Adolescent shin pain can be defined as pain in the large bone on the inside of the lower leg (tibia) felt during activities such as walking, running and jumping. This condition tends to affect 12–18-year-olds who are very physically active. Physical activity places strain on the bones and muscles of the lower leg, having to absorb force as we put weight through the leg, but the bones also provide the anchor for muscles to pull against to produce movement. Therefore, symptoms are often felt during the activity, with almost 1 in 5 active 12–18-year-olds experiencing at least one bout of shin pain.
During our adolescent years, our muscles and bones go through significant changes as we develop from a child to an adult. Adolescence is a period where we go through accelerated periods of change where our bones are not only growing in length but also changing in structure from soft cartilage style bone to the hard adult bone. Add to this peak height velocity over a 12 to 18 month period, where we can gain up to 10% of adult height, and this mixture of growth and physical activity can leave our shin bone susceptible to injury.
Adolescent shin pain can represent a spectrum of injuries from mild irritation where the muscle inserts onto the bone, through to stress fracture of the bone and full fracture. If pain is present for a period of 3 weeks or more on activity and the symptoms are getting worse, you should seek further advice.
Adolescent shin pain can present with a variety of signs and symptoms:
A number of reasons have been suggested as to why people develop adolescent shin pain. These reasons include hormonal changes associated with maturation, but also body image concerns and disordered eating meaning the availability of vitamins and minerals used to build bone and muscle may be reduced. Recent changes to a training programme or increased training volume are also linked to the development of the condition.
This is not an exhaustive list. These factors could increase the likelihood of someone developing adolescent shin pain. It does not mean everyone with these risk factors will develop symptoms.
Adolescent shin pain is present in up to 20% of the athletic population of 12–18-year-olds, with females twice as likely to develop adolescent shin pain than their male counterparts.
Musculoskeletal physiotherapists and other appropriately qualified healthcare professionals can provide you with a diagnosis by obtaining a detailed history of your symptoms. A series of physical tests might be performed as part of your assessment to rule out other potentially involved structures and gain a greater understanding of your physical abilities to help facilitate an accurate working diagnosis.
Your treating clinician will want to know how your condition affects you day-to-day so that treatment can be tailored to your needs and personalised goals can be established. Intermittent reassessment will ascertain if you are making progress towards your goals and will allow appropriate adjustments to your treatment to be made.
Further investigations or imaging may include:
If you develop a bout of aches or pains around the shin in response to an activity which settles within 2 days and does not recur, this is not likely to represent adolescent shin pain and you should continue with your normal activities.
If pain continues to be present on activity for more than 2 weeks, the initial self-management is to stop all aggravating activities for a period of 3 weeks (2). During this time, you can do things to help manage symptoms such as icing or heating the area. You can then gradually reintroduce activity, building back up to your normal activities over 3-4 weeks. If pain returns during this period of build-up, you should then seek further assessment with a musculoskeletal physiotherapist (3).
This will depend entirely on your symptoms and the outcome of any imaging that may be requested. For those with mild symptoms, they may be able to continue to do impact activities alongside a strengthening programme provided symptoms do not worsen (2).
For moderate symptoms, you may be asked to stop all aggravating activities and switch to non-impact activities such as cycling, swimming or aqua jogging. Once symptoms have settled you will be asked to start a programme of strengthening for the legs and trunk (2,3).
For severe symptoms, including limping during or after activity, or a diagnosed stress fracture, you may be asked to take part in a period of non-weight-bearing on crutches and wearing a walking boot. You will then be reviewed and tested and when you are able to walk again pain-free the boot can be removed and you can stop using the crutches (2,3).
Below are three rehabilitation programmes created by our specialist physiotherapists targeted at addressing adolescent shin pain. In some instances, a one-to-one assessment is appropriate to individually tailor targeted rehabilitation. However, these programmes provide an excellent starting point as well as clearly highlighting exercise progression.
This programme focuses on some early strengthening exercises that are safe to perform to ensure that deconditioning (decline in physical function) is limited. Pain should not exceed 4/10 on your perceived pain scale whilst completing this exercise programme.
At this stage the emphasis moves towards trying to strengthen around the area to reduce the risk of the problem occurring in the future. Pain should not exceed 4/10 whilst completing this exercise programme.
At this stage we move towards more loaded and whole-body exercises to help ensure a return to normal movement and a safe and effective return to activity. Pain should not exceed 4/10 whilst completing this exercise programme.
Returning to sport after adolescent shin pain is a gradual process of slowly increasing the difficulty of strengthening exercises and reintroduction to preferred sporting activities (2, 3).
For patients wanting to achieve a high level of function or return to sport, we would encourage a consultation with a physiotherapist as you will likely require further progression beyond the advanced rehabilitation stage.
As part of a comprehensive treatment approach, your musculoskeletal physiotherapist may also use a variety of other pain-relieving treatments to support symptom relief and recovery. Whilst recovering, you might benefit from a further assessment to ensure you are making progress and to establish the appropriate progression of treatment. Ongoing support and advice will allow you to self-manage and prevent future reoccurrence (3).
Unfortunately, a small percentage of patients with this condition do suffer a reoccurrence of their pain and in this instance, they should seek further medical advice before continuing their rehabilitation (1, 2).
For those who do not recover with activity modification, exercises and other comprehensive treatments, the next option is often surgical (7, 8, 9) such as:
Please book an appointment with one of our physiotherapists if you think you are suffering from this condition and would like to find out more.
We have Pure Physiotherapy clinics across the country including Norwich, Ipswich, Manchester, Bolton, Wakefield and Sheffield. Please view our clinics to find the closest physiotherapy clinic for you.
Sciatica is a symptom describing pain and/or pins and needles down the back of the leg.
A condition involving injury to the tendon found around the bone at the inner side of the ankle leading to pain and weakness.
Pure Physiotherapy Limited (PP) understands that your privacy is important to you and that you care about how your personal data is used and shared online. We respect and value the privacy of everyone who visits this website, www.purephysiotherapy.co.uk (“Our Site”) and will only collect and use personal data in ways that are described here, and in a manner that is consistent with Our obligations and your rights under the law.
Strictly necessary cookies are required on this website to help us remember your options, and also protect our website and our users.
We use a range of technologies on our website that restrict and deter the use of bots. These include Google's ReCaptcha service. https://www.google.com/recaptcha/about/
To read more about our Strictly Necessary Cookies, Please Click Here
If you disable this cookie, we will not be able to save your preferences. This means that every time you visit this website you will need to enable or disable cookies again.
This website uses Google Analytics to collect anonymous information such as the number of visitors to the site, and the most popular pages.
Keeping these cookies enabled will help us to improve your experience on the Rehab Direct website.
Please enable Strictly Necessary Cookies first so that we can save your preferences!
Pure uses cookies when you use our website, https://purephysiotherapy.co.uk to help improve security and improve the experience of our users.
Before any cookies are placed on your device, we will present you a message bar and the opportunity to learn about the cookies we use, and we will allow you to give consent to the use of cookies that are not strictly necessary.
Click Here to view our cookie policy.
