Runner running up stairs

Shin Splints

Shin splints are a common exercise problem and sports injury, but what exactly does it mean?  The medical term for shin splints is medial tibia stress syndrome (MTSS).  The stress occurs with the inflammation of muscles, connective tissue and bone tissue along the inner shin bone (tibia).  The stress is directly related to physical activity, typically running or dancing.  Moreover, any type of vigorous activity can bring about this problem, especially if starting a new fitness routine.

What causes shin splints?
The lower leg muscles and bony tissue (periosteum) become overworked and overloaded in the shin, especially with repetitive activity.  A sudden, swift change in workout routine can increase a child’s risk for shin splints.  A simple change from flat surface to hills is a common scenario.  A sharp spike in duration and intensity of a workout routine is another common phenomenon. Flat feet, high rigid arches, and rolling the foot (pronation) often contribute as well.

What are the symptoms?
The most common symptom of shin splints is pain along one or both inner shin bones (tibias).  Pain may be described as sharp or dull during and after activity.  Touching the tibia can cause pain or soreness.  Symptoms typically not present are limp, night pain, swelling, muscle tightness and numbness, color change, or cold foot; these are all red flag warning signs.  A limp is often suggestive of a stress fracture. Night pain could indicate bone injury, stress fracture, a bone lesion or tumor of the bone. Swelling of the shin can occur with a bone injury or blood clot.  Muscle tightness, numbness, color change, cool foot often indicate chronic exertional compartment syndrome or popliteal artery entrapment.

When should your child’s shin pain checked?
Any persistent pain not responsive to basic rest and ice for a few days should be evaluated by a physician especially with any red flag warning signs.  A basic history and physical exam can point the doctor in the direction if tests are need.  Typically a basic x-ray of the shin is the starting point.  Other tests might be necessary during the investigation such as MRI, ultrasound, bone scan and blood tests.

What are typical treatments for your child’s shin splints?
Once the diagnosis is confirmed the goal is to decrease inflammation and get back to activity.  The first secret to success is REST!  Shin splints result from overuse- too much, too fast, too soon.  Decreasing the impact and repetitive activity and substituting with low impact physical activity such as swimming or elliptical is a good first step. The second secret to success is correcting the root cause for the shin splints.  A combination of corrective exercises, flexibility exercises, orthotics, and gait analysis are often employed to help a child onto a road to recovery!

Learn more about shin splints and how the Sports Medicine Department at Nationwide Children’s Hospital can help your young athlete.

Amy E. Valasek, MD, MSc
Amy Elizabeth Valasek, MD, MSc is a physician for Nationwide Children’s Sports Medicine and an Assistant Professor in the Department of Pediatrics at The Ohio State University College of Medicine. She is fellowship trained and board certified in sports medicine. Dr. Valasek attended medical school at The University of Maryland. She completed her residency at Johns Hopkins Hospital in the Department of Pediatrics and sports fellowship at University of Maryland Family Medicine Department in Baltimore, MD. She is a member of the American Academy of Pediatrics, American College of Sports Medicine, and American Medical Society for Sports Medicine. She is active in the community and serves as team physician at Bishop Ready High School in Columbus, Ohio.

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