Shin splints are pains in the front of the lower legs caused by exercise. They usually appear after a period of inactivity.

Shin splints can be caused by any of four types of problems, which are only occasionally serious.

Tibial shin splints are very common. They can affect both recreational and trained athletes, including runners. There are two types of tibial shin splints: tibial periostitis and posterior tibial shin splints. In tibial periostitis the bone itself is tender.

Anterior compartment syndrome affects the outer side of the front of the leg.

Stress fractures usually cause sharp pain and tenderness 1 or 2 inches below the knee. A stress fracture is likely to occur 2 or 3 weeks into a new training program or after beginning a harder training program.

Most shin splints can be treated with rest.

Healing from posterior tibial and tibial periostitis shin splints usually involves a week of rest. Use ice for 20 minutes, twice a day. Over-the-counter pain medications will also help. Do not start running again for another 2 - 4 weeks.

For anterior compartment syndrome, pain will usually go away as the muscles gradually get used to the intense exercise. Complete rest is probably not necessary.

For a stress fracture, rest for at least 1 month. Complete healing takes 4 - 6 weeks. You can use crutches, but they are typically not necessary.

Although shin splints are seldom serious, you may need to call your health care provider if:

• The pain continues and is persistent, even with rest
• You are not sure whether your pain is caused by shin splints
• You don't improve with home treatment after several weeks

The health care provider will perform a physical examination and take a medical history.

Medical history questions may include:

• Time pattern
  • When did the pain start?
  • Is it present all of the time?
• Quality
  • Describe the pain.
  • Is it a sharp pain?
• Location
  • Are both legs affected?
  • Where exactly on the leg is the pain?
• Aggravating factors
  • Have you recently begun exercising?
  • Have you recently increased the amount that you exercise?
  • Have you recently changed the type of exercise that you do?
• Relieving factors
  • What have you done for the pain?
  • How well did it work?
• Other: What other symptoms do you have?

The physical examination may include an examination of the legs.

Home treatment will be prescribed for any of the different types of shin splints. Surgery may be needed in rare cases when shin splints caused by an anterior compartment syndrome do not go away over time.

The pressure can be relieved by splitting the tough, fibrous tissue that surrounds the muscles. Surgery may also be necessary for stress fractures that do not heal.

Carr K, Sevetson E, Aukerman D. Clinical inquiries. How can you help athletes prevent and treat shin splints? J Fam Pract. 2008;57:406-408.