Shin splints is a common term used to describe pain in the lower leg with activity. It is often seen in running athletes, however it can happen with any overuse high impact exercise. The orthopedic term for shin splints is called medial tibial stress syndrome (MTSS). It is an irritation of the periosteal (outer) layer of the bone. There are several muscles that attach to the tibia along the medial side. The posterior tibialis muscle is typically the culprit. That muscle aids in the pushing off mechanism when running.
Patients often present with diffuse medial lower leg pain worse with high impact activity. It can start off as intermittent and then become constant if not addressed. There can be swelling, medial tibia tenderness, and limping with activity. Some people will try to work through the pain but present for treatment when it starts to interfere with their activity level. If left ignored, MTSS can progress to stress fractures in the bone.
While overuse is the most common etiology, other issues such as poor fitting shoes, running on hard surfaces, increasing activity too quickly, gait mechanics, and muscle imbalances can also cause this issue. If you are experiencing lower leg pain that does not subside, it is important to be evaluated by an orthopedic provider to look for signs of MTSS. X-rays can show periosteal elevation where it looks like a small bump over the bone. If necessary, an MRI can determine if a stress fracture is present. Rest is the first line treatment from MTSS. Avoiding running and high impact activity is critical to allow the inflammation to improve. If symptoms are significant enough, a walking boot may be necessary to allow for more adequate rest. Physical therapy can be very beneficial to address any muscle imbalances or gait mechanic issues and ideally prevent the injury from reoccurring. While rest is very important, it is possible to still maintain activity and cardiovascular endurance by cross training and finding alternative activities. This may include swimming, stationary bike, and upper body/core strengthening. Discuss your goals with your orthopedic provider to find ways to maintain your exercise level without further injuring your body
