A general term to describe pain in the front of the legs, or shins caused by exercise. The pain can be felt, usually in both shins after strenuous exercise, particularly running and sports with sudden stops and starts, such as basketball, tennis, squash and badminton. It is important to rest and seek help, as continuing running and putting force through the legs can make the pain or injury worse.
Symptoms: Pain along the tibia, or shin bone, the larger bone in the lower leg that runs down the inner part of your shin. Initially the pain is dull and aching and can become extremely painful if ignored, especially if you continue to exercise. It can become so painful that you may need to totally stop exercising. The pain can be a symptom of injury to the bone or soft tissue surrounding the shin, so it is extremely important to take it seriously not to run through the pain.
Causes: Running on hard surfaces or slopes. Wearing unsuitable shoes that are worn out, don’t fit well or do not have enough support or cushioning. Weak ankles, tight calf muscles or tight Achilles tendon, which joins the calf muscle (gastrocnemius) to the heel. Over-pronation, where the foot rolls inwards, creating extra pressure in the lower legs. Being overweight also puts extra pressure on the legs.
The main cause is medial tibial stress syndrome (MTSS), resulting from intense exercise that the body is not accustomed to; as well as stop start sports, long distance running or increasing the distance or pace of running can place considerable stress on the legs and can injure the bone and surrounding tissue. The layer of connective tissue surrounding the bone, the periosteum can become inflamed. The pain can take weeks to subside after stopping the exercise.
Diagnosis: Consult your doctor if the pain is severe, the shins are hot and inflamed, if the swelling gets worse or you still feel the pain when resting. The doctor may investigate other causes such as a nerve problem from your back, a bulging muscle, a swollen muscle that is compressing nerves and blood vessels (compartment syndrome), stress fractures in the shin bone or reduced blood flow to the legs, especially in smokers.
Treatment: Your doctor may recommend rest from exercise for at least two weeks, pain relief medication, ice packs and stretching or you may be referred to a physiotherapist, a sports therapist or an orthopaedic surgeon, depending on the results of the diagnosis.
Prevention: Wear appropriate running shoes with support and cushioning. Avoid training on hard surfaces. Build up training levels gradually. Improve overall flexibility and strength; learn pre-exercise warmup and post exercise stretching. Wear orthotics (insoles) where appropriate, particularly for over-pronation problems.
Osteopathic/Manual Management: Take a detailed case history to understand the nature of the problem and surrounding issues. Examine the lower, leg, foot and all surrounding tissues; muscles, ligaments, nerves, fascia, etc., for movement, strength and functionality and assess nerve pathways. Perform orthopaedic and neurological tests and determine the root cause. Treat to improve strength, functionality and movement and reduce tension, inflammation, pain and swelling. Advice regarding training regimes, rehabilitation exercises, rest, suitable exercises during rest and recovery, stretching, orthotics. Treatment may include manipulation, deep soft tissue massage, trigger point therapy, muscle energy techniques, fascial techniques, dry needling, etc.
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