The prevention of shin splints in sports: a systematic review of literature.
OBJECTIVE
To review the published and unpublished evidence regarding risk factors associated with shin splints, assess the effectiveness of prevention strategies, and offer evidence-based recommendations to coaches, athletes, and researchers.


METHODS
We searched electronic data bases without language restriction, identified citations from reference sections of research papers retrieved, contacted experts in the field, and searched the Cochrane Collaboration. Of the 199 citations identified, we emphasized results of the four reports that compared methods to prevent shin splints. We assessed the methodologic quality of these reports by using a standardized instrument.


RESULTS
The use of shock-absorbent insoles, foam heel pads, heel cord stretching, alternative footwear, as well as graduated running programs among military recruits have undergone assessment in controlled trials. There is no strong support for any of these interventions, and each of the four controlled trials is limited methodologically. Median quality scores in these four studies ranged from 29 to 47, and serious flaws in study design, control of bias, and statistical methods were identified.


CONCLUSIONS
Our review yielded little objective evidence to support widespread use of any existing interventions to prevent shin splints. The most encouraging evidence for effective prevention of shin splints involves the use of shock-absorbing insoles. However, serious flaws in study design and implementation constrain the work in this field thus far. A rigorously implemented research program is critically needed to address this common sports medicine problem.
Thacker
Stephen B
SB
National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. sbt1@cdc.gov
Gilchrist
Julie
J
Stroup
Donna F
DF
Kimsey
C Dexter
CD
D001265:Athletic Injuries / Q000517:prevention & control*; D012090:Cumulative Trauma Disorders / Q000517:prevention & control*; D005069:Evaluation Studies as Topic; D005260:Female; D015775:Fractures, Stress / Q000517:prevention & control*; D006801:Humans; D007869:Leg Injuries / Q000517:prevention & control*; D008297:Male; D010806:Physical Education and Training / Q000379:methods; D012307:Risk Factors; D012737:Sex Factors; D012775:Shoes; D019876:Sports Equipment; D013978:Tibial Fractures / Q000517:prevention & control