Front (Anterior or Shin Pain)
The injuries listed below are common causes of pain in the front of the lower leg. All conditions that cause pain in this area tend to be grouped together under the common term ‘shin splints’.
Anterior Compartment Syndrome
This condition involves the compartment of muscles in the front of the low leg. These muscles are encased in a thick, rigid layer of tissue. Compartment syndromes occur as a result of a buildup of pressure within this compartment that affects muscle, nerve and artery function.
This problem may occur as a result of a blow to the leg, muscle rupture, overuse, poor warm-up or too much muscle training. Anterior compartment syndrome results in pain which builds up with training until it is impossible to continue, weakness with pulling the foot upwards, a tight calf and pins and needles or numbness extending down in to the space between the big toe and second toe. Pain may decrease with rest, ice and elevation, depending on severity
Tibialis Anterior Syndrome
This problem occurs due to overloading of the tibialis anterior muscle causing inflammation of the tendon and its surrounding soft tissue. Overloading may occur due to excessive running or jumping on a hard surface, during tennis or squash for example. Pain is felt low down on the front of the leg and may extend upwards or down into the foot. Pain may increase when bending the foot upwards at the ankle. Swelling and tenderness may also be felt low down on the front of the shin. It is also common to feel or hear a ‘creaking’ sensation when moving the foot up and down.
Tibial Stress Fracture
Tibial stress fractures are common in all sports that involve running. People who present with stress fractures commonly report a recent increase in training or a recent change of equipment or training techniques. If there is repetitive trauma to the tibia, due to these reasons, the bone is unable to repair itself and inflammation sets in, weakening the bone. Symptoms include a gradual onset of shin pain, which worsens with exercise. Pain will also commonly increase overnight. The bone will be tender to touch on the inside border of the shin and there may be local swelling. Pain may decrease with rest and ice.
This injury is common in sports involving running such as athletics, football and following exercise.
Early Injury Management
For approximately the first 72 hours following an injury, the RICE regime should be followed to ensure control of inflammation and pain relief.
R - Rest
I – Ice
C - Compression
E – Elevation
Rest from aggravating activity.
Ice should be applied in the first 72 hours or when inflammation persists. Ice should be applied for 15 to 20 minutes at a time. Ice should not be applied directly to the skin, but through a wet towel or cloth.
Compression can be achieved with an elastic bandage.
Elevation is used to help swelling to return to the heart through the blood stream.
The injured area should be elevated above the level of the heart.
Strengthening programs should only be commenced when:
- The injury is not painful to touch.
- The injury is not painful in the morning.
- The injury is not painful to stretch.
- The injury is not painful with light to moderate exercise.
Exercises should be 3 sets of 8-12 repetitions.
- Stretches to be held for three sets of 20 to 30 seconds
- A light warm-up such as walking, exercise bike, or range of movement exercises (moving the joint through a gentle, comfortable range) for five to ten minutes, should be undergone before stretching
- Stretches should be held just at the first point of tension.
- Stretching should be slow and gentle and no excessive tension or discomfort should be felt during stretching.
- Stretches can be done to help treat an injury but should also be done before and after exercise.