Anterior and Posterior Shin Splints

How do you know if you’ve got Shin Splints or something more serious?  There are different reasons that your shins could hurt.  The term ‘Shin Splints’ gets thrown around a lot to describe just about any pain in the shins.  If you have shin pain that isn’t Shin Splints…well then what is it?

First of all, let’s review…

What are Shin Splints exactly?

As we have discussed in previous posts ‘Shin Splints’ is a term that can describe just about any pain in the front or the inside of the lower legs.  They are essentially an exercise-induced form of lower leg pain common among athletes. The pain is usually around the tibia (the shin bone).

If the pain is on the front of the leg and is especially intense when lifting your toes off the floor while your heel is firmly planted then you are probably suffering from Anterior Shin Splints.

If the pain is more medial on the inside edge of the shin bone then the problem is most likely the more common Posterior Shin Splints. (Also known as Medial Tibial Stress Syndrome: MTSS)

Ok, so now we’ve reviewed what are Shin Splints but what if you have pain in your shins and you think it might be something more serious than what I have described above?  How would you know?

Well let’s consider the options.  Another pain in the shins that is somewhat more serious than Shin Splints is a Stress Fracture.

Stress Fracture

Tibial Stress Fracture

Most people have at least heard the term ‘Stress Fracture’ but are not really sure what that means.  So what is a stress fracture and how does it differ from Shin Splints?

A stress fracture is a small breakdown in bony tissue or an area within a bone which has been damaged by repetitive impact forces over time.  The tibia (or shin bone) is the site of about 50 percent of all stress fractures in athletes.  

Ok that’s fine and dandy, but how would I know the difference between plain old Shin Splints and a Stress Fracture?

If the injury is Shin Splints, the pain usually disappears once the activity that causes the pain is reduced or stopped. With a stress fracture, the pain does not go away with rest.  There are often complaints of pain at night or while sitting quietly.  Stress fractures usually present with more localized pain and tenderness that is across the leg whereas Shin Splint pain is more up and down the leg and the pain is felt over a larger area. If your pain fits into a possible stress fracture pattern, you should see a health care provider.

Stress fractures can occur as a result of the same training and biomechanical factors that would put someone at risk of developing Shin Splints.  In a previous post we discussed the top 5 reasons that athletes suffer from Shin Splints, and each of those reasons can also contribute to a potential stress fracture.

A stress fracture may also result from an underlying nutritional problem such as inadequate intake or absorption of calcium, or a hormonal problem where varying levels of hormones can alter the integrity of bone and make it more susceptible to injury.

X-rays are often taken to rule out a stress fracture but may not show a fracture line or a healing fracture for several weeks after injury, so a bone scan, a computed tomography (CT) scan or a magnetic resonance imaging (MRI) scan may be used instead for a  quicker and more accurate diagnosis.

Compartment Syndrome

Compartment Syndrome

Also know as Chronic Exertional Compartment Syndrome (CECS), this condition is often incorrectly diagnosed as ‘Shin Splints’ and is another form of shin pain that usually requires the intervention of a health care professional.

The muscles in the lower leg are split into sections or ‘compartments’ surrounded by strong membranes of fibrous tissue (fascia), which wrap up the different muscle groups.  The pain of CECS comes on with exercise, usually after 8-12 minutes, although the timing is variable. The pain grows worse as exercise continues until it is severe enough to force the athlete to stop exercising.  The pain may be accompanied by numbness or tingling in the leg and top of the foot.  A key feature of CECS is that the pain resolves with rest when the athlete stops activity, usually after about 30 minutes.

The pain of CECS develops as a result of pressure imbalances between blood flowing into the muscles and the pressure of the fascia that surrounds the muscles. With exertion, blood flow to the muscle increases and the muscle swells and the athlete experiences pain.  The increased pressure inside the fascia may also compress nerves, resulting in numbness.

The diagnosis for CECS is made by inserting a pressure probe into the affected compartment. Pressure is measured within the affected compartment, first at rest, then at several points while exercising, and finally 5, 10 and 20 minutes after exercise.

The most common treatment for CECS is to surgically split the fascia to allow the muscle more room to expand (a Fasciotomy).  After surgery, 70-85% or patients are able to return to symptom free levels of activity.

If you aren’t sure if your shin pain is Shin Splints or something more sinister like a Stress Fracture or Compartment Syndrome, find a health care professional that can give you some treatment or guide you through your questions and your pain on the way to relief!



Dr. Peggy Malone is a Chiropractor and an Athlete who helps other athletes to overcome injury and get back to their sport. She also inspires patients from all walks of life to take control of their health to be as happy and as healthy as they can be.

A former varsity Basketball and Rugby player, she has since entered the world of endurance athletics where she has completed 2 Ironman Triathlons, 3 Marathons, several Half Marathons and many other Triathlons, Road Races and Off-Road Adventure races of varying distances.

Her own athletic endeavors and injuries have given her valuable insight into working with athletes in her practice for both the care of injuries as well as for the improvement of athletic performance.