Shin Splints Symptoms & Assessment

Shin pain symptoms can often be very similar for a number of different causes. Our quick guide below outlines in simple terms the more common symptoms.

Symptoms of shin splints are usually described as gradual onset pain or soreness on the inside of the shin bone or tibia. Medial tibial stress syndrome is the injury most commonly referred to as shin splints, however, other injuries including a stress fracture of the tibia, chronic compartment syndrome and popliteal artery entrapment should also be considered.

Is it medial tibial stress syndrome?

Symptoms of medial tibial stress syndrome consist of pain felt along the inside and back of the shin bone (shin bone pain) which can vary in intensity. Pain decreases when warmed up but is worse during impact such as jumping or running and is often worse after exercise and first in the morning. Tenderness will be felt when pressing in along the inside of the shin bone where lumps and bumps may also be felt from bone growth. Athletes with shin pain may have flat feet or over pronating feet.

Is it a stress fracture

Symptoms of a tibia stress fracture are similar to medial tibial stress syndrome, however, pain is acute or sharp and along the inside of the shin bone and stays the same or gets worse with exercise. Again it will be very tender when pressing in along the inside of the shin bone.

Is it chronic compartment syndrome?

A compartment syndrome occurs when the muscle becomes too large for the sheath that surrounds it causing increased pressure and pain. Typically symptoms will not include pain at rest. An aching type pain gradually gets worse with exercise. Pain comes on at a specific point into a run and is relieved with rest. There will be little or no tenderness at rest, unless it affects the large muscle on the outside of the shin (tibialis anterior compartment syndrome).

Is it popliteal artery entrapment?

Symptoms of popliteal artery entrapment consist of pain mostly in the calf muscles at the back of the shin bone. The pain gets worse with exercise, especially going up on your toes or jumping. The athletes pulse is diminished when plantar flexing the foot (pointing the foot downwards).

Assessing shin pain

Assessment of any injury should include questions concerning the patients general health, previous injuries and current injury. The aim of these questions is to determine what may be causing the pain and obtain a correct diagnosis. The therapist will then physically assess the ankle and lower leg using a variety of methods, including:

Observation - The therapist may look at the lower leg, paying particular attention to the position and movement of the foot. Having fallen arches, overpronating or oversupinating are common contributors to developing shin splints.

Palpation - The therapist will palpate, or feel, the muscles of the shin. In cases of shin splints the muscle just to the inside of the shin bone (tibia) will be tender to touch. The therapist may also feel that this area feels quite lumpy.

Ankle range of motion - The therapist will look at the range of motion at the ankle joint. They will usually get the patient to move the ankle through all of its movements by themselves before asking the patient to relax, allowing the therapist to move the ankle. In shin splints, there may be pain when the therapist pushes the foot down (stretching the shin muscles) and when the patient actively points the toes up. Dorsiflexion (pointing the toes to the ceiling) will often be limited, indicating tight calf muscles.

The therapist should also look at the position of your feet, looking for overpronation or oversupination. They may do this in standing, walking or even running. There are numerous other tests and assessments that the therapist may choose to perform, these are the most commonly used in cases of suspected shin splints.

Other conditions which must be ruled out when assessing suspected shin splints include stress fractures and anterior and posterior compartment syndromes.

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