Shin Pain

posted Jun 19, 2012, 6:55 PM by LASP Team   [ updated Jun 19, 2012, 6:55 PM ]

‘Shin Splints’ is a general name given to pain anywhere along the shin bone, from knee to ankle. Symptoms can be experienced at the front or inside of the shin bone and can vary from mild to quite severe for some people. Time to look at things in a little more depth . . . .

Anatomy

The lower leg consists of two bones, the tibia and fibula. The larger weight bearing tibia bone is commonly what people refer to as their shin. The outside thinner bone is the fibula. These bones are joined together top and bottom in the form of joints, and along the full path there are ligaments and muscles anchoring off these bones that essentially help to move and control the ankle and foot. The muscles are bound to the tibia and fibula bones the bones in tight ‘compartments’ that bind the muscles to the so they work efficiently. Passing through the compartments of muscles are many nerves and blood vessels supplying the lower leg and foot.
Shin Splints

“Shin splints” is a general term for shin pain. Relating back to the anatomy, shin pain may be caused by any of the structures outlined above – bone, muscle, nerve, blood vessels (and some tricky bits in between). A large body of research has been dedicated to unravelling the often challenging problem of shin splints. Our knowledge on how to diagnose and manage ‘shin splints’ is advanced, however there remains some aspects that are not fully understood. Sports medicine health professionals such as physiotherapists primarily consider the cause of shin pain symptoms to be possibly arising from three possibilities;

-          The bone structure

-          The muscle compartment

-          The interface between the muscle and bone referred to as the “periosteum”

In reality for people with long-standing shin pain, there is probably an element of all three contributing to symptoms. The location and type of symptoms you experience, and how they relate to exercise and sport can give some indication as to the more likely possibility.

The Dividing Line – Outside vs Inside

In the world of sports medicine, we start by dividing your symptoms on where they are located – outside (anterolateral) or inside (antero-medial).

Pain located on the outside of the tibia is of particular concern, and may relate to a nasty type of injury called an ‘anterior tibial cortex stress fracture’. These injuries need to be managed very carefully as the outside of the bone has tensile forces acting on it that can delay healing. Fortunately this is far less common than pain on the inside of the bone, however if you do have symptoms on the outside/front part of your shin that are getting worse with activity, you should have it assessed immediately.

Pain located on the inside of the tibia is far more common. In Sports Medicine, it is most commonly referred to as “Medial Tibial Stress Syndrome” – the name being a reflection of the fact that it has more than one specific anatomical cause as discussed above.

 
Symptoms

Symptoms include pain over the inside lower half of the shin, felt before, during or after exercise. Pain often returns after activity and may be at its worse the next morning. Swelling is occasionally present. Lumps and bumps may be felt when feeling the inside of the shin bone. The overlying skin may be red and inflamed. In some cases, people may report neural symptoms of pins and needles and numbness in the shin or commonly into the foot if nerve structures are involved.

Cause

Physiotherapists consider the problem from many angles in trying to determine why the symptoms have developed in the first place. Ultimately if the cause of the symptoms is not determined, it is difficult to eliminate. The things that may contribute to overload and shin pain may include:

  • Training Errors – sudden changes in your exercise intensity or type can trigger this problem as well as too much of the wrong type of training for your current level of fitness. Shin pain is very common in the recreational runner who has suddenly increased or recommenced their training. People on ‘exercise and weight loss’ kicks can commonly over-do it early on. Over-zealous treadmill walking has the potential to set this process off. All new training activities need to be introduced gradually and then varied to avoid monotonous loading of our body regardless of whether it is a treadmill, hard ground, soft ground or uneven surfaces.
  • Foot Structure – people with very flat feet may be prone to shin pain as the shin muscles are involved in maintaining the instep or arch of the foot. Likewise, people with very high/stiff arches are prone to shin pain as their foot provides less shock absorption of ‘ground reaction forces’ that travel up the leg.
  • Running shoes – wearing the wrong type of shoes for your foot type during exercise. Even shoes that propose to offer ‘high support’ or ‘cushioning’ maybe the wrong choice for you depending on your foot structure or running technique.
  • Running Technique – common running technique faults that may lead to shin pain include heavy heel strike and overstriding. This can often relate to the type of training that you are doing and the shoes you are wearing.
  • Previous Injuries – unresolved injuries and the effect of them may lead to musculoskeletal imbalances that increase loading patterns through the shin region. This may include the lower back, pelvis, hip, knee or ankle. Injuries on the other side of the body may increase loads on the symptomatic side. Subtle changes in the way you move due to stiffness or poor muscle control can alter your biomechanics to be a contributory factor in developing shin pain.
  • Diet – bone and muscle health is a reflection of good dietary habits. Due to the interaction of hormones and diet, females are in particular very sensitive to bone issues if high training volumes are not balanced with an appropriate diet. Muscles need good hydration and the right nutrients to recover.
  • Nurture – we know that people who played twisting/turning sports through their growth years are less likely to suffer with shin pain as adults. We lay down 25% of our lifetime bone density and strength in our puberty growth years. Playing twisting/turning sports in this time frame has a stimulating effect on bone development that sets us up for the rest of our life!! Another reason to get our teenage kids off the couch and from behind the ‘screens’ invading modern lifestyles!

What can your Physiotherapist do for you?

As outlined, the causes can be complex and often multi-factorial for an individual person, meaning there is no one ‘quick fix’ that applies to everyone. A comprehensive physiotherapy history and assessment can help to unravel your “story” and determine an appropriate course of management for you. Occasionally investigations may be required to help direct management along the lines of Xray, MRI or muscle compartment pressure test, but most commonly the diagnosis is a clinical based one.

Treatment options may include;

  • Manual Therapy – to address identified soft tissue and joint imbalances. This may not necessarily be directed at the shin, if for example a stiff hip is a major contributing factor.
  • Taping – various taping techniques can be used to offload pressure on the shin. Examples include taping the foot, or a compressive taping of the shin.
  • Exercise Rehabilitation – to address muscle imbalances and joint stiffness. Muscle strength and endurance of the lower legs has an incredibly protective role for bone, and at the same time stimulates bone health.
  • Orthotic/Shoe Prescription – depending on your foot structure, a change in shoe type, or the addition of orthotics maybe recommended.
  • Advice – regarding training type, intensity and volume. For example, the inclusion of the occasional interval based running session at higher speed can have an enormous positive effect on a long distance runner’s technique, muscle strength and loading patterns. Subtle changes in running technique can make a big difference to your angry shins.
  • Surgery – in rare cases, surgery may be required to ‘release’ the soft tissue compartments. This requires a formal assessment of muscle compartment pressure usually via a Sports Physician or orthopaedic surgeon. Fortunately it is a relatively low risk surgery with a quick recovery.

If you suffer from shin pain, contact us on (02) 4647 3373 to make an appointment with one of our Physiotherapists.

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