Shin Pain and Shin Splints Causes, Symptoms and Treatment

The term shin pain and shin splints are often used interchangeably with a preference for the term shin splints to describe any pain at the front of the lower leg. However, shin splint is a distinct problem and the most common cause of shin pain. It is associated with excessive force on the shinbone due to physical activities like running and is therefore more common in athletes. Therefore not every case of shin pain is due to shin splints.

What is the shinbone?

The correct anatomical term for the shinbone is the tibia. It is the  larger of the two bones that make up the lower leg – the area between the knee and ankle. The other smaller bone of the lower leg is the fibula. The tibia is also called the shankbone, although this term is usually reserved for four-legged mammals. The part of the shinbone that can be felt through the skin at the front of the lower leg is the anterior border of the shaft of the tibia. It is known for its strength, being strong enough to bear several times the body weight, which is necessary to withstand the force of running.

What is shin pain?

Shin pain is any pain felt on the front of leg most notably on and around the shinbone (tibia). Although the most common cause of shin pain is shin splints, there is a difference between these two terms. Shin pain in a symptom – pain at at specific location. Shin splints are an inflammatory reaction of the deep tissue that attaches to the tibia and may also be accompanied by stress fractures. Shin splints also presents with pain.

Shin pain meaning

Shin pain may be pain originating from the shinbone (tibia) itself but could also be due to the surrounding structures – skin, connective tissue, muscles, tendons, blood vessels, lymphatics or nerves. Pain is a symptom of injury to tissue, whether from trauma, infection, compression or reduced oxygen supply. However, the problem may not always exist in and around the shin or even the lower leg. Sometimes, with causes affecting blood vessels and nerves, the problem may be exist higher up or even lower down the body – the low back, pelvis, thigh or even foot. The pain in the shin may be indicative of where the tissue injury is occurring, despite the cause being elsewhere, or it may be radiating pain or referred pain.

Shin pain symptoms

Shin pain is a symptom – pain of the shinbone or the tissue around it. It may be accompanied by other symptoms like :

• swelling of the lower leg
• redness
• heat
• tenderness
• bruising
• discoloration of the skin
• ulcers on the leg
• episodes of leg numbness or tingling
• muscle spasms

Sometimes shin pain can occur on its own with no other concomitant symptoms.

What are shin splints?

Shin splints is medically known as medial tibial stress syndrome.  It actually refers to injury caused by activities that place great stress on the shinbone  and the surrounding muscles and tendons. Sometimes these activities may cause stress fractures and therefore shin splints may also include these injuries.

Shin splints causes

Running and sprinting are the main causes of shin splints It usually arises with running up an incline, downhill or running with poorly fitting footwear that increases stress on the lower leg. It may also be seen with stop and start running or sprinting as is seen in certain sports. Shin splints can arise with vigorous walking but is usually associated with activities such as hiking

Shin splint symptoms

Shin splints have more definitive symptoms. The most prominent of these symptoms is lower leg pain  isolated within a narrow long area of the leg There are broadly two types of shin splints based on the distribution :

• anterolateral shin splint where the pain is felt on the front outer part of the lower leg
• posteromedial shin splint where is felt to the inner part of the lower leg towards the back of the leg

Initially the pain is only present during the causative activity but subsides with rest. Subsequently the pain persists even after activity and for longer periods thereafter. There may be some swelling although it is usually not extremely prominent in mild cases. The pain in shin splints is usually a dull ache and does not tend to discourage a person from continuing activity. As the condition worsens the pain can become excruciating prompting a person to stop the physical activity immediately and even avoid future workouts.

Shin pain causes

Injuries causing shin pain

• Trauma is a common cause of shin pain. It may arise with :
  • Falls, particularly when falling while climbing up a flight of stairs.
  • Accidental kick during sporting activities.
  • Assault.
  • Car accidents where the dashboard collapses against the lower leg, especially on front impact collisions.
• Shin splints
• Stress fractures are tiny cracks that arise in the tibia due to excessive and prolonged high impact physical activity.

Nerve problems causing shin pain

Peripheral neuropathy which is any disease, injury or damage to the nerves in the lower leg or supplying the lower leg. This may arise with :

• Diabetes mellitus (diabetic neuropathy).
• HIV/AIDS.
• Pinched nerve (nerve root compression).
• Chronic alcoholism.
• Trauma to the nerves.
• Heavy metal poisoning.

Circulation problems causing shin pain

Poor circulation may be adue to reduced blood supply to the leg via the arteries (peripheral arterial disease) or inadequate drainage of the leg via the veins (venous insufficiency of the legs). Blood clots may arise in the arteries or veins when these problems exist. These clots, known as thrombi, tend to cause pain of the lower limb more prominently in the calf but can also occur in the shin. Some circulatory problems may lead to the formation of painful ulcers on the shin.

Infections causing shin pain

An infection of the lower leg may involve the skin (impetigo), tissue just under the skin (cellulitis) or bone (osteomyelitis). It more often arises after severe injury to the leg or as is the case with diabetes mellitus or peripheral arterial disease, even after minor injuries to the leg.

Shin pain treatment

A thorough medical history, findings upon physical examination and investigations such as an x-ray or Doppler ultrasound will aid in diagnosing the cause of shin pain. The subsequent treatment of shin pain depends on the cause and may vary significantly. The key for treating and managing the common causes of shin pain like shin splints and stress fractures is rest and immobilizing the leg in a slight elevation. Ice can also be useful in reducing swelling and non-steroidal anti-inflammatory drugs (NSAIDs) may be prescribed for the inflammation. The bone and soft tissue need to gradually heal over a period of time.