Shin pain: when should you seek medical advice?

Brodie Sharpe

Shin pain is a common complaint for runners and medial tibial stress syndrome AKA ‘Shin Splints’ is often the go-to self-diagnosis. This is often followed-up by researching shin splint treatment and asking for advice from other runners. But there are potentially other causes for shin pain which could become worse when applying standard shin splint treatment methods. So, I thought it was important to write on this topic explaining other potential causes and the different presentations for each. However, I highly recommend seeking a clinical diagnosis from an experienced health professional.

Shin splints

This pain is on the inner border of the shin bone following a line often greater than 5cm. In the early phases there will be a ‘warm-up effect’ with symptoms subsiding during the run followed by worsening pain the following day.

Delayed onset muscle soreness (DOMS)

It is rare for DOMS to occur in the shins but will arise the day after intense exercise. This will be located in the muscle at the front of the shin and will be tender to touch. Symptoms will subside within 24-48 hours & for more information on DOMS you can read my previous blog understanding good pain & bad pain for runners.

Stress Fractures

Stress fractures in follow a history of sudden training loads or general health flags which impact bone health. For example RED-S signs and symptoms. In the early stages of the pathology symptoms will increase steadily throughout a run & settle quickly after. Pain is described as an ache around the bone. As the pathology progresses pain is more local on the shin and will include swelling, redness and night pain. For more information have a read of my stress fracture blog.

Compartment syndrome

Like stress fractures, this will get worse throughout a run but over a shorter period of time (often within the first 15 mins). Most cases will settle quickly if the warm-up is adequate or activity ceases. In severe cases, neurological symptoms such as pins and needles, numbness and foot drop might occur which are not present in stress fractures. Tom Goom has a great blog on compartment syndrome which you can read here.

Thrombosis conditions

More often felt in the calf muscle but thrombosis symptoms can cause an ache in the inside of the shin region. These conditions are due to a blockage in the arteries such as DVT. There might be a history of bed rest or long flights. Pain is triggered under less strenuous circumstances such as walking and may also present as obvious swelling/redness. This is a serious medical emergency and an assessment is required ASAP.

The treatment for each of these conditions is extremely different and often unhelpful if mis-diagnosed. If you are unsure or not responding to your current treatment, a second opinion is recommended.

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