From Jonathan Cluett, M.D.,
Your Guide to Orthopedics.
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About.com Health's Disease and Condition content is reviewed by Kate Grossman, MD

What are shin splints?
The term shin splints is a common misnomer in sports medicine. It does not imply a specific diagnosis, rather it is the symptom of pain over the front of the tibia bone. The pain from shin splints can be due to either problems of the muscles, the bone, or the attachment of the muscle to the bone. Therefore, 'shin splints' is simply the name given to pain over the front of the lower leg.

What causes shin splints?
The symptoms of shin splints can be caused by several conditions. These conditions include:

• Medial tibial stress syndrome (the most common cause of shin splints)
• Stress fractures
• Exercise induced compartment syndrome

Shin splints are most commonly due to overuse. When the overuse causes irritation to the tendons and the attachment of these tendons to the bone, the condition is called medial tibial stress syndrome. This is what most people are talking about when they use the words shin splints as a diagnosis.

Medial tibial stress syndrome, or shin splints as most people call this problem, is commonly seen in athletes who suddenly increase their duration or intensity of training. This type of shin splints may also be seen in athletes who have very high demand training levels, such as marathon runners, even if their training levels are not dramatically increased.

Why are some people more susceptible to shin splints?
Everyone has a different body, and each persons body mechanics differ slightly. One factor commonly implicated in causing shin splints is overpronation. Pronation occurs when the foot flattens out when weight is applied. The normal foot should flatten slightly, meaning pronation is a normal foot motion. Overpronation occurs when the foot becomes too flattened out causing the foot to roll inwards. This can cause increased demand on the muscle over the front of the leg and lead to complaints of shin splints.

How is the cause of shin splints determined?
As mentioned previously, the term shin splints is not actually a diagnosis, but a group of problems that causes a typical pain. Therefore, your doctor with perform a careful medical history and physical examination to determine the cause of the shin splints. The area of maximal tenderness may be different in patient who have different underlying problems causing shin splints. There are also provocative tests that can help determine the cause of the shin splints.

Patients with medial tibial stress syndrome typically have a dull, aching type of pain on the inside of their tibia bone. On examination, patients with medial tibial stress syndrome will often be tender over this same part of the tibia. Patients may or may not have a small amount of detectible swelling over this part of the tibia. Some specific maneuvers, especially resisted plantar flexion (pushing down of the foot against resistance), typically causes an increase of symptoms.

In order to determine the underlying cause of the shin splints your physician may order an x-ray or a bone scan. The x-ray can detect fractures, and occasionally detect long-standing stress fractures. The bone scan will detect areas of high bone turnover; these ‘hot’ areas indicate possible stress fractures or other bone problems. Patients with medial tibial stress syndrome may also have an abnormal bone scan, but there is usually a differnce that can be detected to differentiate medial tibial stress syndrome and stress fractures.

For more information, read on about the treatment of shin splints...