Pain in the shin and calf region of the lower leg, commonly referred to as “Shin Splints,” can be due to one of a number of distinct conditions. The treatment for shin/calf pain can vary considerably depending on the cause, and calf pain can be an indicator of more serious problems, such as deep vein thrombosis (DVT), so it is important to have a thorough examination and obtain a correct diagnosis from a medical professional. Some common causes of shin/calf pain are summarised here:

Stress fracture of the tibia (shin bone)

Tibial stress fractures result from repetitive stress or force to the shin bone, causing a small crack/s to form.


  • Pain increases gradually, aggravated with activity
  • Tenderness directly over the fracture.

Treatment and management

  • An MRI may be required to confirm the fracture
  • Osteopathic assessment of abnormal foot biomechanics may be recommended
  • Treatment initially involves rest and reducing weightbearing activity for 4-8 weeks (a moon boot” may be required)
  • Incremental return to activity.

Inflammatory shin pain/periostitis

Inflammatory shin pain is due to inflammation of the fibrous sheath that covers bones (periosteum), typically caused by overuse and strain on the periosteum by the structures adjacent to it.


  • Pain down the inside edge of the tibia/shin bone.
  • Pain that may subside upon movement but returns, and may be worse, after activity

Treatment and management

  • Osteopathic assessment & management of abnormal foot biomechanics
  • An initial period of rest from aggravating activities
  • Reducing inflammation with medications and/or ice.
  • Osteopathic treatment and rehabilitation exercises to relieve muscle tension and improve flexibility in the area

Muscle Strain

Muscle strain is overstretching and/or tearing of muscle fibres and usually results from overuse or improper use of the muscle. A sudden increase in use and inadequate footwear can also contribute to muscle strain.


  • Pain, swelling, muscle spasm and bruising
  • Weakness or impaired mobility of the muscle depending on severity

Treatment and management:

  • Osteopathic treatment and stretching exercises to aid recovery and prevent contraction
  • Initial rest period with the muscle kept in a relaxed, stretched position
  • Anti- inflammatory medications & ice to control pain & inflammation
  • Osteopathic investigation of training, ergonomic or footwear issues that may require modification

Compartment Syndrome

A compartment is a group of muscles, nerves and blood vessels held together by fibrous tissue called fascia. Fascia is not an elastic structure, so bleeding or swelling in the compartment can lead to a painful build-up of pressure, known as compartment syndrome. While acute compartment syndrome occurs after a severe, traumatic injury and can be life-threatening, this article discusses chronic, or exertional compartment syndrome, which is generally due to overuse and is rarely dangerous.

Exertional compartment syndrome commonly occurs behind the shin in the lower limb (deep posterior compartment) or along the tibia at the front of the lower leg (anterior compartment)


  • Pain and cramping during activity, which subsides upon rest.
  • Numbness, tingling due to nerve compression
  • Muscle bulge & associated bursting sensation.

Treatment and management

  • Rest or avoidance of aggravating activity
  • Osteopathic treatment and rehabilitation exercises to relieve muscle tension in the area
  • Osteopathic assessment and modification of training, ergonomic or other predisposing factors
  • Severe or refractory cases may require specialist referral or surgical review

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