Reducing risk in sports: Shin splints and stress fractures

Reducing risk in sports: Shin splints and stress fractures


Reducing risk in sports: Shin splints and stress fractures


Scott Sailor, president of National Athletic Trainers’ Association (NATA).

Scott Sailor, president of National Athletic Trainers’ Association (NATA).

USA TODAY High School Sports and the National Athletic Trainers’ Association have partnered on a monthly column to address injuries, prevention and related issues to help schools, coaches and student-athletes. Here is the latest column from Scott Sailor, the president of NATA.

It’s that time of year when the weather can make it nearly impossible to train outside. Many athletes who have been training on soft turf fields, outdoor tracks and grass have moved indoors to much harder surfaces, such as the basketball court and even school hallways for indoor track. This change from a softer surface to one that is harder and less forgiving can lead to shin pain.

Shin injuries, such as stress fractures, are overuse injuries that occur when the tissues of the lower leg absorb too much force. This can cause micro-tears in the bone or can lead to injury of the soft tissue, such as the muscles and tendons.

Shin splint is a catch-all phrase for pain in the shin. Pain can be due to inflammation of the muscle tissue along the tibia, as well as a stress response or stress fracture to the bone. Your athletic trainer or physician will diagnose exactly what is injured so it can be properly managed.

If you suspect a stress fracture, it’s important to be evaluated as soon as possible. Early detection will help reduce the weeks of pain and the amount of time you may be sidelined from sports. A stress fracture won’t necessarily show up in an X-ray until it’s in the process of healing. For an immediate, definitive diagnosis, your physician may likely order an MRI or CT scan in the earlier stages.

A stress fracture that doesn’t receive proper treatment can lead to a complete fracture of the bone. Some high school athletes have collapsed in the middle of competition because their tibia becomes fractured and displaced. Many reported after the incident that they experienced shin pain for a while, but never sought medical advice. They just tried to “run through” the pain.

 Causes of Shin Pain

  • Working out on hard or uneven running surface such as tar or concrete roads, certain composite or wooden floors and fields that have not been watered.
  • Poorly fitted or old, worn-out shoes.
  • Flat or high-arched feet that don’t absorb enough shock at the arch, so more force is transmitted to the tibia and soft tissue of the lower leg.
  • Poor running style.
  • Overtraining.
  • Doing too much, too quickly. For example, you have not trained all fall for indoor track and on the first day you are asked to run five miles. Your body is not prepared for this sort of activity, and the bone and soft tissue start to break down.
  • Poor flexibility in the knee, ankle and hip which prevents them from going through their full range of motion and could affect running mechanics and how much force is absorbed at the feet.

Signs and Symptoms of a Stress Fracture

  • Pain localized to one specific spot on bone during activity.
  • Bone pain before, during and after workouts.
  • Bone pain at rest or at night.
  • Bone pain when walking.
  • Bone pain going up and down stairs.
  • Possibly bruising in the area.
  • Bone is tender to touch.

Signs and Symptoms of Soft Tissue Involvement/Shin Splint

  • Generalized pain over the muscles/tendons around the bone.
  • Soft tissue is tender to the
  • No shin pain when at rest.
  • Pain with certain resisted ankle movements.
  • Pain at the start of practice that might go away once the body is warmed up.

Treatment for Soft Tissue Involvement/Shin Splint or Stress Fracture

  • Get a clear diagnosis from your athletic trainer or physician as to whether you’ve injured your bone or soft tissue.
  • Have your athletic trainer evaluate your running mechanics, since there might be something in your running style that is causing the injury. You can treat the symptoms, but if you have a mechanical problem (i.e. arch issue) and don’t fix it, the pain will return as you start to run again and/or increase your mileage.
  • Ice after training.
  • Stretch upper and lower leg muscles.
  • Use of calf sleeves sometimes help.
  • Cross train for cardiovascular fitness.
  • Rest to allow the body to heal. You may find this frustrating since missing a few weeks might mean missing much more playing time. Unfortunately, the body can only heal so fast, and if you don’t let the bone or soft tissue fully heal, the pain can return and you will be sidelined again.
  • Always follow the advice and instructions of your athletic trainer or other medical professional who will help guide you safely back to competition.

Preventing Soft Tissue Involvement/Shin Splint or Stress Fracture

If you have flat feet, you might develop shin pain because of your mechanical disadvantage. If needed, look into purchasing special insoles to support your arch and increase the shock absorption at your feet.

  • Gradually increase your training over time. Try not to do too much, too quickly.
  • Wear properly fitted workout shoes that match the mechanical needs for your feet. For example, if you have flat feet, you might want to get a running shoe that has a good arch.
  • If your shoes have more than 400 miles on them or are starting to show wear on the soles, look into replacing them.
  • Don’t wear your running shoes during the school day. This adds mileage to them and decreases their effectiveness over time.
  • If you have a pair of workout shoes that fit and support your feet well, consider purchasing a few extra pairs. If the manufacturer discontinues that model, you won’t have to worry about looking for a new brand or model right away.
  • Do not train on hard surfaces all the time; look into cross training such as biking, swimming or using an elliptical machine.
  • Have an athletic trainer or other health care provider evaluate your running mechanics to see if you are predisposed to lower leg injuries.
  • Maintain a healthy diet.
  • Work on flexibility and strength of the lower and upper leg muscles.
  • Consult with your athletic trainer to ensure you have a healthy balance between training and recovery.

Following these tips can help prevent shin splints and stress fractures in the future. NATA has created an infographic that offers additional information. Also, visit for additional sports safety tips for parents and athletes.


More USA TODAY High School Sports