Shin Pain

Shin Pain (Shin Splints)

What is shin pain?

Shin pain is pain on the front of the lower leg below the knee and above the ankle. It can hurt over the shin bone (tibia) or over the muscles on either side of the shin bone. Shin pain is also called shin splints.

How does it occur?

Shin pain generally occurs from overuse. This problem can come from stress fractures of the tibia or fibula (the other bone in the lower leg) or from irritation of the muscles or other tissues in the lower leg.
The muscles in your leg are grouped within compartments. Inflamed muscles can cause swelling in the leg compartments. This is called compartment syndrome. The anterior compartment is the one must commonly affected in shin pain.
Shin pain can occur 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.

What are the symptoms?

You have pain over the front part of your lower leg. You may have pain at rest, during exercise, or both.

How is it diagnosed?

Your doctor will examine your lower leg. He or she will look for tenderness over the front of your shin. Your doctor may watch you walk or run to see if you have problems with over- pronation. Your doctor may order x-rays or a bone scan to check for stress fractures. If your doctor thinks you have a severe case of compartment syndrome, he or she may order a test that measures pressure within the leg compartments.

How is it treated?

Treatment may include:

applying 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
doing 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 into your leg for 5 to 10 minutes.)
taking anti-inflammatory medication prescribed by your doctor
wearing prescribed, custom-made arch supports (orthotics) to correct over-pronation
doing rehabilitation exercises
having surgery for compartment syndrome that does not improve with other treatment.
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 sport or activity?

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

You may safely return to your sport or activity 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 jog straight ahead without pain or limping.
You can sprint straight ahead without pain or limping.
You can do 45-degree cuts, first at half-speed, then at full-speed.
You can do 20-yard figures-of-eight, first at half-speed, then at full-speed.
You can do 90-degree cuts, first at half-speed, then at full-speed.
You can do 10-yard figures-of-eight, first at half-speed, then at full-speed.
You can jump on both legs without pain and you can jump on the injured leg without pain.

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.
Run on softer surfaces.
Warm up properly and stretch the muscles in the front of your leg and in your calf.