Shin pain in runners can be a disabling condition and difficult to accurately diagnose because of the variety of disorders which present with similar symptoms. Often it is initially just labeled shin splints but it can be caused by stress fractures to the tibia and fibula, medial tibial stress syndrome, and compartment syndrome. Ensuring an accurate diagnosis is important because the management of these different conditions varies significantly.
Stress fractures to the tibia and fibula generally occur in athletes who have made sudden changes to their training routine – a rapid increase in volume or intensity, changes to their running surface or wearing different footwear. These athletes will present with focal tenderness over the bone and attempting to hop on the injured leg will provoke pain. With this type of injury the pain worsens as they continue to run. Treatment consists of a strict period of rest from running for 6-8 weeks and may involve a period of non-weightbearing and a longer recovery period if the stress fracture is particularly bad.
Medial tibial stress syndrome (MTSS) is a condition in which the tibialis posterior muscle tractions on the medial (inner) border of the tibia causing irritation to the periosteum of the bone. Unlike a stress fracture there is no ‘damage’ to the normal architecture of the bone however the symptoms can present very similarly. Usually with MTSS the athlete will experience pain at the start of their runs but find that as they continue running the pain lessens. However the pain will often return soon after the run is completed.
Compartment syndrome is a condition in which the pressure in the muscles increases to extreme levels cutting off blood flow to the affected muscles and nerves. This leads to extreme tightening and pain in the area. Classically with compartment syndrome the runner’s symptoms are ok at the start of exercise but progressively deteriorate as they continue to the point where they are forced to stop.
Physiotherapy can be extremely beneficial for people dealing with shin pain. Importantly, physiotherapists are trained to differentiate between the different causes of pain allowing for an accurate diagnosis and correct management to be started immediately.
Physio treatment provides pain relief through manual therapy, taping and appropriate casting if required. We will also advise you on what activities are suitable and safe for you to complete while recovering from injury. It is also very important to diagnose why your shin pain came on in the first place, and a Running Gait Assessment is ideal for this. It is specifically designed to check for problems in running technique as well as your overall strength and stability, and allows effective programs to be implemented to ensure you return to running with a lower injury risk. This can include progressing to our RunRight coaching program or joining our Runfit.