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Shin Splints
What they are and how to treat them

Lower leg pain is a common complaint in active people, especially those involved in activities that require running and jumping. Injuries usually involve the lower leg bones (the tibia and fibula) and muscles surrounding these bones. Often any pain in the lower leg is described as shin splints, though the causes may vary.

Stress fractures

One of the most common causes of lower leg pain is a stress fracture of the tibia or fibula. Softening of the bone occurs when the bone is stressed repeatedly, faster than it can rebuild. The most common location for stress fractures of the tibia is at the inner and lower part of the bone. (The tibia, the larger bone in the lower leg, is your ‘shin bone.’)

Symptoms: Stress fractures usually happen during activities like running, jumping or dancing. Localized pain usually becomes progressively worse in the tibia or fibula. Often, someone experiencing symptoms has suddenly increased the intensity or amount of training. Pain may be felt at night. Ultrasound treatment by a physiotherapist may make symptoms worse. Rest or a change to non-weight bearing activity usually relieves the pain.

Diagnosis: A bone scan is the best way to diagnose a stress fracture. Plain x-ray of the tibia or fibula is not as useful, as stress fractures in bones frequently appear normal.

Treatment: The main way to treat stress fractures is by changing activity and avoiding all activities causing symptoms until you are pain-free for at least two weeks. Cross training may be done with non-weight bearing activities. Stationary biking, elliptical machine or swimming are all examples. Weight training may also be done as long as it does not produce symptoms.

Typically it takes about six to eight weeks from the time when painful activities stop for stress fractures to heal. After being pain-free for at least two weeks, gradual return to activity can begin. For instance, a walk-run program is a good way to ease back into training. If possible, have a qualified person review your program to ensure training is not excessive. Wearing appropriate footwear is also important.

Chronic exertional compartment syndrome

Another common cause of lower leg pain in athletes is Chronic Exertional Compartment Syndrome (CECS). Each muscle in the lower leg is individually wrapped in a sheet of fibrous tissue called fascia. Loss of flexibility of this fascia impairs the blood flow into and out of the muscle during exercise, which leads to the symptoms of CECS.

Symptoms: As with stress fractures, CECS often occurs in sports such as running, jumping or dancing. Usually, pressure-like pain in the muscles of the front and side of the lower leg gets progressively worse. Pain eventually stops the activity. Symptoms usually improve once activity stops, but will get worse again if activity is resumed immediately. As well, the top of the foot may feel numb. In severe cases, muscles may even feel weak when lifting the toes up to prevent the foot from dropping.

Diagnosis: The best way to confirm CECS is by measuring pressure in the affected muscle right after exercising. If your doctor cannot do this test, you could be referred to an orthopedic surgeon or sport medicine doctor.

Treatment: Managing CECS often involves either stopping the activity entirely or stopping just before the point of causing symptoms. Do other activities that do not involve continuous running or jumping. If you cannot avoid the activity causing the problem, the most reliable treatment is a fasciotomy. An orthopedic surgeon will cut along the length of the fascia surrounding the affected muscle. This allows muscles to swell normally during activity.

Lower leg pain is common in many sport activities. Stress fractures and CECS are often the cause. Other, less common causes of lower leg pain include trapped nerves or blood vessels. Properly diagnosing the cause of the pain is important so that appropriate treatment can be recommended.