Shin Pain

Shin Pain & Shin Injuries Explained

Shin pain can be caused by a number of conditions or injuries and be sudden onset or more likely occur gradually over time. The most common pain on the inside of the shin is known as shin splints which is a general term to describe pain on the inside of the shin of which there can be a number of causes. Pain can also occur on the outside of the shin.

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Gradual onset shin pain

Most shin injuries appear gradually over a period of time, starting out as a niggle which becomes gradually worse. Pain can be located on the inside or outside of the shin.

Pain on the inside of the thin:

Shin splints

Shin splints are the most common cause of shin pain but, although the term is widely used, it is not a specific injury, more a term to describe pain of which there are a number of causes. It is used to describe general pain at the front of the lower leg, which can have several different specific causes. Medial tibial stress syndrome is the most common injury linked to shin splints. Symptoms include shin pain on the lower inside area along the bone which may feel tender to touch with swelling, lumps and bumps felt. Read more on:

Stress fractures of the tibia

Tibia stress fractures have symptoms similar to medial tibial stress syndrome with long term gradual onset pain on the inside lower part of the shin. The shin may also feel tender to touch and show swelling. An Xray may not show up a stress fracture until it has started to heal so they can be difficult to diagnose. Long term rest of a few weeks is often indicated if shin splints type pain persists.

Pain on the outside of the shin:

Anterior compartment syndrome

A compartment syndrome occurs when the muscle swells up within its surrounding sheath causing increased pressure and pain. With gradual onset or chronic shin pain on the outside of the leg the large tibialis anterior muscles increases from training and overuse. It will probably be difficult to lift up the foot. When the athlete exercises, it fills with blood and expands causing pain. With rest the pain eases only to return again when normal training resumes. Treatment may involve longer term rest, biomechanical analysis, taping, or in some cases surgery is required to release the sheath allowing the muscle to expand.

Acute shin pain (sudden onset)

Although less common, shin pain can be acute or sudden onset, usually from a direct impact. Bruising of the bone and muscle contusions are most common and should be treated with rest and cold therapy. If a severe contusion occurs, particularly to the large tibialis anterior muscle on the outside of the shin then an acute compartment syndrome may occur.

Acute anterior compartment syndrome

As well as appearing gradually through overuse, a compartment syndrome can be caused by a direct impact or contusion. Bleeding of the muscle within the sheath occurs causing increased pressure and pain which can be severe. If pain becomes progressively worse and an acute compartment syndrome is suspected then seek medical attention immediately as long term damage can result.

Lower leg fractures

Tibia fractures and fibula fractures can occur after an acute trauma or impact. The lower leg is a common area for fractures and can often be broken in contact sports like rugby. A broken leg can take a while to heal, depending on where the fracture is and how clean the break is.

Less common causes of shin pain

DVT (Deep Vein Thrombosis) is a blood clot in a vein that is commonly seen in the calf muscle, particularly following surgery and long-haul flights. Symptoms include constant pain and tenderness at a point deep in the muscle. It essential this is correctly diagnosed as should the blood clot come loose, for example with massage, then it could find its way into the heart and cause death.

Popliteal artery entrapment is also more likely to appear as calf pain. However, pain may be felt on the outside of the shin in the anterior compartment or the big muscle on the outside of the shin.

There may be a referred pain, where a problem or injury elsewhere causes pain in the shin. It can occur from the spine, from the ankle joint, from a cyst on the knee cartilage or from a Baker's cyst. A Bakers cyst is a swelling behind the knee and, although this can cause pain down into the shin, it is not particularly common.

Osgood Schlatter's disease is a painful injury of the knee affecting children between the ages of 8 and 15 years old. Pain is felt on the bumpy bit at the top of the shin but may radiate down.

Pes anserine bursitis is inflammation of a bursa or sack of fluid on the inside of the knee. Pain is more usually felt on the inside of the knee rather than the shin.

Other less common causes of shin pain in the athlete include Femoral endarteritis, Atherosclerotic disease, Proximal tibiofibular subluxation, and dehydration resulting in cramp.

The following conditions are very rarely seen as a cause of shin pain, however, a doctor or professional practitioner should be aware of them, particularly if shin pain is persistent or not responding to conventional treatments. These include syphilis, sickle-cell anemia, hyperparathyroidism, sarcoidosis, rickets, Paget's disease of the bone and erythema nodosum.

Important not to be missed causes of shin pain

Tumors of bone and soft tissue are rare but most likely occur in athletes in their 20's and 30's. Osteosarcomata can occur in the ends of the long bones particularly of the lower leg causing joint pain.

Infections such as osteomyelitis or cellulitis may cause pain. The condition can be classed as acute, sub-acute or chronic depending on the time frame between the initial infection or injury and the bone infection developing. This can be two months or more in chronic cases.

Immediate first aid

Shin pain should be treated using the P.R.I.C.E. principle (protection, rest, ice, compression & elevation).

Protection- Prevent the shin from suffering from further damage. Stop training or playing immediately and apply a cold therapy and compression wrap.

Rest - Rest is important and vital for recovery. Try to reduce the demands of your daily activity and stop doing any sports that exacerbate the pain. An athlete must know when to stop training and allow the injured area to heal otherwise repetitive minor injuries can often result in a more severe injury that keeps the athlete out for much longer.

Ice - Apply ice or cold therapy to the painful area of the shin to help reduce the symptoms of pain and any inflammation. Apply for 10 minutes every hour initially for the first 24 to 48 hours, reducing frequency to 3 or 4 times a day as symptoms improve. Do not apply ice directly to the skin as it may burn. Either wrap ice in a wet tea towel or use a commercially available cold pack.

Compression - The use of a compression support or compression bandages on the lower leg can can help reduce swelling.

Elevation -  Elevating the lower leg above heart level whenever possible to help reduce swelling due to the effects of gravity.

Read more on PRICE principles