Shin Pain (Shin Splints)

What is shin pain?

Shin pain is pain on the front of your lower leg below the knee and above the ankle. It can hurt directly over your shinbone (tibia) or over the muscles that are on the inner or outer side of the tibia. Shin pain has often been called shin splints.

How does it occur?

Shin pain generally occurs from overuse. This problem can come from irritation of the muscles or other tissues in the lower leg or from a stress fracture. This injury is most common in runners who increase their mileage or the intensity of their running, or who change the surface on which they are running.

When you walk or run your foot normally flattens out a small amount when it strikes the ground. If your foot flattens out more than normal it is called over-pronation. Over-pronation can contribute to shin pain.

Some specific conditions that cause shin pain include:

• Stress fracture: This is a hairline crack in one of the lower leg bones, the tibia or fibula.
• Medial stress syndrome: This is when the muscles that attach to the inner side of your tibia are inflamed.
• Compartment syndrome: Your anterior compartment is an area in your leg that contains the muscles that point your foot and toes toward your body. Your lateral compartment contains muscles that move your foot and ankle away from your body. Your posterior compartment contains the calf muscles which point your foot downwards. When a compartment is overused the muscles will become painful.

What are the symptoms?

You have pain over the front part of your lower leg. You may have pain during exercise, at rest, or both. Stress fractures of the tibia will give you pain directly over your shinbone. It will hurt to touch the part of the bone that is fractured. Stress fractures of the fibula will cause pain on the outer side of your lower leg. With medial tibial stress syndrome, you will have pain and tenderness along the edge of the shinbone, especially along the muscles. With compartment syndrome the muscles in that area will be painful. Blood vessels and nerves are also in the anterior compartment. If the muscles in this compartment become swollen during exercise they may irritate these nerves or blood vessels and your foot may become weak, numb, or cold.

How is it diagnosed?

Your healthcare provider will examine your lower leg. He or she will decide which part of your shin is the source of the pain. Your provider may watch you walk or run to see if you have problems with over-pronation. You may need an X-ray or a bone scan to check for stress fractures. If your provider thinks you have compartment syndrome you may need a test that measures the pressure in your lower leg compartments. This is done using a needle attached to a measuring device. They will do this at rest and then again after exercise.

How is it treated?

Treatment may include:

• Ice: Apply ice packs to your shin for 20 to 30 minutes every 3 to 4 hours for 2 or 3 days or until the pain goes away.
• Ice massage: Freeze water in a Styrofoam cup. Peel the top of the cup away to expose the ice and hold onto the bottom of the cup while you rub ice over your leg for 5 to 10 minutes.
• Medicine: Take anti-inflammatory medicine as prescribed by your healthcare provider. Adults aged 65 years and older should not take non-steroidal anti-inflammatory medicine for more than 7 days without their healthcare provider's approval.
• Shoe supports: Arch supports (orthotics) help correct over-pronation. They can be prescribed and custom-made or you can buy pre-made arch supports at your local pharmacy, shoe store, or sporting goods store.
• Rehabilitation exercises.
• Surgery: Sometimes with compartment syndrome surgery is needed. The tissues which form the covering of the compartments are opened up to reduce the pressure in the compartments. Some tibial stress fractures also need surgery.

While you are recovering from your injury, you will need to change your sport or activity to one that does not make your condition worse. For example, you may need to bicycle or swim instead of run. When you begin to run again, you should wear good shoes and run on soft surfaces.

When can I return to my normal activities?

Everyone recovers from an injury at a different rate. Return to your activities will be determined by how soon your leg recovers, not by how many days or weeks it has been since your injury has occurred. In general, the longer you have symptoms before you start treatment, the longer it will take to get better. The goal of rehabilitation is to return you to your normal activities as soon as is safely possible. If you return too soon you may worsen your injury.

You may safely return to your activities when, starting from the top of the list and progressing to the end, each of the following is true:

• You have full range of motion in the injured leg compared to the uninjured leg.
• You have full strength of the injured leg compared to the uninjured leg.
• You can walk straight ahead without pain or limping.

How can I prevent shin pain?

• Since shin pain usually occurs from overuse, be sure to begin your activities gradually.
• Wear shoes with proper padding and support.
• Run on softer surfaces.
• Warm up properly and stretch the muscles in the front of your leg and in your calf.
• Do not keep running while you have shin pain or it will take longer for the pain to go away.