'Secrets' Behind Shin Pain
Laurier's Athletic Therapy Club Newsletter

Friday, March 9, 2007 - Posted by Jen Childs

Shin splints is a term that may be used by the lay person to describe any continual pain in the lower leg. However, there is controversy in sports medicine literature about what the term “shin splints” includes. With the advent of imaging technologies such as a bone scan and MRI, we are now able to make a more precise anatomical and pathological diagnosis of patients with shin pain.

In order to fully understand what is involved in shin conditions, a brief review of the anatomy of the lower leg is required. The lower leg contains two major bones, the tibia and the fibula which are connected by an interosseous membrane. The fibula functions mainly as a site for muscle attachment whereas the tibia is the primary weight-bearing bone. The muscles of the lower leg are divided into four compartments and separated by thick inelastic connective tissue.

Exercise induced lower leg pain can be caused by a variety of mechanisms and often occurs due to a sudden increase in physical training such as the beginning of a new workout program. A primary cause of shin pain is abnormal biomechanics. A person having flat feet may be more predisposed to overpronation or rolling in of the foot. The foot may be unstable during the push-off phase of walking which forces the muscles of the lower leg to be overworked.

A stress fracture is defined as a fine hairline fracture that appears without evidence of soft tissue injury occurring from micro trauma. The affected bone is tender and sharp localized pain is experienced. Stress fractures often do not appear on x-ray and are better diagnosed using a bone scan. Daily activities such as walking can cause pain. Pain may be constant and intensified with exercise, especially in activities with a considerable amount of running and jumping. Treatment of a stress fracture depends on the severity and location of the fracture, but rest from impact activities is necessary.

Another possible condition causing lower leg pain is periostitis. This condition refers to tearing and inflammation of the periosteum (covering of the bone). Pain is usually present along the lower aspect of the inside of the shin. This is often diagnosed using a bone scan. This type of pain generally improves as the muscles warm up but will slowly return after exercise. Pain can be reproduced by a therapist testing specific muscles in the lower leg. Treatment focuses on stretching the two largest muscles in the back of the leg (gastrocnemius and soleus) as well as decreasing impact. An assessment of a person’s foot including mechanics and footwear is also important.

Compartment syndrome is a shin condition where overuse may inflame the muscles and increase pressure in a compartment of the leg. It is thought that inflammation many cause the connective tissue to become even more inelastic, so when a person exercises the muscles cannot expand properly and results in increased pressure. The compartment pressure cuts off the blood supply to the muscles which inhibits proper muscle function.

When experiencing shin pain that does not resolve, it is important to consult a health care professional. The history and physical examination of a person is crucial in the process of correct diagnosis as it can be difficult to isolate the exact origin of lower leg pain. For example, women may be more predisposed to stress fractures if they have a history of disordered eating or amenorrhea (absent menstruation). The most important part of the patient history is the connection between exercise and pain. In order to correctly treat lower leg pain, therapists must strive to obtain information that is focused on the cause of the problem and not simply the symptom of pain.

This article briefly summarizes three possible conditions that cause shin pain bearing in mind that there are many more possibilities. It is important to remember to treat the cause of pain not just the symptoms. Mechanisms of injury may be fairly similar which may make for a difficult diagnosis, however, a comprehensive patient history and examination including the exercise-pain relationship in shin conditions will allow a health care practitioner to make a diagnosis and implant a therapeutic plan.

Written by: Emily Brouwer

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