Shin Splints

Written by Dr. Jason Ngan, DC

What is Shin Splints?

Shin splints is a general term for pain at the tibia (shin bone). The tibia is the larger bone at :the lower leg below the femur (thigh bone). Shin splits are reactions to over-stressed connective tissues of the leg known as periosteal reaction. There are two common locations where this occurs, the front of the tibia and the inner side of the tibia. The more specific names for shin splits are:

  • Anterior tibial stress syndrome (ATSS): front of the tibia closer to the knee

  • Medial tibial stress syndrome (MTSS): inner tibia closer to the medial malleolus (inside ankle).

What Causes Shin Splints?

Tibial stress syndromes are caused by overuse of the legs. This irritates the entheses, the site between the muscle tendons/ligaments and the bone. This causes inflammation and leads to a reaction known as enthesopathy. Some common activities include:

  • Sports such as running, basketball, dancing

  • Increased training

  • Military training

  • Wearing unsupported shoes

What are the Signs and Symptoms?

  • Insidious onset: symptoms occurs slowly and worsens over time

  • Pain at the shin

  • Pain upon activity and stretching

How is Shin Splints Diagnosed?

Shin splints are diagnosed with a thorough medical history, physical examination, orthopedic testing, x-ray diagnostic imaging, and CT scan.

  • No neurological changes unless associated with a compartment syndromes (irritation to the tibial nerve)

  • X-ray can visualize periosteal reaction at the tibia (additional white layers at the upper part of the tibia)

What are the Treatment Options?

Shin splints can be treated by rest or modifying activities. If untreated, the shin splints can lead to stress fractures, break in the bone due to overuse.

  • Mobilization

  • Soft tissue therapies

  • Gua-sha

  • E-stim

  • Ultrasound

  • Rehabilitative exercises and stretching

Other treatments that patients may seek (not provided at Ngan Chiropractic) include pain medication.

References

  1. Alfayez SM, Ahmed ML, Alomar AZ. A review article of medial tibial stress syndrome. J Musculoskelet Surg Res 2017;1:2-5

  2. Deshmukh NS, Phansopkar P. Medial Tibial Stress Syndrome: A Review Article. Cureus. 2022 Jul 7;14(7):e26641. doi: 10.7759/cureus.26641. PMID: 35949792; PMCID: PMC9356648./

  3. Galbraith RM, Lavallee ME. Medial tibial stress syndrome: conservative treatment options. Curr Rev Musculoskelet Med. 2009 Oct 7;2(3):127-33. doi: 10.1007/s12178-009-9055-6. PMID: 19809896; PMCID: PMC2848339.

  4. Schulze C, Finze S, Bader R, Lison A. Treatment of medial tibial stress syndrome according to the fascial distortion model: a prospective case control study. ScientificWorldJournal. 2014;2014:790626. doi: 10.1155/2014/790626. Epub 2014 Oct 14. PMID: 25379543; PMCID: PMC4212583.

  5. Tolbert, Timothy A PhD, ATC; Binkley, Helen M PhD, ATC, CSCS*D, NSCA-CPT*D. Treatment and Prevention of Shin Splints. Strength and Conditioning Journal 31(5):p 69-72, October 2009. | DOI: 10.1519/SSC.0b013e3181b94e3c