By: Lori Morris-Platte, ATC

Lower leg pain is a common complaint among athletes, especially as they transition to a new sports season. The change in playing surfaces, movement patterns and training can result in shin pain. This is common in activities such as track & field, basketball, soccer, field hockey and dance.

But, how can you tell if the pain is caused by common shin splints or by a more serious injury, like a stress fracture?

Medically, shin splints are diagnosed as medial tibial stress syndrome, which describes the location of the signs and symptoms. Shin splints usually involve pain at the front of the lower leg along the inside edge of the shinbone, or tibia. This pain is often described as achy tightness, which improves after warm up and in regular activity such as walking or light jogging. This condition can be caused by a sudden increase in activity, increased intensity of training or by improper foot support from the athlete’s shoes. The overuse or overstressing of the muscles surrounding the tibia causes inflammation and pain. As the stress to these muscles continues, the pain becomes more frequent and can begin to affect the athlete’s ability to perform their activity.

Stress fractures are small fractures that begin as a result of excessive repetitive stress on a bone. If the muscles of the lower leg are not strong enough to absorb the force placed on the leg during activity, the stress transfers to the bone. This can cause the bone tissue to thin out faster than it can lay down new cells, resulting in small fractures. The most common site of stress fractures in the lower leg is in the tibia. The main symptom of a stress fracture is localized pain in a small area of the bone that is very tender to touch. Research shows that females are more likely to suffer stress fractures than males, and they are especially common in individuals who increase activity or intensity levels suddenly, and those who run more than 25 miles per week.

What should you do if you suspect you have either condition? First, see a medical professional to properly diagnose and treat your injury. The athletic trainer at your school or your physician can best determine the diagnosis. An X-ray, MRI or bone scan may be needed to identify a stress fracture.

The treatment for both is similar:

• Stop all running activities temporarily to rest the injured area. With shin splints this may last from a few days to a week. In the case of stress fracture, you will need to rest for several weeks to several months, depending on the severity of injury and speed of healing.
• Cross-training activities, such as biking and swimming, are usually allowed during the rest period.
• Use ice and anti-inflammatory medications as prescribed.
• Stretch and strengthen the surrounding muscles of the lower leg.
• Select quality shoes with the appropriate support for your foot structure and the activity in which you are participating.
• Maintain a healthy diet, including appropriate levels of vitamin D and calcium.
• Once cleared to return to activity, gradually increase the length and intensity of your training by less than 10% per week to prevent recurrence of the injury.
• Be sure to continue to cross-train and get adequate rest between workouts.

Shin pain can simply be an annoyance at the beginning of the sports season, but if left untreated it can become an injury that will sideline you for some time. Be sure to see your school’s athletic trainer or your pediatrician for any suspected injury.

About CHKD Sports Medicine

CHKD's sports medicine program offers the most comprehensive care for your young athlete. From diagnosis and treatment to customized rehabilitation plans, we specialize in physical therapy and injury prevention programs for active children and teens. Our team is composed of pediatric orthopedic surgeons, sports medicine specialists, physician assistants, certified athletic trainers and pediatric sports medicine physical therapists.