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Shin Splints

What are Shin Splints

“Shin splints” is the word athletes, trainers, and doctors use for pain in the shins during or after vigorous exercise. Victims complain of burning or tingling pain over the shin, sometimes down to the ankle. The pain is usually worse as the foot comes down onto the ground with each step or jump. The actual cause of shin splints is not known. They are in the category of sports-related injury that doctors call “overuse syndromes.” Most sports medicine doctors now believe that the term “shin splints” probably includes pain from a number of different causes. One cause may be repeated minor injuries from impact of the foot with the ground or a hard surface. Another cause may be small abnormalities in the way the foot and lower leg bones line up, which can cause subtle twisting of the bone. Regardless of the cause, the thick covering of the bone called the “periosteum” (pear-ee-oss-tea-um) becomes inflamed. This inflammation is what causes the pain.

Shin splints are most common in athletes who have recently increased their level of training, or at the beginning of training. Athletes and performers like runners and dancers complain frequently of shin splints. Running, dancing, or jumping on hard or paved surfaces can make the pain worse.

What is the biggest concern?

Shin splints are not dangerous. The biggest concern for the athlete is pain and the question of when s/he can continue in sports or performance. Shin splints can range from mild discomfort that many athletes and performers choose to put up with, to serious pain that can reduce their ability to perform well.

Shin Splints Treatment

There is no one way to treat shin splints, and unfortunately the only way to make them go away completely is often to stop the activity. This rarely goes over well with a young athlete or performer. There are a few things that can help, however, all aimed at reducing the inflammation in the shin. The most effective medical treatment is a drug in the category called “non-steroidal anti-inflammatory drugs” (NSAIDs). Ibuprofen (Advil®, Motrin® and many others) is the best known NSAID. It is quite safe when taken as directed. The most common side effect of ibuprofen is stomach upset or irritation. This is directly related to the dose of medication, so most teens find a balanced between a dose too low to work and too high for stomach comfort. Most people over about 100 pounds (50 kg) can take 600 – 800 mg every six hours without too much trouble. If stomach upset occurs, you can try an antacid like Maalox or Mylanta or an oral anti-acid medicine like Prilosec®.

The most important thing to remember about NSAIDs is that they work best when they have a steady level in the blood. Have your athlete or performer take the medication dose regularly, not just “as needed for pain.” If s/he only takes it as needed, s/he will never get a good and steady level in the blood.

Unless the pain is very minor, it’s always a good idea to rest for a few days before returning to normal athletic activity. This will give the sore bone covering a chance to start to recover. Ice and heat don’t help much, but keeping the legs up on a couch or bed whenever possible can help. Your teen can certainly return to normal walking and can go to school.

Some sports medicine specialists, trainers, and other experts recommend using a special shoe insert called an “orthotic” device. The idea is to cushion the impact of the foot with the ground, and to gently turn the bones of the foot so they line up correctly. There is some debate among the experts about how useful these devices really are. They can be quite expensive when they are custom-built for your athlete. Please talk with your doctor or orthopedist about whether an orthotic is the right thing for your athlete.

When should I be worried?

Shin splints are never dangerous. The only real worry is that an overly-competitive athlete or performer may want to return to the field despite significant pain. In some cases this can cause the person to trip or fall, which can then cause a more serious injury like a sprain or a broken bone. Please talk carefully with your athlete about the value of giving him or herself a few days to recover before returning to competition.

Other points of concern

If your child is performing or competing on the wrong surface, the shin splints are likely to get worse over time. Please be sure that your child’s activity takes place on a soft or resilient surface. The right surface depends on the activity, of course. Track and field activities should be on natural grass, dirt, or specially-designed surfaces, not asphalt or concrete. Indoor activities should be on wooden or specially-designed surfaces. These kinds of surfaces reduce the chance of all kinds of injuries, not just shin splints.

Other Conditions that Might Be Present with Shin Splints

Very rarely a condition called “chronic compartment syndrome” can cause pain that acts like the pain of shin splints. This is an unusual condition, but if your child feels pain getting worse despite resting, or develops numbness, tingling, weakness, or pain in the calf or foot, please give your doctor a call.