually very welcomed by an athlete. The answer is plain and simple, REST. Continuing to train/run with shin splints will usually make the situation worse. Small, micro breaks, can turn into full stress fractures that require casting. An option for the avid athlete is to cross train using activities that don’t put pressure on the legs (e.g., biking, swimming, lifting weights). Pain can be helped in the short term by ice and acetaminophen (Tylenol). The class of medications, NSAIDS (the most commonly available being ibuprofen/Motrin) is controversial in the treatment of shin splints. While they help with inflammation and pain, they may inhibit healing.

How do I prevent shin splints?

There is wisdom in the saying, take it slow. Build up tolerance to increased activity. A kid (or adult for that matter), shouldn’t go from sitting on the couch all winter, to running 5 miles a day. The rule of thumb is:

1. Increase activity by 10% a week.
2. Eat healthy, especially a diet rich in Calcium and vitamin D.
3. Stretch/warm up prior to activity.
4. Wear proper/supportive shoes.

What is compartment syndrome?

Technically speaking, the pain that happens on the lower leg (on the muscle that is on the front outside edge) is not a shin splint, but may be a compartment syndrome. It happens when there is too much pressure from swelling muscles in a limited area. It can be diagnosed by testing the pressure (with a needle) during the exercise. Compartment syndrome can be a big deal requiring surgery to relieve the pressure.

If there is any question about your child’s diagnosis, I recommend going to your doctor. He/she can help sort it out and let you know how best to handle the situation. Best of luck!