Dr Natasha Beach: Shin pain is definitely not ‘shin splints’

Shin pain is one of the most common conditions a Sports Doctor will see – particularly during the spring and summer months when runners increase their mileage in the better weather or team sports return to training on harder ground. But what are the different medical conditions that cause it, why does it happen and how do you work out what is causing the pain? Dr Natasha Beach investigates.

Female runner with knee or shin pain

Why does shin pain happen?

Like most things there is rarely one single factor leading to pain developing.

Some of the most common triggers include:

  • Increasingly mileage or over training
  • Hill running
  • Running on a camber or on a hard surface
  • Shoes past their use-by date or without the right support for your foot type
  • Muscle imbalances/tightness
  • Stiff ankle/knee joints
  • Hypermobility
  • Low bone density

What are ‘shin splints’?

‘Shin splints’ is not a diagnosis – it’s a description commonly used to describe the feeling of pain at the front of the shin. Investigations are needed to work out what the specific cause of the pain is.

MTSS/Bone Bruising/Stress Fractures

MTSS, (or Medial Tibial Stress Syndrome to use its full title) results in the feeling of pain in the lower part of the inside of tibia which is thought to be as a result of overloading this area of the leg.

Further loading (e.g. continuing running) can lead to the development of bone bruising and if this continues a stress fracture can form.

What about radicular and referred pain?

While pain may be felt in the shin, it could be coming from elsewhere. For example, a number of different nerves within the lower back can each cause pain within the shin if they are trapped or restricted (this is known as radicular pain) and this isn’t always associated with back pain.

Equally the way the body is wired can sometimes lead to confusing messages, with pain being felt in the shin which is actually coming from somewhere else such as the knee or the ankle.

How is the diagnosis made?

This depends on the diagnosis and the reasons behind it developing in the first place. Generally, patients are referred for a period of rehab with a physiotherapist or osteopath with an interest in lower leg injuries. A review from a podiatrist may also be recommended and this could result in a change in trainers or the addition of orthotics.

Those with stress fractures will likely be placed in a boot and or crutches to allow the fracture time to heal, and this will be accompanied by additional tests to look at bone density (DEXA scan) and bloods tests too look for contributing factors. Also, for some people, a review by a dietician may be useful to optimise the patients diet for an optimum recovery.

Will pain return?

For the majority of people, the pain should slowly disappear during the rehab process, however some people may notice a reoccurrence in ether leg in the future. In this instance the patient should be re-reviewed to identify the trigger so that the symptoms can be dealt with quickly.

Find out more

To find out more about shin pain, contact Dr Natasha Beach (Sports Medicine and MSK Consultant) by filling out the form to make an appointment.

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Written by Dr Natasha Beach

Dr Natasha Beach is a Consultant in Sports and Musculoskeletal Medicine at OneWelbeck Orthopaedics who also specialises in Paediatric injuries.