Shin Splints (Shin Pain)

What are Shin Splints?

Shin splints is the term commonly used to describe pain on the shin bone.

What causes shin splints?

Shin pain is most commonly caused due to one or a combination of the following:

• Bone Stress

  Definition

  Due to sudden increase or continuous application of load, a small sliver or crack may develop in the tibia. This is termed as stress fracture, bone stress or hairline fracture. Tibia is the long bone on the inside of the leg between the knee and the ankle.

  Symptoms

  • Gradual onset of shin pain aggravated by exercise
  • Pain at rest and night
  • Localised tenderness over the tibia – bony tenderness

  Who is at risk:

  • Runners
  • Athletes who participate in high impact sports /activities – ballet dancing, gymnastics
  • People playing sports on rigid unforgiving surfaces
  • People with a high arch and/or rigid foot type (cavus foot type) which is less effective in bearing load
  • People with flat feet (pronated foot type)
  • People with leg length discrepancy (one leg shorter than other)

  Treatment

  • Imaging: Along with a clinical examination, a bone scan and MRI may be required
  • Rest - Use of crutches to minimize load on affected leg may be recommended
  • Use of Non Steroid Anti- Inflammatory Drugs (NSAIDS)
  • Patients may be recommended to use a pneumatic brace while training during the healing process of the stress fracture. The healing process could take 4-8 weeks
  • If pain still persists, resting from any load bearing activity is recommended until the bony tenderness disappears. Once the bony tenderness has disappeared completely and no pain is felt while walking, gradually increase the intensity of exercise over a period of time. Continue with low impact exercises such as walking and swimming to maintain conditioning

  
  
• Midial Tibial Traction Periostitis

  Definition

  Inflammation of the connective tissue that surrounds the tibia. It is an overuse injury commonly seen in runners due to excessive traction or pull on the inner side of the tibia.

  Symptoms

  • Diffuse (spread out) pain along the medial border of the tibia (long bone in the lower leg between the knee and the ankle). There may be slight pain before exercising. This pain reduces while warming up and during the exercise, however the pain returns after exercising and gets worse the following day.

  Causes

  • People with abnormal biomechanics (flat feet)
  • Training errors – doing too much too soon
  • Training on hard surfaces
  • Muscle dysfunction
  • Fatigue
  • Decreased flexibility in the ankle due to tightness in the calf muscle
  • Poor footwear design

  Treatment

  • Imaging: : Along with clinical examination, an X-ray and a bone scan may be required
  • Ice the affected area
  • Use of Non Steroid Anti- Inflammatory Drugs
  • Participation in low impact sports/training such as swimming is recommended
  • Taping of the foot - to control pronation (flat feet)
  • Massage to relieve tightness of calf muscles
  • Wear appropriate footwear and orthotics (for cushioning & support)

  
  
• Chronic Exertional Compartment Syndrome

  Definition

  Compartment syndrome is the increased pressure in an area (compartments) of the leg which leads to reduced blood flow in that particular area (compartment). This causes ischaemic pain (unpleasant excruciation pain caused due to reduced blood supply) and compartment damage.There are 4 main compartments in the leg. Anterior compartment, lateral compartment, superficial posterior compartment and deep posterior compartment. Anterior compartment syndrome is the most common.

  Symptoms

  • No pain at rest. Increase in pain and sensation of tightness with increased exertion
  • Presence of muscle bulge

  Who is at risk:

  • People with abnormal biomechanics (flat feet)
  • Training errors – doing too much too soon

  Treatment

  • Imaging:Along with clinical examination, an X-ray and a bone scan may be required
  • Rest
  • Reduce strenuous exercise
  • Soft tissue therapy (massage)
  • Correction of biomechanical abnormalities using orthotics
  • Surgical release of the compartment if pain does not resolve with above treatment(s)

  
  

Other causes of shin splints (shin pain) are:

• Nerve Entrapment - Compression of the nerve
• Stress fracture of the fibula. Fibula is a long bone on the outside of the leg between the knee and the ankle
• Vascular Entrapment - Compression of an artery leading to reduced blood flow