Background Shin pain is a common complaint among running athletes
and can be caused by bony, muscular, vascular or neural
Objective This article discusses the likely causes, assessment and
management of shin pain in athletes presenting in the
general practice setting.
Discussion Accurate diagnosis is important as treatment differs
depending on the cause. The characteristics of the pain and
examination findings after exercise give strong clues to the
diagnosis; further investigation may be unnecessary. Bony
stress reactions and fractures are the most common cause
of shin pain; patients describe a ‘jarring’ sensation along the
bone margin with heel strike. Other causes include recurrent
exertional compartment syndrome (RECS), tenosynovitis,
neurological entrapment and rarely, vascular entrapment.
Symptoms of vascular entrapment may be similar to RECS
and this may cause diagnostic confusion. Increased bone
stress in athletes is largely due to inappropriate training
program design and can usually be alleviated by reducing
impact loading until pain resolves.
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