Shin Pain
Shin splints is a general term used to describe pain along the shin bone (tibia) that normally develops or gets worse with exercise. The actual term itself is confusing and not a medical term, but the term ‘shin splints’ is still used widely by sports public.
About shin pain
Depending on the type of injury you have, the pain may come on gradually or you may have a sudden twinge of pain. Shin pain usually develops in people who do repetitive activities and sports that put a lot of stress on the lower legs. Often the pain comes about at the commencement of an exercise program or if there has been a recent change in type or intensity of activity. It affects a wide range of sports from explosive jumping and landing sports such as Netball and Athletics, to more repetitive sports such as Running. Pre season, early season and increased intensity all seem to be common times to get this painful injury.
Types of shin pain
There are 3 main diagnoses for exercise related Shin pain.
- Medial tibial stress syndrome. This is inflammation / irritation where the tendon attaches to the thin layer of tissue that covers the bone (periosteum). This is the most common shin pain and it responds well to a variety of treatment modalities, which could include Podiatry, Physiotherapy, Massage.
- Stress fractures. They can develop after repeated periods of stress on your bones or after a sudden high intensity bout of training. The tibia is the 2nd most affected bone in the body for stress fractures. Treatment here involves a period of time out of sport to allow the bone to heal and then a through rehab program to reduce or eliminate risk factors. A multi faceted approach works well here, which may involve Sports doctors, Podiatrist, Physio, Coach (technique) and Nutritionist.
- Compartment syndrome. Groups of your our muscles are confined by a compartment, some peoples compartments are quite restrictive so the muscle group so doesn't have much room to expand. When the pressure in your muscle increases it causes the symptoms of compartment syndrome, a tightening of the lower leg muscles that can be very limiting to activity.
Risk Factors:
In the most recent studies the biggest risk factor to be highlighted was history of exercise related leg pain. People who get shin pain tend to be at risk of getting it again.
Biomechanics of the feet and lower legs: it has been postulated that poor foot mechanics can cause there to be overuse of muscles in the lower leg and also affect shock absorption. This is why often those with shin pain respond well to orthotic therapy by a Sports Podiatrist. There is also a thought that increased bending forces on the inside of the tibia can be a contributing cause. Anecdotally to me clinically this would hold true. I often see patients with bowed legs (Tibial Varum) suffering from persistent shin pain.
Calf muscle flexibility and strength have also been nominated to play a part, especially in tibial stress fractures, as has the diameter of the tibia. A rehab program following shin pain should at some stage incorporate exercises for this.
Self help for shin pain.
You should rest your injury from offending activities, and seek advice to hasten your full return to sport. With some shin pain it is OK to continue training to a certain extent, as long as the condition is not being aggravated. Again seek professional advice here.
Check your sports shoes to see whether they are in good condition and provide enough support and cushioning, and are flexible in the right areas, such as under the forefoot. If in doubt consult a Podiatrist.
Ice the affected area when sore particularly after sport.
If in doubt seek professional help as this can greatly improve your chances of returning to 100% as quickly as possible.
Simon Wheeler is a Sports Podiatrist consulting at Active Health QEII
simonw@activehealth.co.nz
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