How to treat shin pain
How to treat shin pain?
Shin splints are a generic term that many runners use to broadly cover shin pain. Sports medicine practitioners have needed to develop more specific terms to differentiate conditions and treatments required when addressing shin pain.
These terms try to reflect the tissues affected and their different causes. Whilst some shin pain may present similarly, it is important to correctly identify the pain and provide appropriate treatment. Below are common shin pain issues we see at intraining Running Injury Clinic.
- Medial tibial stress syndrome
- Stress fracture
- Compartment syndrome
- Nerve entrapment
- Muscle and tendon strain
Below we briefly describe; how to diagnose shin pain, common symptoms and how to treat the injury appropriately. If you have shin pain that is holding you back from enjoying your running, click the button below to make an appointment to see one of our podiatry or physiotherapy team.
MEDIAL TIBIAL STRESS SYNDROME
The most common cause of shin pain is medial tibial stress syndrome. This pain hurts along the inside of the shin most commonly in the lower half and isolated to the medial border of the shin bone, the tibia. It is an inflammation of the tibial skin, called the periosteum, where the fascia of the leg attaches. The fascia is the stiff layer of tissue that holds all the muscles in place. Little tears occur along this attachment causing inflammation and pain.
The pain can sometimes hurt after waking or rest but most commonly hurts at the beginning of a run before warming up. When bad it can begin to hurt again at the end of a run and will hurt a lot afterwards.
Treatment involves a direct icing technique for a few days with the addition of a gentle distraction massage after that time. Screening for any underlying biomechanical causes may be necessary if continued running aggravates the injury. Extended rest is not recommended as the scar tissue may become more entrenched and harder to resolve in the long run.
Prognosis is generally quite good with a significant (greater than 50%) reduction of pain within a week and complete resolution within a month.
Medial tibial stress syndrome that goes untreated may lead to more severe injuries to the bone like bone stress or stress fractures. Stress fractures are most commonly found on the inside (medial) border of the tibia but may also occur on the front (anterior) border. It is often overtraining that is the culprit, where it has occurred more than a month prior to injury onset.
Pain usually occurs at the start of a run and gets worse without going away. It can ache afterwards and sometimes the pain will wake you at night. Pain is usually localised to a spot on the bone and may hurt on both borders and the shaft. Normal x-rays may pick up a stress fracture after 3-4 weeks but an MRI is the best scan to use.
Unfortunately bone injuries are one of the few injuries that require complete rest from activity. If it is bone stress than after a week there will be significant improvement in point tenderness while a stress fracture will take at least three weeks. With bone stress you can return to running when the pain is gone but stress fractures require 6 to 8 weeks of no running. Once the stress fracture has healed adequately there is less chance of recurrence in the same location.
A compartment syndrome can be defined as the increase in pressure within the limited anatomical space of a fascial compartment which compromises the circulation and function of the tissues within that space. If compartment volume is limited or decreased due to tight or thickened fascia then compartment pressures can increase upon normal muscle swelling during exercise. The anterior compartment muscles are most commonly affected in running.
Generally there is no pain at rest or at the start of a run. Pain comes on at a certain distance of each run and is quickly too severe to continue. The muscle feels tight and may be firm to the touch. Within a few minutes of stopping the pain has gone completely. If the anterior compartment is affected, the foot may ‘slap’ excessively when running. This is because the purpose of the anterior compartment muscles are to control ankle movement as the runner lowers the forefoot to the ground after heel strike.
Non-surgical treatment includes changing biomechanics through form modification, change in footwear or orthotics. Avoiding hills or rough surfaces may help as will a reduction of training below the threshold distance of onset of symptoms. Icing and Myofascial release massage techniques can help to release the adhesions between fascia and muscle that may be causing the compartment syndrome.
While immediate improvement can occur complete resolution can take a very long time. In some cases surgical intervention is the only successful treatment.
NERVE AND VASCULAR ENTRAPMENT
There are more rare forms of shin pain may mimic some of the more common injuries as described above. Entrapment of the popliteal artery has the same symptoms as compartment syndromes but the onset seems to be more related to intensity of activity rather than duration. Neural entrapments can feel like stress fractures but have less consistent symptoms.
Arterial entrapment will give a lack of pulses at onset which does not occur with chronic exercise induced compartment syndromes. The symptoms of neural entrapment can be reproduced by palpation or percussion of the affected nerve.
Physiotherapy is the best initial treatment however surgery may be required.
MUSCLE AND TENDON STRAINS
The posterioral tibialis muscle is the most common strain in the shin. This muscle acts to control pronation in a similar way that the anterior compartment muscles control ankle motion. The peroneal muscles on the outside of leg, control supination of the foot (roll out), to prevent ankle inversion sprains. Peroneal muscles may also be strained. Pain is usually related to activity and may last for a long time after a run. Pain may occur during other activities of daily living.
Damage may just be normal delayed onset muscle soreness (DOMS) caused by unaccustomed activity or it may be more severe rupture of muscle or tendon. More commonly there was a traumatic event that occurred to cause the injury.
Treatment requires rest and icing for 72 hours. Massage, stretching or heat during this time will make the injury significantly worse. After the 72 hours then a gradual return to activity with massage, stretching and continued icing should see most strains resolve within a week. If the tendon was damaged, or if it was a chronic strain, then a much longer rehab period will be needed.
From these brief descriptions of some of the more common injuries you can see how important correct diagnosis and treatment can affect the outcome and subsequent return to exercise. Incorrect diagnosis can prolong the healing period and can also lead to further injury and increased delay in return to activity.
Steve Manning is the owner and CEO of the intraining Running Centre and works as a podiatrist at the intraining Running Injury Clinic in Milton.
If you have shin soreness and want to get back out and running as soon as possible, visit the intraining Running Injury Clinic. Our podiatry and physiotherapy are all runners and understand how important it is to correctly diagnose and treat your injury to ensure you can return, pain free, to running as quickly as possible.
For bookings, please call us at the intraining Running Injury Clinic on 3367 3088, or book online.