When it comes to runners and athletes, two of the more common conditions causing shin pain are stress fractures and shin splints. Sometimes, it can be difficult to tell the difference between the two conditions. So, here’s a guide on how we determine shin splints vs stress fractures, along with tips on how to treat these conditions.
What are Shin Splints?
Shin splints, also known as medial tibial stress syndrome, are an overuse condition caused by inflammation of the muscle attachments to the inside of the shin bone. They are caused by repetitive stress to the shin bone, brought on by activities such as running and changing direction.
Sudden changes in activity volume or intensity, flat or rigid feet, stiff ankle joints, tight calves, and poor footwear are common causes of shin splints.
Symptoms of shin splints
- Generalised aching on the inside of the shin
- Pain is usually worse at the start and gets better as activity continues
- Rest usually settles shin pain quickly
What are Shin Stress Fractures?
A shin stress fracture is a crack in the bone itself. Repetitive stress on the bone with inadequate rest leads to fatigue, swelling and cracking. Unlike shin splints, stress fractures affect the lower leg bones, the tibia and the fibula. Generally, a stress fracture affects the inside of the tibial bone. Sometimes, the front of the tibia (anterior tibia) or the fibula can be affected.
Symptoms of stress fractures
- Sharp localised pain to one point in the shin
- Pain that worsens with activity and fails to warm up
- Rest or night pain is typical in more severe cases
- Localised swelling and tenderness to touch
The most critical factor in causing a stress fracture is a sudden change in the volume or intensity of training. Excessive training without adequate rest leads to bone fatigue and breakdown. Other risks include biomechanical factors such as calf weakness and tightness, flat or rigid feet, and poor footwear. In some cases, bone health concerns from weak bones (osteopaenia), vitamin D deficiency and irregular or absent periods in women can increase the risk of developing a stress fracture.
Shin Splints vs Stress Fractures: How to Tell
| Symptoms | Shin Splints | Shin Stress Fractures |
|---|---|---|
| Location of Pain | Along the inner shin | Specific point on shin |
| Type of Pain | Dull, aching and generalised | Sharp, localised and severe |
| Pain During Activity | Warms up with activity | Worsens during activity |
| Swelling | Possible mild generalised swelling if severe | Swelling common at fracture site |
| Response to activity | Improves quickly with rest | Often persists for days – sometimes with limp |
Sometimes, it can be challenging to differentiate shin splints from stress fractures in the early stages, as the symptoms can be the same. However, stress fractures generally get worse with persistent weight-bearing activity. Severe rest or night pain, localised swelling, and limping make a shin stress fracture more likely.
Diagnosing Shin Splints vs Stress Fractures
If shin pain does not improve with simple treatments such as reduced activity, it is essential to see a sports doctor to obtain a correct diagnosis. Shin pain management depends on a specific diagnosis: shin splints are treated differently from stress fractures.
Your doctor will assess your symptoms and ask questions regarding your pain location, duration, severity, and triggering and relieving factors. Next, your doctor will examine your shin to find clues about the exact cause. Localised, pinpoint tenderness and pain with hopping are most likely due to a shin stress fracture.
Usually, we use imaging, such as X-rays or MRI, to decide whether you have shin splints or a stress fracture. In general, MRI is the preferred choice as it can diagnose and grade the severity of a shin stress fracture. A higher grade of stress fracture means a more severe injury, which will need more rest from activity. Also, MRI can diagnose other causes of shin pain, such as a calf muscle tear.
Do stress fractures show up on X-rays?
Sometimes. On X-ray, stress fractures produce a thickening of the bone lining and a black line. However, only about 30% of shin stress fractures are detected on X-ray. So, a standard X-ray does not exclude a shin stress fracture.
Treatment of Stress Fractures vs Shin Splints
The treatment of these two conditions is generally different. So, a diagnosis is critical to returning to running or sports without delay.
Treatment of Shin Splints
- Relative rest and reduced activity are necessary to allow the tissues around the shin to heal. Sometimes, this may involve stopping running or sports.
- Ice the affected area for 10-15 minutes several times daily to reduce inflammation.
- NSAIDs used for 1-2 weeks may be helpful for acute pain. Ibuprofen 400mg three times a day with food is an example. You should speak to your doctor about whether it is safe for you to take these medications.
- Compression socks can help to decrease swelling.
- Stretching and Strengthening Exercises for the lower legs, especially the calves, can prevent recurrence. Hip and pelvic strengthening exercises may also help. You should see a physiotherapist who has expertise in treating lower limb injuries.
- Orthotics and Proper Footwear: Consider shoes with better support and possible orthotic inserts to reduce strain on the shins. You should see a podiatrist to assess your footwear and the need for orthotics.
- Shockwave Therapy can assist in severe cases. Speak to your doctor about using shockwave therapy for complex cases. Sometimes, a cortisone injection can also help.
Treatment of Stress Fractures
- Complete rest from weight-bearing activity: This is critical for healing. Avoid any weight-bearing activities, such as running or team sports. Also, in the early stages, you should keep your daily walking step count lower than usual.
- Maintain aerobic conditioning by swimming and cycling. Upper and lower body weight training should be ok, although you should avoid jumping.
- Use Braces or Crutches to relieve pressure on the tibia and promote healing. Sometimes, doctors use a walking boot to keep you mobile while protecting the stress fracture.
- Pain Management: Ice and regular paracetamol can help. For stress fractures, we suggest you avoid oral NSAIDs such as ibuprofen, as evidence suggests these medications delay bone healing.
- Gradual Return to Activity as your stress fracture heals. Generally, you can start a running programme once you have been pain-free for a month and can hop without pain. However, you should speak to your doctor to ensure you’re ready to return to running. In higher-grade stress fractures, you may need more time away from weight-bearing activity. Sometimes, we use an anti-gravity treadmill to enable a quicker return to running.
- Bone Health: Ensure adequate calcium and vitamin D intake and address underlying bone health issues. Sometimes, if doctors are concerned about bone health, they recommend investigations such as a bone density scan and blood tests to check bone markers and Vitamin D.
- Bone Healing Treatments: Your doctor may sometimes recommend treatments to encourage bone healing, such as focused shockwave or LIPUS (low-intensity pulsed ultrasound stimulation).
Other Frequently Asked Questions about Shin Splints vs Stress Fractures
Can shin splints cause stress fractures?
No. We don’t think shin splints cause a stress fracture. However, factors that increase the risk of shin splints can also cause stress fractures. It is common to find both conditions in an athlete with shin pain.
Can you run with a stress fracture?
Generally, in the initial stage of stress fracture treatment, we recommend resting from running. However, as the stress fracture heals, you can resume running. The key is to return gradually to prevent the recurrence of shin pain. Sometimes, we use an anti-gravity machine to help athletes return to running faster.
Do stress fractures hurt to touch?
Usually, yes. Touching a stress fracture often causes pain. However, if the stress fracture is at the back of the shin bone, it may be covered by the calf muscle, so touching the bone may not cause pain.
What exercises can I do with a tibial stress fracture?
We recommend non-weight-bearing activities such as swimming or upper body weights in the early stages. As the bone heals, you can tiptoe into a partial weight-bearing activity such as cycling or using an elliptical machine. Your doctor should guide you when you are ready to run again.
Do shin splints cause a lump?
A lump is not common in shin splints. If a lump occurs with shin pain, it could be a bone stress fracture or another cause.
Is it ok to run through shin splints?
Yes, generally. However, you may need to reduce your running volume and intensity early to control your pain. Other treatments, such as ice and medication, can also help.
Do vitamin D and calcium intake play a critical role in treating a stress fracture in the shin?
Yes. A recent study found that women with a daily calcium intake of less than 800mg have a sixfold increased risk of a stress fracture. Ensure a daily calcium intake of 1200mg. Vitamin D is also essential for good bone health; supplementation is needed if levels are less than 75.
Do we treat anterior tibial stress fractures differently?
Yes. Stress fractures in the anterior tibia are at higher risk of delayed healing. These fractures need to be treated more aggressively with prolonged rest. Good bone health is critical, with optimal vitamin D and calcium intake. Sometimes, we use focused shockwave or LIPUS therapy to help bone healing. Occasionally, surgery may be needed, although the risks of surgery are high.
Final word from Sportdoctorlondon regarding Shin Splints vs Stress Fractures
Sometimes, knowing if shin pain is due to shin splints or a stress fracture can be difficult. If you feel your shin pain is becoming unmanageable, see a sports medicine doctor to get the correct diagnosis. Early detection and mameanent means you’ll return to pain-free running or sport in no time.
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