By Jeremy Joslin, M.D. and Brian Krabak, M.D., MBA


Term "shin splints" is used to describe a painful condition involving the tibia bone in your lower leg. Although professionals use the term loosely to represent several disorders that cause the same pain, we will use the term more strictly here to discuss pain associated with repetitive use of the leg, but not related to stress fractures or compartment syndrome (a painful condition where lactic acid builds up in a fleshy compartment causing swelling and cell death).

Even within our definition, shin splints can be caused by irritation at the spot where your tibialis muscle attaches to your shin bone (tendonitis), or by irritation of microtears of the connective tissue covering your shin bone (periostitis). Regardless of the technical definition used, it is a painful overuse syndrome that can be debilitating to a runner.

Risk Factors

Studies have been done to help select factors that place some runners at a greater risk than others for developing overuse injuries such as shin splints. These factors include lack of running experience, competitive running, excessive weekly running distances, poor physical condition, and previous injury. Other factors seem to be discovered while looking at a particular population of athletes, but then disappear when evaluting a different population for the same factors. These include age, gender, warming up, cooling down, stretching, excess running mileage, running on hills, poor running surface, previous athletic activity, and joint laxity.

Most of the risk factors discussed above seem to be in play when considering typical ultramarathon events!


Pain is often described as burning during running, or aching after exercise is completed. The only physical finding may be tenderness to the anterior or medial tibial surfaces.


The mainstay of treatment is similar to other overuse injuries and comprises the following:

  • Rest until pain has resolved
  • Anti-inflammatory medication such as ibuprofen
  • External anti-inflammatory measures such as cool water soaks or indirect ice


The bottom line of prevention seems to be that running large distances should be undertaken gradually, using good running technique, and with good equipment. While most people find stretching and warming up help prevent injury, the science of these practices has yet to be proven helpful.

To prevent shin splints, avoid overusing these muscle groups until heavy use has already been gradually achieved.


1.) The prevention of shin splints in sports: a systematic review of literature. Med. Sci. Sports Exercise, Vol. 34, No. 1, 2002, pp. 32–40.
2.) Emergency Medicine: A Comprehensive Study Guide - 6th Ed. (2004).
3.) Current Diagnosis & Treatment in Orthopedics - 4th Ed. (2006).

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