Shin splints

If your child or teen has developed shin splints, it will comfort you to know that Children’s Hospital Boston’s Orthopedic Center has a tremendous amount of experience treating this injury, developing therapies for healing and conducting research that leads to better care.
 

What are shin splints, and why do they occur?

Shin splints are an overuse injury caused by repetitive stress to the muscles, tendons and/or tissues associated with the shin bone (tibia) over a period of time, without enough rest to give the leg enough time to heal.

Muscles and tendons adapt to stress—that’s how they become stronger. But they also need to rest and rebuild between the episodes of stress. With an overuse injury like shin splints, the muscle or tendon receives the stress, but never gets a chance to rest.
 

What factors can contribute to young people getting shin splints?

Shin splints can occur if a runner or athlete:

• is experienced but is overtraining (often occurs late in the sports season)
• resumes hard training after a lay-off
• increases the duration or intensity of training too quickly
• trains on hills
• is a novice who begins training too hard before he’s conditioned
• runs on surfaces that are too hard or uneven
• runs in improper or outworn footwear
• pronates (turns his feet outward) while running
• has flat feet or fallen arches
• has poor running mechanics
• has tight muscles
   

What are the symptoms of shin splints?

Pain and/or inflammation at the side or front of the shin bone can be symptoms of shin splints. The pain tends to intensify in stages:

• At first, the injury may hurt mildly when the child plays his sport.
• As more trauma occurs, the child will experience constant pain when he’s playing.
• At the end stage, the child has constant pain in his lower leg, even when he’s not playing. At that point, the affected area will have sustained a significant amount of damage.
   

How are shin splints diagnosed?

Your child’s doctor will do a physical examination, and may use diagnostic tests—including x-rays, an MRI (magnetic resonance imaging) and, rarely, a bone scan—to get detailed images of the injury and rule out a stress fracture.
 

How are shin splints treated?

The primary therapy for most cases of shin splints is simply to rest the injured leg—restricting all activities that involve stressing the leg for a period of weeks or months. Your child’s doctor may also recommend a cast or walking boot in order to:

• relax the stress on the leg
• protect the leg from further damage
• force the athlete to rest
   

For an unusually severe overuse injury, treatment options may include:

• temporary use of crutches or a wheelchair
• physical therapy to stretch and strengthen the injured muscles and tendons
• surgery if the injury is recurring, if there’s persistent pain, or if a muscle or tendon is badly torn
                                                                                   

Why is there an increase in overuse injuries in kids these days?

Youth and adolescent participation in organized sports has grown to about 35 to 40 million kids across the United States. Not surprisingly, the incidence of sports injuries is rising—statistics suggest that 30 to 60 percent of student athletes will have an overuse injury at some point in time. In one Sports Medicine practice at Children’s, for example, at least half of the young patients have an overuse injury.
 

Aren’t organized sports supposed to be good for kids?

Organized sports are very important and help kids—not just in the sports themselves, but in academics and social situations—and they’re good for children’s overall development and growth. The downside is that “overuse syndrome,” where the kids repeat the same drill over and over, causes overuse injuries.
 

How can parents and coaches help kids avoid shin splints and other overuse injuries?

Parents and coaches have a great deal of influence—for better or for worse. Parents and coaches should stress moderation in training and should restrain the zeal with which they push youth and teens.

Coaches themselves should learn and use proper training techniques and should avoid too many repetitive drills, since these are the overwhelming reason for overuse injuries. Coaches should also teach proper running mechanics and other sport-specific motion techniques.

Physical education departments should make sure that the surfaces of a track or field are in good shape, and that proper equipment, footwear and protective gear are used for each sport.

Our orthopedic specialists advise:

• warming up and stretching before practice
• resting at least one day a week
• cross-training/alternating sports: It is usually unwise for a child or teen to specialize in just one sport. Multi-sport athletes tend to get fewer overuse injuries than those who specialize in just one sport.
• alternating exercises during practice: Not only is the athlete less likely to experience an injury—studies have also shown that over the long term, muscle memory actually improves if one varies the drills.
   

Are there other guidelines and resources for injury prevention and safer training?

The American Academy of Orthopaedic Surgeons (AAOS) has issued comprehensive guidelines for helping to prevent sports injuries. Below is an excerpt from the AAOS recommendations:

• Use proper equipment.
   
• Warm up.
   
• Stretch.
   
• Drink water.

  • Drink enough water to prevent dehydration, heat exhaustion and heat stroke.
    Drink 16 ounces (one pint) of water 15 minutes before exercising, another 16 ounces after cool-down.
    Drink water every 20 minutes or so while exercising.

• Cool down.
  • Cool down for twice as long as warm-up.
  • Slow down motion and lessen intensity for at least 10 minutes before stopping completely
     
• Rest.
  • Schedule regular days off from exercise, and rest when tired.
  • Fatigue, soreness and pain are good reasons to not exercise.

Who at Children’s will be caring for my child if he develops shin splints?

Members of the Orthopedic Center will provide expert care and support for your child. Our staff includes 10 primary care sports medicine specialists, 24 orthopedic surgeons, two podiatrists, a nutritionist, a sports psychologist, eight physician assistants, 14 nurses and four certified athletic trainers.
 

What is the Orthopedic Center doing to encourage injury prevention and safer training?

With Children’s goal of dramatically reducing overuse injuries in youth sports, members of our team often travel to local and regional schools, youth groups and sports clubs to teach leg strengthening and other techniques. We also conduct frequent safe training programs and clinics for coaches. Call 617-355-3501 for details.

FAQ
 

Q: What are shin splints?
A: Repetitive training can inflame the muscles, tendons and periosteum (the thin layer of tissue that covers a bone) associated with the tibia, as well as the tibia itself. “Shin splints” is a catch-all term for tenderness and pain:

• along or behind the inside (medial) edge of the tibia (posterior)
• along the tibia in the front of the lower leg (anterior)

Q: How do shin splints happen?
A: Muscles and tendons adapt to stress—that’s how they become stronger. But they also need to rest and rebuild between the episodes of stress. Repetitive or overly-rigorous training (usually running) can result in the pain and inflammation of shin splints.
 

Q: What are the signs and symptoms of shin splints?
A: Pain and/or inflammation in the lower leg can be signs and symptoms of shin splints or stress fractures, so a proper diagnosis is important. The pain tends to intensify in stages—from occasional and mild to constant and severe.
 

Q: What should we do before we see the doctor for a diagnosis?

A: If you suspect that your child has shin splints, home care before your child gets to the doctor should include:

• rest:Make sure he doesn’t exert in any way that involves the injured area; he can use crutches or a cane, if it helps.
• ice:Wrap a towel around ice cubes, or use a bag of frozen vegetables, to ice the area at two-hour intervals, for 20 minutes each time.
• compression:Wrap a bandage or soft brace (from the drugstore) around his injury.
• elevation:The child should remain seated or reclining, with his leg elevated, as often as possible before seeing the doctor.
   

Q: How are shin splints usually diagnosed?
A: Your child’s doctor will do a physical examination, and may use diagnostic tests—including x-rays, an MRI (magnetic resonance imaging) and, rarely, a bone scan—to get detailed images of the injury and rule out a stress fracture.
 

Q: How does Children’s treat shin splints?
A: The most important therapy for shin splints is simply to rest the injured area—restricting all activities that involve using the injured muscle, tendon or bone—for a period of weeks or months. Your child’s doctor may also recommend a cast or boot to protect the shin from further injury.
 

Q: Will my child be OK?

A: Most kids with shin splints can return to sports and regular activities after several weeks or months of rest and healing time. Your child’s doctor will give you guidance about how long your child’s leg should be rested in order for it to heal.

During the healing period, it’s important to support your young athlete’s resolve to rest his leg, since he may feel disappointed and frustrated at not being able to play his sport.

Q: How long will it take for my child to recover from shin splints?
A: Children usually heal faster and better than adults. Your child should heal from an overuse injury in a period of weeks or months, depending on the severity of the injury.
 

Q: If my child has been injured playing sports, should he go back to sports?
A:If your child’s doctor has cleared him to go back to sports, the many benefits and life lessons he’ll gain from playing greatly outweigh the risks of injury. These benefits include:

• physical fitness
• teamwork, competitive prowess, accomplishment
• improved body composition—less risk of obesity
• reduced risk of heart disease and diabetes
• stronger immune system
• academic fitness—kids who play sports often academically outperform kids who don’t
• emotional and psychological fitness—improved self-esteem, self-concept, self-confidence, empowerment and perception of competence
   

Q: Are some kids’ bodies physically more suited to certain sports than others?
A: There are intrinsic reasons—such as their bony alignment—that can predispose kids to be more or less suited to a given sport. A prime example is hockey goalies: there are little kids who “toe-walk” and sit like a “W” because their hips are built that way. Those kids are built to be hockey goalies because they can get into the goalie position.

Other kids walk “like Charlie Chaplin” because their hips are built the opposite way, with a twist in the femur. These kids shouldn’t be hockey goalies because their hips just can’t go into that position. If they try to play goalie, they can end up causing damage.
 

Q: What is Children’s experience in orthopedics?

A: The Children’s Orthopedic Center is known for our clinical innovations, research and leadership. Ranked among the top three in orthopedics for 2012-13 by U.S.News & World Report, we provide the most advanced diagnostics and treatments, several of which were pioneered and developed by Children’s researchers and clinicians—including platelet-rich plasma (PRP) treatment for tendon repair and physeal-sparing ACL procedures for children whose growth plates are still open.
 

Causes

As more and more kids play organized sports, there’s been a rise in the number of shin splints and other overuse injuries (microtraumas to bones, tendons, ligaments or muscles) among adolescents and children, largely from repetitively using the same parts of the body. Shin splints are most often seen in runners—usually because of overtraining, running with improper footwear or training too hard while still a beginner.
 

Signs and symptoms

Pain and/or inflammation at the side or front of the shin bone can be symptoms of shin splints. The pain tends to intensify in stages:

• At first, the injury may hurt mildly when the child plays his sport.
• As more trauma occurs, the child will experience constant pain when he’s playing.
• At the end stage, the child will have constant pain in his lower leg, even when he’s not playing. At that point, the affected area will have sustained a significant amount of damage.
   

When to seek medical advice

Consult your child’s doctor if his lower leg is painful or inflamed. Tell the doctor if your child:

• has been training very hard (usually running or aerobics)
• has changed his exercise routine
• has been running on hard surfaces
• has been running with improper footwear
   

Questions to ask your doctor

You and your family are key players in your child’s medical care. It’s important that you share your observations and ideas with your child’s health care provider and that you understand your provider’s recommendations.

You probably already have some ideas and questions on your mind, but it can be easy to forget the questions you wanted to ask when you’re talking to your child’s doctor. It’s often helpful to jot them down ahead of time to make sure that all your concerns have been addressed. You may also suggest to your child that she writes down questions to ask her health care provider, too. Some of the questions you may want to ask include:

• What has happened to my child’s leg, and why?
• Is this a serious injury? Will it do any permanent damage?
• What tests will you perform to diagnose my child?
• What actions might you take after you reach a diagnosis?
• Will my child be OK if he has shin splints?
• Will there be restrictions on my child’s activities? If so, for how long?
• What should we do at home?
• How can we help him understand that he needs to rest the injury?
   

Who’s at risk

• runners and, less often, aerobics participants
• runners who
  • run on surfaces that are too hard or uneven
  • have recently changed their training routine or started running hard up steep hills
  • are using outworn footwear
  • have had prior shin splints
  • are not conditioned, yet are suddenly training rigorously
  • have flat feet or rigid arches
  • tend to pronate (turn feet outward) when running
• (to a lesser degree) aerobics participants
• (to a lesser degree) athletes whose sports involve quick cutting and side-to-side motions, such as basketball
                                                                          

Complications

If an overuse injury like shin splints isn’t treated and the injury continues to worsen, a stress fracture can result. Complications after proper treatment for shin splints are uncommon, but can occur. These can include:

• failure to respond to treatment
• vulnerability of the area to re-injury
   

For teens

Many teens who have shin splints are not only high-performing, determined athletes, but also high-performing, determined students. If you approach your rest and healing period with that same spirit of determination, you should be back to sports and your active lifestyle within a few weeks or months, depending on how severe your injury was in the first place.

The most important thing you can do to get back into your sport is to give your leg a total rest. But even though you know the importance of rest and recovery, you still could find this to be a tough time. If you feel frustrated, depressed or angry during this important time, speak to your doctor, parent or counselor—they’re all on your team, and they all want to help.
 

For parents

If your teen is like many young athletes who have an overuse injury, he’s not only a high-performing, determined athlete—he’s also a high-performing, determined student. Encourage him to approach his rest and recovery period with the same spirit of determination that he applies to other areas of his life. With patience and perseverance, he’ll probably be back to sports and his active lifestyle within a few weeks or months.

Even though you and your teen know the importance of resting his leg, you both might experience his healing period as a difficult time. Parents who identify with their children’s success can feel frustrated or depressed along with their children, so speak to your doctor or counselor if you need help.
 

Prevention

Our Sports Medicine specialists advise young athletes to:

• warm up and stretch before practice
• rest at least one day a week
• cross-train/alternate sports: It’s usually unwise for a child or teen to specialize in just one sport. Multi-sport athletes tend not to get as many overuse injuries as those who just specialize in one sport.
• alternate exercises during practice: Not only are you less likely to experience an injury—studies have also shown that over the long term, muscle memory actually improves if you vary the drills.
   

Shin splints glossary

• cast or walking boot: custom-made protections worn around the lower leg while shin splints heal
• cartilage: a smooth, rubbery tissue that cushions the bones at the joint, and allows the joint to move easily without pain
• diagnosis, diagnostics: identifying disease or injury through examination, testing and observation
• ligament: elastic band of tissue connecting bone to bone
• medial-tibial stress syndrome: the medical term for shin splints
• microtrauma: a small injury to the body, such as microtears to muscle fibers, stress to the tendon, bruising of the bone; can occur to bone, muscle, tendon or ligament. If not allowed rest in order to heal, accumulated microtraumas can lead to overuse injuries, such as shin splints.
• MRI (magnetic resonance imaging): produces detailed images of organs and structures within the body; shows the amount of damage from an injury
• non-surgical (non-operative) treatments: alternatives to surgery; most treatments for overuse injury are non-surgical
• orthopedics: the medical specialty concerned with diagnosing, treating, rehabilitating and preventing disorders and injuries to the spine, skeletal system and associated muscles, joints and ligaments
• orthopedist/orthopedic surgeon: a physician concerned with diagnosing, treating, rehabilitating and preventing disorders and injuries to the spine, skeletal system and associated muscles, joints and ligaments
• osteopenia: less bone mineral density than normal, a precursor to osteoporosis
• osteoporosis: loss of bone density
• overuse injuries: sports-related microtraumas that result from repetitively using the same parts of the body, usually by overtraining; can occur to muscle, tendon, ligament or bone
• periosteum: the thin layer of tissue that covers a bone
• physical therapy: a rehabilitative health specialty that uses therapeutic exercises and equipment to help patients improve or regain muscle strength, mobility and other physical capabilities
• shin splints: pain and inflammationto muscles, tendons and tissue in the area of the shin bone (tibia)
• tendon: a band of tough, inelastic fibrous tissue that connects a muscle with its bony attachment
• tibia: shin bone