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Definition

Shin splints are characterized by a pain in the front and sides of the lower leg that develops or worsens during exercise. There may also be tenderness over the shin and edema (the accumulation of fluid) of the surrounding tissues. Shin splints are a common problem to runners.

Causes

Shin splints may be caused by various disorders, including compartment syndrome (buildup of pressure in a muscle as a result of exercise), tendinitis (inflammation of a tendon), myositis (inflammation of a muscle), a muscle tear or periostitis (inflammation of the outer layer of a bone).

Symptoms

Shin splints (an inflammation of tendons and muscles of the shin) is typically brought on by the impact forces of exercise. The shinbone (or tibia) is covered by the periosteum, a band of soft tissue that has both nerve tissue and a blood supply. Just above the ankle and below the knee, tendons help attach muscles to the periosteum. When the shin is over-stressed, problems can develop in the periosteum, the tendons, the muscle, on the shinbone or in the four muscle compartments of the lower leg, which are covered with a wall of connective tissue (called the fascia). If recurrent, this latter condition is called chronic compartment syndrome. Shin splints are a common, often seasonal injury that usually occurs when you start to run after a long layoff. They can also result from playing a sport (such as tennis) on a hard surface, changing your style of workout shoes, dramatically increasing workouts, or gaining a substantial amount of weight and then exercising. Anterior shin splint is due to a muscle or tendon injury (that help to lift the front of the foot) and results in pain and tenderness on the front outside of the leg. Posterior pain (a soreness that radiates along the back and inner side of the lower leg or ankle) is typically caused by stressed muscles that help support and stabilize the arch of the foot. An important injury to distinguish from shin splints is a stress fracture (a small hairline crack in the shinbone) which develops slowly after repeated stress and impact to the leg. Symptoms develop during exercise and include a sudden, burning pain. Unlike other forms of shin splints where pain is spread out over the shin, you can pinpoint the spot from which the pain of a stress fracture is emanating. In mild to moderate cases, the pain subsides when exercise ends, and will heal completely with adequate rest in a month or so. Stress fractures should be taken seriously, so if you suspect you have one, you should consult a physician before continuing to engage in any exercise or activity.

Treatment

If pain is severe or you suspect a stress fracture, contact your physician for an examination. After a medical history and examination, he or she may suggest x-rays to detect any minute cracks in the shin - the sign of a stress fracture. If chronic compartment syndrome is suspected in the lower leg, the doctor will take a pressure test of the sore muscle compartment. Anti-inflammatory medication may be prescribed, or in the case of compartment syndrome, minor surgery may be recommended.

Self Care

At the first sign of pain in the shins, stop your activity. Trying to exercise through the soreness will only aggravate the condition and cause it to worsen. Immediately massage the area with ice to reduce inflammation and irritation. The ice acts like a quick-acting, anti-inflammatory medication. For pain relief and help to decrease the swelling, your physician may suggest taking ibuprofen, as directed. Do not apply heat to the area. Shin splints are an inflammatory condition, and heat will only irritate the area even more. Healing time can be as little as two to three weeks (if you cut back on your exercise and begin aggressive self-help measures), but in some cases, recovery can take as long as 12 to 14 weeks before pain subsides.

Prevention

Shin splints may be avoided with some common sense measures:

Replace or repair exercise shoes that are worn down to the heels. Switch to well-fitting shoes with plenty of impact-absorbing material in the forefoot and heel area. Remember that your running shoes may lose much of their shock absorbency after as few as 500 miles.
Warm up before running by first walking, then gradually increasing your speed to a jog.
When you raise your heart rate and lightly perspire, stop and stretch your calf muscles with a wall stretch. One way to stretch out tight calf muscles and Achilles tendons after warming up is to walk slowly on your heels for 100-200 yards.
Whenever you go for a run or walk, do it on dirt, grass, cinder or a rubberized track to minimize shin trauma.
In an aerobics class, make sure the floor is wooden and slightly raised off of the ground so it will "give" as you exercise. This will reduce impact forces.

Questions

How long should ice packs be applied? How much rest does the shin need to heal? What exercises do you recommend? What is a stress fracture?