Q: I have been having a lot of pain on the inside of my lower leg right next to the bone. I have been Internet researching it and wanted to know what the difference is between shin splints and a stress fracture?
A: “Shin splints” is a generic term for the description of pain that is near the large lower leg bone, or the tibia. The pain is usually a result from overload on the tibia and inflammation of the soft tissue of the tibia, known as the periostium. There are several reasons why the periostium may become inflamed ranging from poor and improper footwear, engaging in sports with frequent stops and starts, and training for too long, or too hard, too quickly.
The treatment of shin splints is rather simple. The difficult part is actually setting aside enough time to heal properly, for some severe cases, up to several weeks. First, you will need to decrease activity loads until the pain goes away entirely (and this may mean complete inactivity or using crutches for mobilization). Second, ice as frequently as tolerable. And third, stretch the posterior muscles of the lower leg and start to strengthen the muscles that control the ankle so they don’t have to strain as much to stabilize the joint during movement.
Taking over-the-counter anti-inflammatories such as ibuprofen or naproxen will help decrease the swelling. Furthermore, I would suggest changing your footwear or arch support to improve the biomechanics of the foot during contact to toe-off by minimizing overpronation and supporting flat arches. Getting soft tissue massage to loosen up the periostium at its attachment on the tibia may also help. Once the pain is gone with walking, continue with the exercises and stretching, while gradually adding back your sport or running activity.
The reason why it is important to seek treatment immediately for shin splints is that it could lead to a more serious diagnosis of a stress fracture. If the overload on the tibia becomes overbearing for the bone to sustain, a small crack or stress fracture may form. In some severe cases a positive reading will show on X-Rays or a MRI. But, unfortunately, many go unnoticed in diagnostic tests and you will have to rely on your own intuition.
The biggest difference between stress fractures and shin splints is the intensity and longevity of the pain. Bone, or stress fracture pain, usually lasts well beyond activity and may be persistent at night. Whereas, most shin splint type pain increases with activity, but then subsides as soon as the activity is halted. In most shin splint cases, pain is not present at night.
Unfortunately, once a stress fracture has been confirmed, treatment is much more restrictive then shin splints. All activity is halted and in most cases the affected leg is splinted and the patient is forced to non-weight bear with crutches for up to several months. Short-term prescription of a calcitonin-salmon nasal spray may be indicated to promote increases in bone matrix formation. Long-term changes in diet and training intensity are absolutely necessary.
In summary, if you feel like you may fall in the shin splint category, I would take as much time off as you can to allow for optimal healing. In you are already having symptoms similar to the stress fracture description, seek medical advice immediately.