Differential Diagnosis
It is very important in diagnosing shin splints to make sure that you are actually dealing with shin splints and not a stress fracture or a case of compartment syndrome.
Stress Fractures
The question you should ask yourself when you feel shin pain from running is, “Am I feeling shin pain from shin splints or is something else going on?” This may not be an easy question to answer.
In the initial stage of shin splints pain often reduces in intensity after the first few kilometers into a run. In contrast, the pain from a stress fracture tends to build up gradually during running, often beginning as an annoying irritation and becoming unbearable as the run continues. In the early stages of shin splints there is often a clear differentiation. The problem lies in that the pain in later stages of shin splints could be so severe and continuous that it would be impossible to determine if a stress fracture is the actual injury. That is why professional advice should be obtained early on.
There are several tests that a sports practitioner can perform which will help to differentiate which condition you are dealing with. Unfortunately, routine X-rays will probably not be one of those tests. X-rays are often of little value in detecting a stress fracture. A much better test is a bone scan (or MRI) which is much more sensitive in detecting these fractures.
From a symptomatic perspective there are some clues that often present themselves upon physical examination that indicate you many have a stress fracture. For example, with a stress fracture there is often a specific point of tenderness on the shins (tibia) rather than a more diffuse region of pain as felt with shin splints.
Compartment Syndrome
Another condition that must be ruled out is compartment syndrome (CS). The muscles of our legs are divided into rigid compartments. These compartments are bound by strong fibrous tissue (deep fascia), and bones.
The anterior compartment contains some very important structures. It contains the dorsi flexors, the muscles directly linked to shin splints.
Anterior compartment Contains:
· Dorsiflexion muscles of the ankle and foot
CS occurs when the pressure inside these compartments increases to the point where it interferes with the blood supply to your muscles and nerves. This can occur when the muscle inside the compartment becomes too large, increasing the pressure. CS can also occur from trauma, bleeding, swelling, overuse or even excessive medication.
In a case of anterior compartment syndrome, a runner may experience sharp pain and swelling over the shins. They may also notice weakness of the dorsi flexors, especially against resistance. In addition there is often a decrease in the extremities pulse and a decrease in sensation. There are two types of compartment syndromes: chronic and acute.
Chronic Compartment Syndrome is not a medical emergency and can often be treated with manual therapies (ART, Graston, Massage). Chronic CS is also referred to as exertional CS. The pain of exertional CS in runners usually comes on with the first 15 minutes of running, then subsides within an hour after the run. The pressure of these compartments can be measured by a medical practitioner. A resting pressure of greater than or equal to 15 mm Hg is an indication that compartment syndrome is present.
Acute Compartment Syndrome could be a serious limb-threatening condition. Any delay in treatment may lead to infection, complications and even limb amputation. In most cases an acute compartment syndrome occurs after a traumatic event, and is most commonly seen with traumatic fractures.
If you suspect a stress fracture or compartment syndrome you need the help of a medicial practitioner.
In Part Three of Shin Splints we will cover: Running and Dorsi Flexor Strength, and Treatment of Shin Splints.
If you would like information about our clinic in Calgary Alberta please go to www.kinetichealth.ca.
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