Shin splints is a general medical term denoting medial tibial stress syndrome, a slow healing and painful condition in the shins, often caused by high impact stresses with certain activities e.g. running, jumping, dancing, sprinting, marching, gymnastics and racquet sports. This general term is used to describe anterior shin pain which can be caused by several different conditions.

Shin splints are very common sporting injury and are reported as the cause of 13% of all running injuries. Runners may experience them after increasing their running distance, intensity, reducing their recovery time or changing the surface they run on from a relatively soft surface to a hard surface.

The most common cause is inflammation of the periostium of the tibia  which is a sheath surrounding the bone. Resulting traction forces on the periosteum from the muscles of the lower leg cause shin pain and inflammation.

Pain may start during the run or may be felt after the run. Depending on the exact cause, pain may be located along either side of the shinbone or in the muscles and the the area may be painful to the touch.

Shin splints are a symptom of an underlying problem which might (may) include.

• Reduced ankle or foot mobility
• Reduced hip mobility
• Poor lower limb strength conditioning (stability control)
• Tight, irritated and swollen muscles, caused by overuse.
• Stress fractures
• Over-pronation (flat feet)

Repetitive overloading does not cause macro fractures but may lead to mirco tears as its tensile strength is repeatedly exceeded. This results in structural failure at a micro level in the bony architecture these are called micro-fractures.

When high forces are applied often through repetitive loading e.g. running on hard surfaces micro fractures can occur. Overloading the bony tissue and not providing sufficient recovery time for the bone to heal and become stronger can exacerbate this condition.

If this process continues i.e. overloading continues with insufficient rest then the micro fractures can merge, increasing in size to form a macro fracture known as a stress fracture. The main symptoms of shin splints are:

• Dull aching pain
• Throbbing
• Tenderness along the inside of the shin (pain can also radiate to the outside of the shin)

Appropriate management will address acute pain management, underlying lower limb biomechanics / mobility, as well as developing appropriate loading and recovery cycles.