What are the symptoms?
Shin splints are typified by persistent leg pain, usually the inside of the shin, halfway down the lower leg. The pain might be felt during exercise or directly after. Some people experience a dull ache over their shin that lasts for quite a while after exercise stops, while for others the pain may be sharp and fade quickly. The pain is often progressive, becoming worse with shorter distances. Eventually, shin splints can severely impact activity levels as the pain becomes too severe to continue exercising.

Shin splints can be extremely painful and very disruptive to activity levels. As the pain usually starts gradually and progresses many people find themselves unable to continue training. Shin splints may progress to stress fractures if not diagnosed early and managed effectively.

How does it happen?
Shin splints are predominantly seen in runners who increase their distances quickly, often while training for an event. Activities that require repetitive weight-bearing of any kind, such as marching or high impact sports have also been shown to cause shin splints. Although the pathology of shin splints is unclear, studies have been able to identify certain risk factors that may predispose someone to shin splints. These include...

· An quick increase in activity level;
· Improper footwear and support;
· Higher BMI;
· Training on hard or uneven surfaces;
· Tight calf muscles;
· Flat feet;
· Increased external rotation range of the hips;
· Females are more likely to develop shin splints than males;
· Prior history of shin splints.


How can physiotherapy help?
The first step for your physiotherapist will be to address any contributing factors to your injury and help to adapt your training program to a level that is optimum for you. A period of relative rest may be recommended along with a targeted strengthening and stretching program for any weak or tight muscles.

​Switching to low-impact activities such as swimming, cycling and yoga may also help to maintain fitness during recovery. Your running technique may be analyzed and any training errors corrected. When getting back into your training routine, it is usually recommended that distances are not increased by more than 10% per week as this allows the tissues of the body to react to the increased demands and adapt accordingly. ​

What is a stress fracture?

A stress fracture is a microscopic fracture of the bone that is often not picked up on X-ray. If left untreated, a stress fracture can cause significant disability and develop into a full fracture, possibly even requiring surgery.
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The majority of stress fractures occur in the lower limb, being particularly common in the hip, shins and foot at points where the most force passes through when weight bearing. Most stress fractures are overuse injuries and are common in long distance runners.

What are the symptoms?

As with many overuse injuries, the pain of a stress fracture starts gradually, beginning with pain during or after activity or sometimes the morning after. If activity continues without modification, the pain will gradually increase. Eventually most people are unable to maintain their usual activity level. Stress fractures are common in runners and military personnel who are required to march for long periods. A stress fracture will be more likely to occur in a person who has weaker bone strength, such as someone with osteoporosis, which is itself affected by many factors such as adequate calcium intake, vitamin D deficiency and a history of inactivity.

How are stress fractures treated and how long will it take to get better?

Stress fractures can easily be mistaken for other conditions such as shin splints. As the fracture is often too small to show up on X-ray, definitive diagnosis can be made using MRI, CT or bone scan.

After diagnosis, the most important part of treatment will be resting the area to allow the bone to heal before resuming activity. Stress fractures usually need at least 6 weeks to recover fully. Some areas of the body have poor blood supply, which makes healing more complicated.  For example, stress fractures of the navicular bone of the foot may need to be kept still and placed in a boot or cast for a period of time to heal properly.

Other aspects of treatment will involve correcting any factors that contributed to the original injury. There is some evidence that unsupportive footwear is a risk factor, along with poor biomechanics and weak muscles that provide inadequate support to the skeletal system during activity. Speak to your physiotherapist if you suspect you may have a stress fracture or if you want to know more.