Description

• American Medical Association defines shin splints as “pain or discomfort in the leg from repetitive running on hard surfaces or forcible excessive use of the foot flexors”:
  • Definition excludes stress fracture or pain from ischemic origin
• Synonym(s): Medial tibial stress syndrome (preferred term); Medial tibial periostalgia; Tibial periostitis; Shin soreness; Tibial stress syndrome; Medial tibial syndrome

Epidemiology

Incidence
Can account for 4–35% of all running injuries (1)

Risk Factors

• Runners (particularly sprinters and hurdlers)
• Dancers (particularly ballet)
• Gymnasts, basketball players
• Military personnel
• Usually categorized into intrinsic (personal) and extrinsic (environmental) factors (1,2):
  • Intrinsic factors:
    • Overpronation
    • Female sex
    • Increased hip internal/external range of motion
    • Higher body mass index
    • Leaner calf girth
  • Extrinsic factors:
    • Previous history of shin splints
    • Inexperienced runner
  • Other factors thought to contribute (but lack study support):
    • Training errors (increased mileage, increased intensity of workout)
    • Low calcium intake in female athletes
    • Running on hard or inclined surfaces
    • Running while wearing worn-out footwear

General Prevention

Suggested recommendations include:

• Screening for overpronation
• Designing appropriate training regimen/identifying training errors
• Regular stretching, strength, and flexibility exercises
• Rehabilitation of previous injuries
• Wearing proper footwear

Pathophysiology

• Somewhat controversial, with many different theories, including bone stress reaction, periostitis, periostalgia, periosteum traction, low bone mineral density, tendinopathy, periosteal remodeling
• Several structures possibly involved or implicated, including the soleus, deep crural fascia, flexor digitorum longus, flexor hallucis longus, and tibialis posterior

Etiology

Likely multifactorial, drawing from biomechanical, anatomic, and environmental causes