Shin splints

Symptoms of shin splints

The main symptom of shin splints is pain in the shin bones, which run down the front of your lower legs.

The pain tends to:

• begin soon after starting exercise
• gradually improve when resting – sometimes the pain may fade while you're still exercising, but it can eventually become constant and continue even when resting
• be dull and achy to begin with, but may become increasingly sharp or severe and stop you exercising
• affect both shins
• be felt over a large part of the shin (an area over 5cm across) – pain in a small area may be caused by a stress fracture instead

Sometimes there may also be some swelling.

Causes of shin splints

It's not always clear what causes shin splints.

They're usually brought on by running or repetitive weight bearing on the legs. It's thought this leads to swelling (inflammation) of the tissue around the shin bone.

Several things can increase your chances of getting shin splints, including:

• a sudden change in your activity level – such as starting a new exercise plan or suddenly increasing the distance or pace you run
• running on hard or uneven surfaces
• wearing poorly fitting or worn-out trainers that don't cushion and support your feet properly
• being overweight
• having flat feet or feet that roll inwards (known as over-pronation)
• having tight calf muscles, weak ankles, or a tight Achilles tendon (the band of tissue connecting the heel to the calf muscle)

Treating shin splints at home

Shin splints can usually be treated at home. The following may help relieve the pain and allow your legs to heal:

• rest – stop the activity that causes your shin splints for at least two to three weeks; you can then start gradually returning to your normal activities
• ice – hold an ice pack against your shins (a bag of frozen peas wrapped in a tea towel works, too) for around 10 minutes every few hours for the first few days; this helps with pain and swelling
• pain relief – take over-the-counter painkillers, such as paracetamol and ibuprofen, to help relieve the pain if you need to
• switch to low-impact activities – using a cross-trainer, cycling, swimming and yoga are good ways to keep fit without putting too much pressure on your shins while they heal

You can start to return to your usual activities over the following few weeks once the pain has gone. Take care to increase your activity level gradually, building up the time you spend running or doing sports.

Make sure you follow the steps to prevent shin splints outlined below to reduce the risk of the pain coming back.

When to see your GP

It's a good idea to see your GP if your pain doesn't improve despite the treatments mentioned above.

Your GP may:

• ask about your symptoms and examine your legs to try to work out what's causing your pain
• refer you for an X-ray or special scan of your legs – an X-ray may be normal, so a more detailed scan may be needed to help with diagnosis or identify other causes of lower leg pain
• refer you to a physiotherapist – they can assess your injury, show you some exercises, and recommend a suitable programme of activity
• refer you to an orthopaedic surgeon or a consultant in sport and exercise medicine

Preventing shin splints

The following measures may help reduce your chances of getting shin splints:

• wear trainers with appropriate cushioning and support – it may help to speak to an expert at a specialist running shop for advice if you're buying running shoes for the first time
• run and train on flat, soft surfaces, such as a recreation ground or playing field, whenever possible
• introduce any changes to your activity level gradually
• mix high-impact exercises like running with low-impact exercises like swimming
• lose weight if you're overweight
• improve your overall strength and flexibility
• warm up before exercising and stretch after exercising – in particular, stretching your calves and the front of your legs may help

Speak to a foot specialist called a podiatrist if you have flat feet or your feet roll inwards. They may recommend supportive inserts for your shoes (orthotics) to reduce the pressure on your shins.

Other causes of lower leg pain

Pain in the lower legs and shins can also be caused by:

• stress fractures (tiny cracks in the bone) – the pain often affects one leg, but can affect both, and is usually focused in a small area; there may also be some swelling
• a sprain or strain – this can cause swelling, bruising and pain that continues during rest 
• a tendon injury – symptoms include pain, stiffness, weakness and a grating or crackling sensation when moving the affected area
• reduced blood supply to the legs (peripheral arterial disease) – this causes an aching pain triggered by physical activity that fades after a few minutes of rest
• swelling of the leg muscle (compartment syndrome) – this can cause cramping pain in the muscles that develops gradually during exercise and fades quickly at rest