Shin pain (often referred to as shin splints), is most commonly experienced by runners. Shin pain can come on due to a bone stress, inflammation at the muscle insertion into the tibia or compartment syndrome. Shin pain most commonly occurs secondary to abnormal biomechanics, either a very rigid foot or excessive pronation (flat feet), or due to tight calf muscles.
Stress fractures often occur in those with a rigid, high arched foot (causing poor shock absorption) or a very flat foot (causing muscle fatigue). This places stress through the bone and subsequently a stress fracture may occur. Other factors such as poor diet, excessive impact training, weight loss and the menstrual cycle can contribute to the occurrence of a stress fracture. Pain from a stess response or fracture is often worst at night and first thing in the morning, very tender to palpate and worse with impact activity, such as hopping and running.
Medial Tibial Stress Syndrome
Inflammatory shin pain, known as medial tibial stress syndrome, occurs when inflammation is present along the insertional point of muscle into the tibia, normally at the medial border (inner border). Pain is normally worst in the morning or after exercise, but normally decreases as the muscles warm up. There is normally tenderness along the inner border of the tibia.
Muscles of the shin are contained in different sections (compartments), surrounded by thick fibrous tissue called fascia. When a muscle is overworked, it can swell, causing excessive pressure in that particular compartment. This can impede blood flow, leading to the development of compartment syndrome. Compartment syndrome is worst with increased exercise and usually ceases with rest. There may sometimes be associated pins and needles/numbness into the toes. There is usually minimal tenderness on palpation.
Treatment of shin pain initially includes soft tissue release of tight muscles, dry needling plus, ice therapy and sometimes taping. Rest from the particular aggravating activity is also required. A biomechanical assessment with a podiatrist is also important in determining the cause of injury. If the shin pain is not responding to treatment, pressure testing and scans may be performed. In worst cases, surgery is carried out to release tight compartments.
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