Sports injuries

January/February 2010

FocusSports injuries

Shin pain in athletes

Assessment and management

Volume 39, No.1, January/February 2010 Pages 24-29

Paul Blackman


Shin pain is a common complaint among running athletes and can be caused by bony, muscular, vascular or neural pathology.


This article discusses the likely causes, assessment and management of shin pain in athletes presenting in the general practice setting.


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.

Shin pain is a common complaint among running athletes. Patients often say they are suffering from ‘shin splints’, however these words simply describe the pain and do not represent a specific diagnosis. The characteristics of the pain and examination findings after exercise generally give strong clues to the diagnosis without the need for further investigation. Table 1 shows the common, less common, and rare causes of shin splints in athletes.

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