Shin Splints Symptoms & Causes

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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.

The 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 and 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. 

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.

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

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.        

What should I know about shin splints?

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?                                                                       

Can my child return to sports after having shin splints?

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

Who's at risk for shin splints?

•   runners and, less often, aerobics participants
•   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.

How can I prevent shin splints?

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

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•   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 inflammation to 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

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- Sandra L. Fenwick, President and CEO

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