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Shin pain is a type of pain that occurs at the front of the lower leg at the shin bone. You may experience shin pain when walking although you may also experience shin pain at rest. The pain can be split into two categories.
The first condition is called is shin splints, although in the medical profession it is sometimes referred to as medial tibial stress syndrome (MTSS). The second cause of shin pain is called compartment syndrome.
Shin splint pain is concentrated in the lower leg between the knee and ankle. The condition mostly affects those people who engage in a strenuous sporting activity, such as tennis or football. The pain can be intense, so you may have to stop doing the activity that caused it.
Compartment syndrome is a painful condition in part of the lower leg called a muscle compartment. The muscle compartment is the tissue that surrounds each group of muscles in the arms and legs, along with nearby blood vessels and nerves. This tissue is called fascia. Compartment syndrome occurs when there is bleeding or swelling within this bundle of muscles.
There are two types of compartment syndrome. Acute compartment syndrome is the sudden onset of shin pain, while chronic exertional compartment syndrome is brought about by repetitive strain the legs.
Shin pain resulting from MTSS and shin pain resulting compartment syndrome may have very different rehabilitation exercises prescribed due to the different nature of the condition and underlying biomechanical causes.
In some cases of MTSS-related shin pain there may be some underlying metabolic issue which may contribute to the tibial stress response. Similarly, if the symptoms are indicative of compartment syndrome, in rare cases there may be a structural problem to the soft tissue compartment housing the muscle groups.
The most common cause of shin splints is too much stress on the leg. Because shin splints is a cumulative stress disorder, repeated stress on the lower legs prevents the body from being able to naturally repair itself.
Typical causes of shin splints include:
- Exercise after a period of not being active
- Shin pain from running or jumping on a hard surface
- Poor running style or technique
The excessive stress causes the muscles to swell, which puts more pressure on the bone. This leads to inflammation and pain.
Shin pain caused by compartment syndrome is also typically caused by exercise. It occurs when the muscle compartment pressure increases. This can restrict the blood flow to the lower leg, damaging the muscles and any nerves. Diagnosis of compartment syndrome is a common occurrence in runners, football players and skiers.
The most common symptom of shin pain is pain in the lower leg. This can be felt as a dull ache in the front of the shinbone. If you are suffering with shin splints, you may also experience the following shin splint symptoms:
- Pain in the lower leg that develops during exercise
- Pain on either side of the shinbone
- Pain in the muscles of the lower leg
- A mild swelling in the lower leg
- A numb sensation in the feet
If you have compartment syndrome, you may experience:
Shin splints treatments
Although the shinbone (tibia) is good at withstanding vertical forces, it is thought that shin splints are the result of excessive rotational forces. The treatment for shin splints from running will, therefore, involve a period of rest or reduced activity level followed by a course of physiotherapy.
Stopping exercising should, however, be only a temporary measure. Rehabilitation will address the strengthening of the muscles with the aim of resisting this rotation of the lower leg. Primarily these muscles are located around the hip and ankle and foot with the muscles around the knee primarily able to flex and extend the knee only.
Early stage hip rotational strengthening exercises around the hip may involve clam exercises, which involve rotating the top knee away from the floor in a side-lying position. These may be progressed to performing this rotational movement against resistance band.
Further shin splint stretches may include pelvic bridging, squatting or lunging exercises with a resistance band around one or both knees.
The main force to stabilise the ankle and foot against excessive rotation (over pronation) is the tibialis posterior muscle and tendon.
A variety of shin splint exercises exist but early stage exercises will often involve inverting the foot inwards into a ball or against resistance band. These exercises may be progressed to heel raising exercises squeezing a ball between to the heels.
Compartment syndrome treatments
Rehabilitation exercises for compartment syndrome will be focused on a gradually introducing more difficult strengthening exercises to the shin muscles.
Early in the rehabilitation process this may involve lifting the foot and toes against a resistance band. This may be progressed to lifting the foot and toes against gravity while sitting. More advanced level exercises may involve foot and toe lift in standing or heel walking to build endurance.
Throughout the rehabilitation process a physiotherapist may also work on releasing tight areas of the compartment with soft tissue techniques as well as advise self-applied soft tissue release exercises as part of a home exercise routine. This may involve using a massage ball or foam roller over the shin muscles.
To ensure steady progress, clients suffering with compartment syndrome may be monitored with strength and endurance tests by a physiotherapist.
Balance and proprioceptive exercises for shin pain
Once significant strength and stability has been built up in the rotational stability muscles of the lower limb and flexibility has improved, a physiotherapist will introduce further challenges to the program.
These balance-related exercises are also referred to as proprioceptive exercises. The exercises place the joints and muscles of the lower limb into a correct alignment and work on functional movements that challenge the balance of the stabilising muscles. This may help to prevent shin splints.
Common examples may be to place the client in a single leg stance position on a balance board or cushion and produce single leg squat movements or striding movements while maintaining pelvic stability.
In later stages of the shin pain rehabilitation process, these may be progressed to lumping and landing on stable and progressed to unstable surfaces focusing on the alignment of the hip, knee and ankle.
