Shin Splints & Lower Leg Pain

Shin pains are common in runners and they’re often referred to as ‘shin splints’. This is a very general term - there are several different conditions that can cause this type of pain, and knowing which one you’re suffering from is important for getting the right treatment.

Below we’ve outlined some of the main conditions that cause lower leg pain. If you think you might be suffering from one of these, make an appointment to see a doctor or sports injury specialist.

Medial Tibial Stress Syndrome (MTSS)

What are the symptoms?

Shin pain is brought on by running and may take hours, even days, to ease up. There is tenderness around the lower two quarters of the inner tibia.

What causes it?

MTSS is often associated with over pronation (this means the way your foot strikes the ground when you run doesn’t allow shock to be absorbed properly). The condition is also linked to running on hard surfaces, or running in worn out shoes.

How’s it treated?

Treatment involves taking a rest from running, but you can keep up your cardiovascular fitness by cycling or swimming instead.

You may need some physiotherapy to improve the strength and flexibility of your calf, Achilles tendon and ankle. You’ll also need to review your training programme to spot anything that could be making the condition worse.

What else should I be aware of?

Before diagnosing MTSS, your doctor or physiotherapist might arrange for you to have an x-ray or bone scan to rule out a stress fracture.

Tibial stress fracture

What are the symptoms?

Like MTSS, runners suffer pain after running, but with a stress fracture the pain gets worse and lasts longer with each run. The runner may also suffer from a sharp, rising pain when they’re in bed at night, and have tenderness over an area of their tibia.

What causes it?

Stress fractures are caused by repetitive strain and overworking the bones. They’re more common in women and are often associated with overtraining, low body weight, osteoporosis and amenorrhea (lack of periods).

How’s it treated?

An x-ray or bone scan will show the fracture, and you’ll need to rest from running for 6 to 8 weeks. Your return to running should be gradual, starting with short distances and alternating running sessions with low impact exercise. Again, you’ll need to look at your training programme and make any necessary changes to your workouts.

What else should I be aware of?

All fractures are different and take different lengths of time to heal for each individual. In the most extreme cases, runners may need to rest completely and wear a plaster cast for a while.

Chronic Compartment Syndrome (CSS)

What are the symptoms?

A pain in the lower leg muscles whilst running. The pains eases with rest and might feel like a cramp, tightening or burning sensation.

What causes it?

CSS can be caused by your leg muscles increasing in size and becoming too big for the tissues which surround them. These tissues (fascia) aren’t flexible enough to cope with the increase in size, causing pressure, nerve damage and reduced blood flow in the muscles.

Like MTSS, CSS is also associated with over pronation.

How’s it treated?

On examination, a doctor or sports injury specialist might not be able to find anything wrong with you because CSS only occurs during exercise. They may need to do some tests while you’re running to diagnose the condition.

Rest will ease the pain but if it returns when your start training again, surgery may be required. The procedure is called fasciotomy - it simply opens up the fascia to relieve the pressure.

What else should I be aware of?

Chronic Compartment Syndrome shouldn’t be confused with Acute Compartment Syndrome – a much more serious condition which occurs after surgery or an injury and requires immediate attention.

Other injuries and conditions

Here are some other conditions that can cause shin and lower leg pain - remember it’s always best to see your doctor if you’re concerned.

Calf sprain

A tear in the calf muscles is a common sporting injury and is best prevented by warming up thoroughly before exercise.

If you suffer a sprain, apply ice wrapped in a towel to ease the pain. Resting your leg, keeping it elevated and physiotherapy will also help.

Referred back pain

Sometimes lower back pain can be felt in the legs and mistaken for a running injury.

Nerve compression

A trapped nerve of artery around the back of the knee can also cause leg pain.