David Popoli, M.D., on Shin Splints

One of the Most Common and Overlooked Overuse Injuries

David PopoliDr. Popoli is a primary care sports physician at Children’s. He sees patients at our Children’s at Fayette location.

As athletes return to training for spring sports, we can expect a fair number of them to experience overuse injuries. One of the most common and overlooked overuse injuries is shin splints. Although it is easy to dismiss its severity, shin splints–or medial tibial stress syndrome (MTSS)–can become a more significant injury if not properly treated. Since this is such a common injury, it is worth a brief review.

What are shin splints?

Shin splints are a stress injury of the tibia, or shin bone, due to overuse of the lower leg muscles. Repeated jumping, running and cutting puts a high demand on the muscles and bone. There are several risk factors for shin splints. They include:

  • Starting an aggressive exercise program too quickly
  • Training on hard surfaces
  • Biomechanics, like excessive foot pronation or poor Achilles tendon flexibility

Who gets shin splints?

Shin splints can affect any athlete. It is most common in runners, accounting for between 13.2 and 17.3 percent of all running injuries.* Any athlete whose sport involves repetitive jumping or prolonged running are at a high risk for shin splints. Basketball, tennis and volleyball players fall into this category.

Where does an athlete with shin splints complain about pain?

Most often, an athlete with shin splints will have pain along the inner ridge of the shinbone. At first, the athlete might say he only feels the pain at the beginning of the activity. As the injury progresses, however, symptoms will become more persistent and the pain will change from dull to sharp. The pain may even continue when the athlete is at rest.

Why is it important to recognize and treat shin splints early?

Shin splints are an early stage of a stress injury. If an athlete does not treat shin splints and continues high-impact exercises, the injury may eventually progress to swelling within the bone or even a stress fracture.

How are shin splints diagnosed?

In addition to a detailed history, examination of the athlete’s leg is important. Usually, the leg is painful over a large portion of the shinbone. If there’s one spot that really hurts, it’s important to rule out a stress fracture. To do this, a care provider may consider imaging. X-rays come back negative in patients with shin splints but can show a black line if there's a stress fracture. Magnetic resonance imaging (MRI) scan is not generally needed to diagnose shin splints. If an MRI is performed, the bone can appear brighter than usual, and there can be fluid build-up in the muscle.

When can an athlete with shin splints return to play?

Generally, a period of rest from the activities that cause pain is encouraged. Once the athlete is pain free, he can begin a gradual return to the sport, beginning at 60 percent of the usual activity level. He can increase his activity level by 10 percent each week in terms of frequency, intensity and duration.

*Yates, B; White, S: “The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits.” The American Journal of Sports Medicine, 1988. Vol. 10. Pp 201-205.