What is it?
There are many causes of shin pain in athletes. The most common causes include “shin splints,” or medial tibial stress syndrome, stress fractures and exertional compartment syndrome. Shin splints are caused by overuse of muscles that attach to the tibia, which then becomes inflamed. Frequently, shin splints begin after initiating or modifying a running/exercise program.

Symptoms
With shin splints, pain will be over the inner part of the shin and will worsen with activity. There is usually not any swelling or redness. The pain is usually spread over the bone, compared to a stress fracture where there is tenderness in just one spot on the bone. Compartment syndrome usually presents as tightness in the calves and can sometimes have associated numbness. As the pain with shin splints progresses, the pain may occur earlier into activity and with less activity. The pain may last for quite a while after the activity is over.

Sports Medicine Evaluation and Treatment
A sports medicine physician will obtain the history of the athlete’s symptoms and perform a physical exam. The doctor may push along the shin bones, evaluate walking gait, and test flexibility and strength. He or she may order an X-ray initially to look for a stress fracture and an MRI if the x-ray is normal. If the athlete’s symptoms and physical exam findings are concerning for possible exertional compartment syndrome, compartment pressure testing before and after exercise would be considered.

Treatment options may include:

• Ice packs or massage after workouts
• Short-term anti-inflammatory use
• Appropriate shoes for various foot types
• Over-the-counter or prescription orthotics
• Physical therapy to increase strength and flexibility

Injury Prevention
Shin splints may be prevented by warming-up properly, wearing appropriate shoes and gradually increasing activity. Other things to consider are running on softer surfaces and icing after exercise.

Return to Play
Return to play can be safely done when pain is minimal and upon completion of a rehabilitation program, usually after four to six weeks. There may be a need to continue home exercises and a stretching program, as well as icing after activity, to prevent shin splints from recurring. 

AMSSM Member Author: Jeffrey Bytomski, DO

Reference
Winters M, Eskes M, Weir A, Moen MH, Backx FJ, Bakker EW. Treatment of medial tibial stress syndrome: a systematic review. Sports

Med. 2013 Dec;43(12):1315-33.