Shin Pain in Sport | Sydney Sports Medicine Centre - Education

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Shin Pain in Sport: Many Possible Causes

by Dr Scott Burne

Athletes with repetitive heavy landings, (e.g. runners, basketball, triathletes) are prone to chronic shin pain. Many will be troubled for months by pain that affects training ability and may lead to time off sport. In elite competition even Olympic or World Championship selection can be affected.

The key presenting feature is shin/calf pain. Musculoskeletal diagnoses are usually either: chronic periostitis, stress fracture, and compartment syndrome; these are in separate anatomical areas and present with overlapping, but different, clinical features. All usually have an insidious, slow onset. Other less common causes include vascular, referred pain or local bone pathology.

Periostitis (most so-called “shin splints”), cases have diffuse pain on inner lower leg (tibia) border. Typically pain on warm-up, improving with activity, and noticeable on warm-down is typical. Palpation reveals tenderness over 5-15cm, and the diagnosis is clinical. Ice/anti-inflammatories often help symptoms, but do not resolve the condition.

Stress fracture cases have pain, worsening with activity, often noticeable at night. Hopping will often reproduce pain. Tender- ness is more focal. Diagnosis is via bone scan, aided by CT.

Chronic exertional compartment syndrome presents with “crescendo” (builds up) pain in the front (anterior) muscles of the shin or the back of the calf (posterior). Often a tightness accompanies pain. The athlete will sometimes notice sensory changes such as paraesthesia and/or numbness, suggestive of nerve compression. Diagnosis is via a compartment pressure test (which can be done at SSMC). Surgery is indicated in persistent cases.

Biomechanical assessment is of utmost importance. Usually it will be appropriate for the athlete to undertake a physiotherapy opinion with recommendations for detected abnormalities. Podiatry is also often utilised to assess and treat foot mechanics, if this is considered a risk factor for further pain.

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