Common reasons for shin pain are:
- Shin Splints
- Stress Fracture of the Tibia
- Stress Fractures of the Fibula
- Chronic Compartment Syndrome
Shin Splints - The term 'shin splints' has been used to describe pain along the inside border of the shin commonly experienced by runners. It is necessary to make a precise pathological diagnosis and therefore the term 'shin splints' should be avoided.
Shin pain generally involves one or more of three pathological processes:
1. Bone Stress – a continuum of increased bone damage exists from bone strain to stress reaction to stress fracture.
2. Inflammation – inflammation develops at the insertion of muscles and fascia to the inside border of the tibia ( shin bone).
3. Raised Intracompartment Pressure – the lower leg has a number of muscle compartments each enveloped by fascia. These muscle compartments may become swollen and painful as a result of overuse or inflammation.
One of the major causes of all three injuries is abnormal biomechanics.
Stress Fracture of the Tibia
Stress fracture of the tibia causes a gradual onset of shin pain aggravated by exercise. Pain may occur with walking, at rest or even at night. The patient with 'shin splints' as it was known but is now more accurately referred to as inflammatory shin pain or traction periostitis complains of various symptoms. Pain along the inside border of the shin, which usually decreases with warming up. The patient can often complete a training session but pain gradually recurs after exercise and is worse the following morning. Initial treatment is to reduce inflammation. Podiatric assessment and advice regarding stretching and training are also important components of the management of this condition. The most effective definitive treatment involves a deep physiotherapeutic massage therapy.
Stress Fractures of the Fibula
Stress fractures of the fibula can cause shin pain. These can be caused by muscle traction and torsional forces placed through the bone. This injury is often associated with biomechanical abnormality. It is treated with rest from activity until the tenderness settles and then with a graduated exercise programme. Soft tissue abnormalities should also be corrected.
Chronic Compartment Syndrome
Chronic compartment syndromes are a common cause of shin pain. The exact cause of these conditions is still unclear. It may be due to overuse; an inflammatory process is established that leads to fibrosis and reduced elasticity of the fascia surrounding the muscle compartments. As a result, when the patient exercises, the muscles attempt to expand but are unable to do so. This results in increased pressure and therefore pain. Treatment consists initially of a conservative regimen of decreased exercise and deep massage therapy and assessment and correction of any biomechanical abnormalities. Surgery is indicated if this treatment fails.
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