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Shin Bone Pain

  • Method Health
  • Dec 6, 2024
  • 6 min read

  • Clues or common symptoms? 

    • When someone thinks they have “Shin splints,” they refer to either: 

      • 1) Shin bone pain (the medical term is medial tibial stress syndrome) = Pain around a broad area of the shin bone (tibia) that is a length greater than 5 cm between the ankle and below the knee (see images below) that increases with running, hopping, or jumping. Symptoms might reduce after beginning activity and then can be sore again post-activity. The big conditions with similar presenting symptoms to not miss are shin bone stress fractures (pin-point pain or pain less than 5 cm section of sore bone that usually doesn't reduce after beginning activity). 

      • Or 2) Shin muscle pain, with symptoms perceived as “tight” or “throbbing and full” during exertion in the region of the large tibialis anterior muscle that attaches to the front of the shin (see images below).

    • Imaging is unnecessary for diagnosing each type of shin pain, even if we suspect a stress fracture. Imaging results do not help predict recovery time. Shin bone pain is not due to structural bone changes consistently seen on medical imaging. Be skeptical of any theories you hear blaming “micro-damage” for pain.

    • Both bone and muscle pain usually develop without a trauma event. Another condition that similarly presents itself to be ruled out with a good physiotherapy assessment is compartment syndrome or tendon pain of a local muscle or a blood vessel condition typically affecting the whole lower limb. A palpable mass, swelling, and redness are unusual for shin pain.


Shinbone pain= Location of common symptoms of shin-bone pain or medial tibial stress syndrome (MTSS).


The left image depicts the absence of muscles from commonly painful bone sites around the back of the shin bone. The right image shows the location of the tibialis anterior, where shin muscle pain can be perceived.


  • How common is it? Shin pain affects 30% of those participating in running-based sports/activities. 


  • What is wrong? 

    • Most of the time, a rapid progression of lower limb impact activities “too much too soon” during running or running sports has made the length of your tibial bone or shin muscle irritable, like a headache rather then “damaged.” 

    • You may have a reduced ability to tolerate bone  or muscle strain or to recover from increased exertion due to periods of high mental stress, worsened sleep, or persistently low food intake. 

    • No muscle attaches to the area of common bone pain (see image above), so direct muscle weakness of any lower limb muscle cannot be attributed to shin bone pain.  


  • Why me? What can I do about it? 

    • Educate yourself on the condition by asking us for validated, up-to-date information (unfortunately, lots of unhelpful physio fluff is out there). 

    • The best management for shin muscle or bone pain is usually a short reduction of activity, especially if your symptoms are really intense. This is followed by the initiation of a gradually progressive lower leg training program, including the “impact” exercises you want to tolerate more. 

      • For example, if running is the cause of symptoms, management might start with a 2-6 week deload, followed by a symptom-guided progressive running program. Your weekly running volume could be increased by 1-5% every 1 to 2 weeks when symptoms in the shin tolerate your current dosage where symptoms are minimal throughout each session. An intentional increase in running cadence, starting with 10%, lowers peak stress on the shin and might be helpful for some to tolerate impact for short periods as well. Progress volume as long as symptoms of bone pain stay minimal. Start with a dosage of exercise that is primarily pain-free or elicits very minimal symptoms or awareness along the shin. Progress dosage monthly as long as symptoms stay nil to minimal. 

    • To emphasis, what is unique for shin bone pain compared to other painful conditions is that pushing through tolerable pain is not recommended and we encourage ceasing exercise for that session. Exertion with tolerable symptoms is is safe for shin muscle pain. 

    • Pain-free cross-training (swimming, rowing) and non-painful strength and conditioning work can be helpful for those with highly severe symptoms who want to keep up their fitness.

    • The typical broad presentation of shin pain is unlikely to progress to a bone stress fracture, which many are concerned about. In contrast, a stress fracture presents differently and should be managed differently than general shin bone pain. A tibial stress fracture, if suspected, is managed initially with a 2-6 week period (depending on your severity and individual risk factors for poor bone injury recovery) of non-weight bearing or walking with crutches, while lifestyle risk factors are identified and managed. Then, a progressive exercise program is initiated, to return to valued activities.

    • While exercise gradually progresses across months, overall bone health management should be optimised like improving your nutrition and sleep habits. 

    • Some people might benefit from adding lower leg exercises, especially to the calf muscles, to improve tolerance to the activities impacted by shin pain. This might indirectly help the shin bone tolerate your impact activity. 

    • Trialing heel taping and changing footwear or orthotics can be helpful for some people if they wish (self-taping or off-the-shelf orthotics are just as good as anything fancier). No type of shoe will help everyone with shin pain, despite advertisements. Other “quick fixes” or “shortcuts” will likely be costly and unhelpful for shin pain. Surgery is hardly ever suggested for shin pain. 


    • Busting Myths?

    • How long will it take? If you are optimistic, have clear expectations and education about what shin pain means (avoiding large changes in bone pain during training), and follow realistic, up-to-date advice, many can feel much better before or after three months. Sometimes, it takes more than 12 months to feel better, especially if you have taken more time off sports. Just optimistically, keep doing the things we suggest that are helpful for your bone health, like improving your general health through ensuring high sleep quality and dosage and eating enough high-quality food to support your regular bone strength-promoting activities. 


      What can Physio or Ex Phys at MH offer? 

      • We can offer individual advice to help tailor a bone health exercise program at a specific dosage you can tolerate and help guide you to a realistic progression plan each week. We can also give you individual advice about leg strength exercises to add to your weekly routine to support your lower limb's tolerance to impact activities affected by shin pain. 

      • We can help with taping, orthotic, and footwear choices if you think these will be helpful.  

      • We can be your support crew to encourage lifestyle changes that can improve your general health, such as coaching you on sleep, guiding you through ways to reduce mental stress, or adding things to your life to better cope with stress. 

      • Suppose you have had persistent shin pain and are very confused about why you still have it. In that case, we can help you make sense of the pain, highlight management areas to prioritise or be more optimistic about, and give you individual guidance to assist in managing and resolving your shin pain. 


Resources:



Diagnostic pathway for shin pain.

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