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Adolescent Shin Pain

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Introduction

Shin pain is very prevalent in the adolescent population ranging between 12-19 years old. The Term ‘shin splints’ is widely used but this covers a spectrum of conditions involving the shin bone. The underlying physiology may involve, tendon, periosteum and bone usually worsening in that order. Essentially these structures are unable to cope with the load being placed upon them and start to cause changes in the periosteum – the Velcro that sticks soft tissue to the bone, causing inflammation and pain. Continued loading at this point can lead to damage within the bone and ultimately to a fracture.

Signs & Symptoms

Adolescent Shin Pain can present with a variety of symptoms:

  • Pain on the inside or outside of the shin, worsened when putting pressure through it.
  • Symptoms can present anywhere along the bone length but mainly in the middle or bottom 1/3.
  • Worse when active (walking, running, playing sports).
  • Symptoms are generally alleviated by rest.
  • Calf Pain.
  • Limp at any point in the day or after activity even if only for a short period.
  • Gradual onset without trauma that progressively worsens and starts to cause symptoms earlier into activity.
  • Sudden worsening of symptoms after activity.

Causes

Symptoms usually arise from a recent increase in training volume or return from a break which results in a (relatively) sudden overload to the local structures. Those presenting with greater than 3 weeks of pain, a limp and worsening symptoms should be considered for further management.

Prevalence

  • Females are twice as likely to suffer this condition as males.
  • Adolescents experiencing accelerated growth between 12-16 are more susceptible.
  • Up to 1 in 5 who engage in high impact sports such as sprinters, distance runners, basketball, soccer players and dancers are at risk.
  • Those with low levels of Vitamin D or poor diet.
  • Girls who have delayed menarche, a family history of Osteoporosis and engage in high impact sports are at greatest risk.

Assessment & Diagnosis

At Pure, your Physio will take a detailed history of your symptoms followed by a thorough clinical examination to establish an informed hypothesis of the structures contributing to your pain and provide a working diagnosis. A fast and accurate diagnosis will mean that the most effective treatment and management plan can be implemented straight away, helping to achieve optimal outcomes. Your Physiotherapist will want to know how your condition is effecting you day to day so that your treatment can be tailored to your needs and will mean personalised goals can be established. Regular re-assessment will ascertain if your are making progress towards your goals and will allow adjustments to your treatment to be made.

 

The majority of those presenting with shin pain, will require rest and gradual re-introduction of activity but those who have had multiple episodes of shin pain, or those who have tried to push on and hope the pain will settle may require further investigations.

 

Vitamin D

This is a blood test that will give an indication of bone health for most adolescents should be between 75 and 95. If you are below this the Doctor may discuss with you about diet and supplementation unique to your injury needs.

 

Imaging

If your symptoms have not resolved within 3-4 weeks the Doctor may decide to send you for X-rays or MRI to determine what is happening. If you have had previous stress fractures and suspect another one you may be sent for a DEXA scan to establish your overall bone mineral density but this is rarely needed.

Self-Management

Your Physio will educate you on the condition so you can understand how to effectively manage your symptoms and facilitate recovery, in partnership with your clinician. Symptoms can last for anything between 3 weeks and 6 months. Most people will require activity modification and rest from pain causing activities till symptoms settle, complete some loading exercises and  then can gradually re-introduce themselves to their activity under guidance of a therapist.

 

If you present with pain on the outside of the Tibia in the middle 1/3 you may be asked to wear a boot or go onto crutches and not put any weight through your leg until it is pain free to do so.

 

Underlying issues such as low vitamin D, poor diet or digestive issues need to addressed to reduce the likelihood of recurrence. Every case is different and if you are unsure you should seek advice from a Physiotherapist with experience in treating children and athletes.

Physiotherapy

As your symptoms settle, you will then start gradual strengthening and eventually specific activities to allow return to sports play at anything up to 6 months. Your Physiotherapist will create an individualised and progressive rehabilitation plan that will aim to increase the strength and resilience of local soft tissue to achieve a successful recovery and to mitigate the likelihood of complications in the future.

References

Brukner and Kahn (2016) Clinical Sports Medicine 5th Edition Livingstone Paediatric Injuries Section.

 

Korsh, J., Matijakovich, D., & Gatt, C. (2017). Adolescent shin pain. Pediatric annals46(1), e29-e32.

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