Most runners and walkers have, at some point, been warned
about getting the dreaded ‘shin splints’. While it’s a widely
known term, it can actually refer to a variety of different
conditions, each of which requires a different treatment or
approach to help heal.
In most cases these conditions can easily be told apart with a
careful history and physical examination, without needing any
additional diagnostic imaging. The most common of these
conditions are as follows:
Medial Tibial Stress Syndrome
This is what most people would refer to as the classic shin splints. It is usually felt as a diffuse
ache along the inside edge of the shin that warms up during activity and is often sore again
afterwards. It is common in runners who have increased their training load, changed running
surfaces, or have weak calf and hip muscles. It usually responds well to load management,
strengthening, and a gradual return to running.
Tibial Stress Fracture
A stress fracture tends to cause a sharper, more localised pain over a specific point on the
bone, which can be present at rest and gradually worsens over time. It is important to pick up
early, as it needs a period of reduced impact and sometimes imaging to confirm. Continuing to
run on it can make the injury worse.
Tendinopathy of the Shin Muscles
Tendinopathy causes pain along the front or inside of the shin that is usually felt as the foot
moves. It is common in hikers, newer runners, or people whose footwear or training surface has
recently changed. It tends to respond well to a progressive tendon loading program.
Chronic Exertional Compartment Syndrome
This is a less common cause. The pain builds up predictably during exercise, often with a
feeling of tightness or pressure, and settles within a few minutes of stopping. Some people also
notice numbness, foot drop, or weakness while running. Diagnosis usually involves specialist
testing.
Nerve Irritation
Sometimes shin pain is referred from the lower back or comes from irritation of a local nerve.
Pins and needles, numbness, or a burning quality are common clues.
How Can Physiotherapy Help?
Each of these conditions requires a different treatment approach, some are much more serious
than others. Your physiotherapist will conduct a thorough assessment to identify the most likely
cause of your shin pain and the factors contributing to it. In many cases the diagnosis is clear at
the first visit, and a realistic plan to get you back to running or walking can be built from there.
None of the information in this newsletter is a replacement for proper medical advice. Always
see a medical professional for advice on your individual injury.