Vic Goradia, MD
Sports Medicine Specialist
Go Orthopedics
GoOrtho.net

Question: I am a runner and was forced inside on the treadmill more than normal this past winter and spring due to the weather. I noticed a lot of pain in the area of my shins. A friend suggested I might have “shin splints.” What are shin splints? What causes them? How can I prevent them?

Answer: The term “shin splints” is often used to describe any pain along the lower leg. When patients come to my office with this complaint, I think of three main causes: stress fracture, exercise induced compartment syndrome and true shin splints.

Stress fractures typically cause pain that begins immediately when you begin your run and it gets worse as you progress. Most individuals have to stop their run. Examination usually reveals very localized tenderness. Unfortunately a stress fracture may not appear on regular x-rays. If suspicion is high then a bone scan or MRI can be ordered. The treatment is to remove all “stress” from the bone. This means eliminating all activities that cause pain. If walking causes pain then crutches are needed. A cast is almost never needed. The fracture usually heals in six weeks.

Exercise induced (or exertional) compartment syndrome is a condition where pressure builds within one or more of the four muscle compartments of the lower leg and causes pain. In this condition the pain gradually develops during the run and is relieved when you stop the run and rest for 15-30 minutes. Examination, X-rays, and MRI are all normal. The doctor diagnoses the condition based on a history of typical symptoms and by excluding other causes. If severe, the condition can be treated with surgery.

Shin splints occur when the periosteum of the posterior (back), medial (inner) tibia becomes inflamed. The periosteum is a thin tissue that covers bone. This condition can occur from overuse, running conditions, shoes, inflexibility or mal-alignment.

As for running on treadmills vs. outdoors, this change in surfaces can cause problems. Most treadmills have softer more giving surfaces. If you normally run five miles on the treadmill all winter then suddenly continue this distance outdoors on the road you may develop shin splints. When going from a soft to hard surface you should decrease your distance and pace initially. It will take you a few weeks to adapt to the harder surface. At that time you can increase the distance and pace.

Shoes and mal-alignment can be related causes. You may need a thorough gait analysis from a qualified sports medicine specialist to determine if you over-supinate or pronate or have some other condition. Most basic conditions can be corrected with good running shoes. There are however differences between shoes for pronation and supination so you can’t simply buy a pair of shoes that your friend uses and likes. In some cases you may also need custom orthotics for your shoes.

If you do develop shin splints, you can initially treat with ice, massage, anti-inflammatory medications, stretching and modifying your activities. You may need to cross train into some lower impact activities such as biking, swimming or using an elliptical machine.

If symptoms persist, you should visit a sports medicine specialist to make sure it is not a more severe condition.

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