Skip to main content

Shin Pain

  • Chapter
  • First Online:
The Sports Medicine Physician

Abstract

“Shin” (leg) pain, “shin splints,” and medial tibial stress syndrome, are general terms used to describe pain and lower leg discomfort. It could affect recreational and professional athletes indistinctly, mainly distance runners, athletes of endurance sports, dancers, and the military, confirming that higher physical demands (overload) are closely related to this injury.

Although shin pain has been described as an exercise-related problem, i.e., overuse injury, it has a broad differential diagnosis, and soft tissue inflammation (tendons, muscle, and fascia), exertional compartment syndrome, vascular deficiency, medial tibial stress syndrome, and stress fracture should be carefully investigated. This chapter aims to discuss athletes’ complaints, the influence of the intensity of sports training overload), and physical and radiological assessment of different clinical problems related to shin pain.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Vajapey S, Miller T. Evaluation, diagnosis, and treatment of chronic exertional compartment syndrome: a review of current literature. Phys SportsMed. 2017;45:391–8.

    Article  Google Scholar 

  2. Flick D, Flick R. Chronic exertional compartment syndrome testing. Curr Sports Med Rep. 2015;14:380–5.

    Article  Google Scholar 

  3. Bloomfield J, Polman R, O’Donoghue P. Physical demands of different positions in premier league soccer. J Sports Sci Med. 2007;1:63–70.

    Google Scholar 

  4. Heiderscheit BC, Chumanov ES, Michalski MP, Wille CM, Ryan MB. Effects of step rate manipulation on joint mechanics during running. Med Sci Sports Exerc. 2011;43(2):296–302.

    Article  Google Scholar 

  5. Gabbett TJ. Quantifying the physical demands of collision sports: does microsensor technology measure what it claims to measure? J Strength Cond Res. 2013;27(8):2319–22.

    Article  Google Scholar 

  6. Read D, Weaving D, Phibbs P, Darrall-Jones J, Roe G, Weakley J, Hendricks S, Till K, Jones B. Movement and physical demands of school and university rugby union match-play in England. BMJ Open Sport Exerc Med. 2017;2(1):e000147.

    Article  Google Scholar 

  7. Brewer RB, Gregory AJ. Chronic lower leg pain in athletes: a guide for the differential diagnosis, evaluation, and treatment. Sports Health. 2012;4(2):121–7.

    Article  Google Scholar 

  8. Burrus MT, Werner BC, Starman JS, Gwathmey FW, Carson EW, Wilder RP, Diduch DR. Chronic leg pain in athletes. Am J Sports Med. 2015;43(6):1538–47.

    Article  Google Scholar 

  9. Franklyn M, Oakes B. Aetiology and mechanisms of injury in medial tibial stress syndrome: current and future developments. World J Orthop. 2015;6(8):577–89.

    Article  Google Scholar 

  10. Craig DI. Current developments concerning medial tibial stress syndrome. Phys Sportsmed. 2009;37(4):39–44.

    Article  Google Scholar 

  11. Becker J, Nakajima M, Wu WFW. Factors contributing to medial tibial stress syndrome in runners: a prospective study. Med Sci Sports Exerc. 2018;50(10):2092–100.

    Article  Google Scholar 

  12. Warden SJ, Burr DB, Brukner PD. Stress fractures: pathophysiology, epidemiology, and risk factors. Curr Osteoporos Rep. 2006;4(3):103–9.

    Article  Google Scholar 

  13. Paik RS, Pepples D, Hutchinson MR. Chronic exertional compartment syndrome. BMJ. 2013;346(7896):35–7.

    Google Scholar 

  14. Dunn JC, Waterman BR. Chronic exertional compartment syndrome of the leg in the military. Clin Sports Med. 2014;33(4):693–705.

    Article  Google Scholar 

  15. Wilder RP, Sethi S. Overuse injuries: tendinopathies, stress fractures, compartment syndrome, and shin splints. Clin Sports Med. 2004;23(1):55–81, vi.

    Article  Google Scholar 

  16. Ringhof S, Stein T. Biomechanical assessment of dynamic balance: specificity of different balance tests. Hum Mov Sci. 2018;58:140–7.

    Article  Google Scholar 

  17. Thacker SB, Gilchrist J, Stroup DF, Kimsey CD. The prevention of shin splints in sports: a systematic review of literature. Med Sci Sports Exerc. 2002;34:32–40.

    Article  Google Scholar 

  18. Lieberman DE, Venkadesan M, Werbel WA, et al. Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature. 2010;463:531–5.

    Article  CAS  Google Scholar 

  19. Kortebein PM, Kaufman KR, Basford JR, Stuart MJ. Medial tibial stress syndrome. Med Sci Sports Exerc. 2000;32(3 Suppl):S27–33.

    CAS  PubMed  Google Scholar 

  20. Edwards PH Jr, Wright ML, Hartman JF. A practical approach for the differential diagnosis of chronic leg pain in the athlete. Am J Sports Med. 2005;33(8):1241–9.

    Article  Google Scholar 

  21. Doral MN, Alam M, Bozkurt M, Turhan E, Atay OA, Dönmez G, Maffulli N. Functional anatomy of the Achilles tendon. Knee Surg Sports Traumatol Arthrosc. 2010;18(5):638–43.

    Article  Google Scholar 

  22. Longo UG, Ronga M, Maffulli N. Achilles tendinopathy. Sports Med Arthrosc Rev. 2018;26(1):16–30.

    Article  Google Scholar 

  23. Magnan B, Bondi M, Pierantoni S, Samaila E. The pathogenesis of Achilles tendinopathy: a systematic review. Foot Ankle Surg. 2014;20(3):154–9.

    Article  Google Scholar 

  24. Rompe JD, Furia J, Maffulli N. Eccentric loading versus eccentric loading plus shock-wave treatment for midportion Achilles tendinopathy: a randomized controlled trial. Am J Sports Med. 2009;37(3):463–70.

    Article  Google Scholar 

  25. Espinosa N, Maurer MA. Stage I and II posterior tibial tendon dysfunction: return to running? Clin Sports Med. 2015;34(4):761–8.

    Article  Google Scholar 

  26. Alvarez RG, Marini A, Schmitt C, et al. Stage I and II posterior tibial tendo dysfunction by a structured nonoperative management protocol: an orthosis and exercise program. Foot Ankle Int. 2006;27(1):2–8.

    Article  Google Scholar 

  27. Kulig K, Burnfield JM, Reischl S, et al. Effect of foot orthoses on tibialis posterior activation in persons with pes planus. Med Sci Sports Exerc. 2005;37(1):24–9.

    Article  Google Scholar 

  28. Steb HS, Marzano R. Conservative management of posterior tibial tendon dysfunction, subtalar joint complex, and pes planus deformity. Clin Podiatr Med Surg. 1999;16(3):439–51.

    CAS  PubMed  Google Scholar 

  29. Roster B, Michelier P, Giza E. Peroneal tendon disorders. Clin Sports Med. 2015;34(4):625–41.

    Article  Google Scholar 

  30. Espinosa N, Maurer MA. Peroneal tendon dislocation. Eur J Trauma Emerg Surg. 2015;41(6):631–7.

    Article  CAS  Google Scholar 

  31. Taljanovic MS, Alcala JN, Gimber LH, Rieke JD, Chilvers MM, Latt LD. High-resolution US and MR imaging of peroneal tendon injuries. Radiographics. 2015;35(1):179–99.

    Article  Google Scholar 

  32. George C, Hutchinson M. Chronic exertional compartment syndrome. Clin Sports Med. 2012;31:307–19.

    Article  Google Scholar 

  33. Rajasekaran S, Hall M. Nonoperative management of chronic exertional compartment syndrome. Curr Sports Med Rep. 2016;15:191–8.

    Article  Google Scholar 

  34. Edmundsson D, Toolanen G, Thornell LE, et al. Evidence for low muscle capillary supply as a pathogenic factor in chronic compartment syndrome. Scand J Med Sci Sports. 2010;20(6):805–13.

    Article  CAS  Google Scholar 

  35. Winkes M, Scheltinga M. Chronic exertional compartment syndrome of the deep posterior lower leg. Br J Sports Med. 2018;52(19):1279–80.

    Article  Google Scholar 

  36. Pedowitz RA, Hargens AR, Mubarak SJ, et al. Modified criteria for the objective diagnosis of chronic compartment syndrome of the leg. Am J Sports Med. 1990;18:35–40.

    Article  CAS  Google Scholar 

  37. Schepsis AA, Fitzgerald M, Nicoletta R. Revision surgery for exertional anterior compartment syndrome of the lower leg: technique, findings, and results. Am J Sports Med. 2005;33:1040–7.

    Article  Google Scholar 

  38. Fouasson-Chailloux A, Menu P, Allorent J, Dauty M. Determination of the predictive clinical parameters to diagnose chronic exertional compartment syndrome. Eur J Sport Sci. 2017;18:279–85.

    Article  Google Scholar 

  39. Carneiro Júnior FCF, Carrijo ENDA, Araújo ST, Nakano LCU, de Amorim JE, Cacione DG. Popliteal artery entrapment syndrome: a case report and review of the literature. Am J Case Rep. 2018;19:29–34.. Review.

    Article  Google Scholar 

  40. Gaunder C, McKinney B, Rivera J. Popliteal artery entrapment or chronic Exertional compartment syndrome? Case Rep Med. 2017;2017:1–5.

    Article  Google Scholar 

  41. Elias DA, White LM, Rubenstein JD, Christakis M, Merchant N. Clinical evaluation and MR imaging features of popliteal artery entrapment and cystic adventitial disease. AJR Am J Roentgenol. 2003;180(3):627–32.

    Article  CAS  Google Scholar 

  42. Newman P, Witchalls J, Waddington G, Adams R. Risk factors associated with medial tibial stress syndrome in runners: a systematic review and meta-analysis. Open Access J Sports Med. 2013;4:229–41.

    Article  Google Scholar 

  43. Moen MH, Tol JL, Weir A, Steunebrink M, De Winter TC. Medial tibial stress syndrome: a critical review. Sports Med. 2009;39(7):523–46.

    Article  Google Scholar 

  44. Gaeta M, Minutoli F, Scribano E, Ascenti G, Vinci S, Bruschetta D, et al. CT and MR imaging findings in athletes with early tibial stress injuries: comparison with bone scintigraphy findings and emphasis on cortical abnormalities. Radiology. 2005;235(2):553.

    Article  Google Scholar 

  45. Gaeta M, Minutoli F, Vinci S, Salamone I, D’Andrea L, Bitto L, et al. High-resolution CT grading of tibial stress reactions in distance runners. AJR Am J Roentgenol. 2006;187(3):789–93.

    Article  Google Scholar 

  46. Anderson MW, Ugalde V, Batt M, Gacayan J. Shin splints: MR appearance in a preliminary study. Radiology. 1997;204(1):177–80.

    Article  CAS  Google Scholar 

  47. Fredericson M, Bergman AG, Hoffman KL, Dillingham MS. Tibial stress reaction in runners. Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Am J Sports Med. 1995;23(4):472–81.

    Article  CAS  Google Scholar 

  48. Kijowski R, Choi J, Shinki K, Del Rio AM, De Smet A. Validation of MRI classification system for tibial stress injuries. AJR Am J Roentgenol. 2012;198(4):878–84.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sérgio Rocha Piedade .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 ISAKOS

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Piedade, S.R., Mendes, L.A., Carvalho, L.M., dos Santos, R.M.F., Marques, L.C., Ferreira, D.M. (2019). Shin Pain. In: Rocha Piedade, S., Imhoff, A., Clatworthy, M., Cohen, M., Espregueira-Mendes, J. (eds) The Sports Medicine Physician. Springer, Cham. https://doi.org/10.1007/978-3-030-10433-7_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-10433-7_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-10432-0

  • Online ISBN: 978-3-030-10433-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics