Shin Splints in Young Athletes

Shin splints (medial tibial stress syndrome) is a common cause of lower leg pain in young athletes who run regularly. It is an overuse condition that develops gradually over a period of time rather than from an acute or sudden injury. Shin splints are caused by repetitive stress to the lower leg muscles, causing inflammation in the area where the muscles are attached to the shin bone (tibia).

Risk factors for this condition include running on hard surfaces, increasing running mileage too rapidly, wearing worn out or nonsupportive shoes and running with improper form. Young athletes who have flat (pronated) feet are also more likely to develop this condition. Typical symptoms of shin splints are aching pain and tenderness. At first, the pain occurs only after running, but it can develop further to cause pain both during and after running.

What are other causes of lower leg pain that may occur in young runners?

There are two additional causes of lower leg pain in young athletes who engage in running activities. The first is exertional compartment syndrome, which causes pain during running that ends a few minutes after the running stops, with no additional leg tenderness.

Stress fractures of the shin bone are the second additional cause of lower leg pain. This pain happens during a run as well as after running stops. Young athletes with stress fractures have soreness of the lower leg with point tenderness on one spot. By comparison, young athletes with shin splints have tenderness over an area that is at least one inch in length.

Are X‐rays necessary to diagnose shin splints?

During an evaluation of lower leg pain in a young athlete, a doctor may order X‐rays to confirm the diagnosis and rule out other causes of leg pain. In patients with shin splints, X‐rays are usually normal.

How are shin splints treated?

Treatment of shin splints includes rest from running, especially if there is pain during running activities. Applying ice or an ice massage also can help relieve the pain. Create an ice massage by freezing a foam cup of water, then tearing off the rim of the cup and applying the ice to the leg in gentle, circular motions for five to 10 minutes.

Anti‐inflammatory medication may also help relieve the pain of shin splints. The doctor may recommend an over‐the‐counter medicine such as ibuprofen or naproxen, or he may prescribe a medicine.

Rehabilitation exercises such as lower leg stretches and heel walking can also help young athletes manage this condition.

Once the pain ends, the young athlete can resume running. He should be careful to increase his running distance slowly, over a period of several weeks, and on soft, level surfaces. It also is important that he use well‐conditioned, supportive shoes while running, and adding arch supports and shin sleeves may further help to prevent pain from developing.

Tips for young runners to treat and prevent shin splints

  • Never try to run through the pain because it will worsen and may to progress to a stress fracture.
  • The amount of time needed to rest and recover fully may be as much as four to six weeks. During this time, cross‐training is usually well tolerated in the form of biking, swimming or using a low‐impact, elliptical machine.
  • Train on level ground, preferably a rubberized, cushioned track or grassy, cross‐country trail. Running hills, stadiums, bleachers and hard‐pavement surfaces may increase the risk of developing shin splints.
  • Keep running shoes in good repair, replacing them every 350 miles or each year, whichever one is reached first.
  • Add some extra shock absorption to shoes by inserting cushioned arch supports, especially if you pronate or have low arches.
  • Apply a compressive wrap such as an elastic bandage or weave‐type tape over the shins during running activities.
  • When starting a new running program or returning to running after an injury, make sure to increase your mileage gradually, specifically 10 to 15 per week.