This information is not a definitive list but only a guide to possible causes of your pain which can be helped by your physiotherapist. There are a wide range of medical conditions that can cause your pain. An assessment by one of our physiotherapists will allow them to take a detailed history and perform a thorough examination to give a diagnosis. They can then treat you effectively or recommend a medical referral if it is required.
Muscle strain
There are a number of muscles that can be strained on the front of the lower leg. There is normally pain over the muscle and pain on stretch of the muscle and when movement is resisted.
Physiotherapy can help with advice, ice, massage, soft tissue techniques, ultrasound and taping. Exercises can be set to regain flexibility and strength of the muscle and progress you back to sport.
Stress fractures
The majority of stress fractures occur to the back middle tibia (main lower leg bone) and a smaller number to the front edge of the tibia. Typical symptoms include pain that starts gradually and is aggravated by exercise which can be pinpointed when touching the bone. The pain may even occur with walking, at rest and even at night usually lasting up to a few months.
Stress fractures of the fibula (small bone on outside of lower leg) are rare and tend to happen secondary to muscle pulls on the bone.
Physiotherapy can help by determining which factors are contributing to the problem and advise on exercise that can be done without causing pain and making the problem worse. They will refer you to a medical specialist to confirm the diagnosis and monitor the healing process of the stress fracture.
Medial tibial traction inflammation (periostitis)
This is an inflammatory reaction of the tibia due to a pulling of the muscles on the tibia. A number of factors can contribute to it including muscle problems, fatigue, shoe issues, training errors. Tbe pain is normally along the inside of the tibia bone and usually becomes less as you warm up.
Physiotherapy can help with anti-inflammatory advice, taping, soft tissue techniques to the calf muscles, ultrasound, stretching and strengthening exercise programmes.
Periosteal contusion (bone bruising)
The perisoteum is a covering over the bone. Contusion also known as bruising happens as a result of a direct blow to the bone ie. from football. Often it is extremely painful at the time of injury but settles quite quickly. If the pain lasts longer it will normally be due to formation of a haematoma (bleeding) from the site of injury. It is advised to rest and protect the area. Ultrasound and massage can help with quicker resolving of any swelling and bruising of surrounding soft tissues.
Acute compartment syndrome
This should be considered in anyone with a marked haematoma (bleeding within the leg) or swelling. Compartment refers to the group of muscles on the front of the leg. Symptoms include ongoing aching shin pain, which is greater than one would expect and swelling. Pain is increased with providing a stretch to this group of muscles. Pins and needles, loss of feeling and some weakness may also be present due to the nerves being compressed. An urgent referral for medical help is required in this situation.
Popliteal artery entrapment
The popliteal artery runs behind the knee and in the calf. When the artery is trapped it rarely causes calf pain but pain on the shin. The pain usually disappears immediately when exercise is stopped. Often there is also pins and needles and numbness in the calf and foot. If your physiotherapist suspects this they will recommend a medical review.
Chronic exertional compartment syndrome
This is a long term pain that occurs in the compartment containing the muscles of the front of the leg. Symptoms include pain with exercise and no pain at rest. After exercise the pain can take over an hour to subside. If your physiotherapist suspects this is the cause of your symptoms they will recommend a medical referral. Normally surgery is recommended and then physiotherapy is required after surgery to regain your movement in your knee and provide advice on returning to sport as well as prescribing appropriate exercises to regain flexibility and strength.
Fracture of tibia and fibula bones
A fracture is usually a result of direct violence to the bones from landing from a jump or twisting the foot. Obviously medical assistance is required for the fracture and a plastercast or supportive boot put in place.
Physiotherapy can help by maintaining strength of the upper leg when in the cast or boot. When cast or boot is removed physiotherapy help to restore movement and strength in the lower leg, ankle and foot and return you to your hobbies or sport.
Tumors
The cause of tumors in the shin is unknown and rare. The pain is often deep and nagging often at night and unchanged with activity. An urgent medical review is required if this is suspected.
Referred pain
It always needs to be considered that pain in the shin can be referred from another part of the body ie. The lower back, knee, ankle joint, superior tibiofibular joint and nerves being entrapped.
Chronic Pain
Acute pain is the pain we feel immediately after injuring ourselves and while the injury is healing. Chronic pain is pain that continues even though healing has occurred and it is not unusual to find no direct link between the pain and the original injury that may have healed a long time ago. Chemical changes happen in the brain and spinal cord to re-route signals to pain centres in the brain. Then any normal sensation such as a movement, touch, pressure, stretching etc can be felt as pain. In some instances the pain system can be activated without any physical stimulus ie changes in weather, mood, thoughts or no stimulus at all.
Physiotherapy for chronic pain has to involve many aspects and address other factors that come into play rather than just the pain itself. They will treat the pain and also use methods to help you manage your pain including advice on pacing and coping with flare ups and negative thoughts, graduated exercise programmes and goal setting. They will aim to return to you being able to participate again in activities you were involved in before developing chronic pain whether work, sport of hobby related. We can also recommend top London pain consultants who can help you.
Other possible causes
Your physiotherapist will take a detailed history of your symptoms and past medical history before performing a full physical examination. There are a number of other possible causes of your symptoms which are not appropriate for a physiotherapist to treat in any way or that need a medical opinion alongside physiotherapy treatment. In this case they will recommend you to your GP or an appropriate specialist doctor or specialist consultant. These possible causes include:
- cardiovascular symptoms
- respiratory (breathing) symptoms
- gynaecological symptoms
- urinary or genital symptoms
- digestive symptoms
- immune system symptoms
- lymph system symptoms
- hormonal symptoms
- neurological symptoms
- dermatological (skin) symptoms
- medication side-effects
- virus
- infection
- cancer
- disease process
- psychological problem ie. depression, anxiety
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