Shin Splints - Medial Tibial Stress Syndrome

Painful But Treatable

What Are Shin Splints?

Long ago, the term shin splints was used to describe general pain in the lower leg, because lower leg pain was all lumped together and called shin splints -- regardless of what or where the pain was located.

Today, we know that shin splints occur in a particular area and are a separate diagnosis from other problems, such as stress fractures or compartment syndromes. Researchers and doctors are now more knowledgeable and are trying to be more specific in naming causes of lower leg pain.

They also are trying to base the name of the diagnosis on where the pain is located and by what is actually causing the pain. Typically, the pain associated with shin splints is felt on the medial-posterior (inside-back) tibia. Therefore, shin splints are now called medial tibial stress syndrome.

There is still much debate on what actually causes the pain. Possible causes of the pain are: periostitis (inflammation of the covering around the bone), traction periostaligia (pain of the covering around the bone due to muscle pulling on it), tendinopathy (problems with the tendons), periosteal reaction (formation of new bone due to injury) and fatigue failure of the connective tissue connecting muscle to bone.

The term "shin" is a common name for the large, lower leg bone called the tibia. If you take your hand and touch the front of your lower leg, the hard bone you feel is your tibia. Shin splints frequently affect people who run.


  • • Running downhill
  • • Running on uneven surfaces
  • • Weak muscles in the front of the leg (stronger muscles in the back of your leg)
  • • Over-pronation (when your foot rolls to the inside and your arch flattens)
  • • Wearing inappropriate shoes (worn-out or incorrect for your foot type)
  • • Training too hard too soon (not increasing your activity gradually), because muscles that fatigue quickly lose their ability to absorb shock and therefore more stress is placed on the bones
    • • Resuming activity (exercise) after a period of no or reduced activity

    Signs and Symptoms

    • • Tenderness over the inside shin area (may start as a dull ache and progress to a sharp pain)
    • • Pain starts with activity and then seems to disappear, but may return at the end of activity, as shin splints get worse the pain may last longer
    • • Lower leg swelling
    • • May see lower leg redness (rubor)
    • • May feel a lump or bump on the lower leg
    • • Pain with toes or ankle pointed downwards


    The diagnosis is usually made from your history and physical examination. Pain is usually located 3-12 cm above the tip of the inside ankle bone (medial malleolus) and is "vertically oriented" (runs up and down) as opposed to pain with a stress fracture, which is horizontal (across or side to side). Your podiatrist or doctor should perform a biomechanical exam to see if your foot type is contributing to your shin splints. If the diagnosis is still unclear, your doctor may order an x-ray, MRI or bone scan. An MRI is able to show a difference between shin splints and stress fractures: A stress fracture will show a "wide signal abnormality" whereas shin splints will show a "linear signal abnormality."

    However, an MRI is usually not needed if the physical exam findings are obvious.

    Sometimes, a bone scan may be done, which can show a linear (long line) of increased signal uptake, highlighting the difference between shin splints and stress fractures.


    • • Rest (no exercise)
    • • Ice/ice massage
    • • Appropriate shoes
    • • Arch supports
    • • Orthoses (orthotics)
    • • Taping/bracing
    • • Anti-inflammatories (NSAIDs)
    • • Cross training (swimming, biking, walking)
    • • Train on softer surface (soft grass, smooth dirt, asphalt, concrete)
    • • Relative rest (lengthening the time between workouts easing the amount and intensity of the workouts)

      Other Causes of Lower leg Pain:

      • • Stress fracture
      • • Bone tumor
      • • Lipoma
      • • Vascular disease
      • • Cellulitis
      • • Infection
      • • Nerve entrapment


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