Shin pain in athletes - assessment and management.

BACKGROUND: Shin pain is a common complaint among running athletes and can be caused by bony, muscular, vascular or neural pathology. OBJECTIVE: This article discusses the likely causes, assessment and management of shin pain in athletes presenting in the general practice setting. DISCUSSION: Accurate diagnosis is important as treatment differs depending on the cause. The characteristics of the pain and examination findings after exercise give strong clues to the diagnosis; further investigation may be unnecessary. Bony stress reactions and fractures are the most common cause of shin pain; patients describe a 'jarring' sensation along the bone margin with heel strike. Other causes include recurrent exertional compartment syndrome (RECS), tenosynovitis, neurological entrapment and rarely, vascular entrapment. Symptoms of vascular entrapment may be similar to RECS and this may cause diagnostic confusion. Increased bone stress in athletes is largely due to inappropriate training program design and can usually be alleviated by reducing impact loading until pain resolves.