Children's Hospital Colorado: Stress Injuries to the Lower Leg

Children's Hospital Colorado: Stress Injuries to the Lower Leg

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Sports Medicine Center


Stress Injuries to the Lower Leg

Shin conditions are most frequently seen in athletes who increase their intensity in training, increase the amount they train, or change the surface on which they are playing their sport. Other contributing factors include tight muscles in the lower leg and ankle, failure to warm-up properly before physical activity, and improper shoe wear. Shin splints, stress reactions, stress fractures, and compartment syndrome are a few of the conditions that can occur in the low leg region.

Symptoms include pain over the front, inner or outer parts of your lower leg. Pain may occur during exercise, at rest or both.

  • Shin splints: Pain and tenderness in a broad area along the edge of the shinbone and surrounding muscles will occur. This pain is typically worse at the beginning of activity and shortly after running, but may worsen to the point that it is too painful to begin workouts at all. For more information, visit Children’s Colorado’s website.
  • Stress reactions: A stress reaction is the precursor to a stress fracture. While at the stress-reaction stage, the bone structure is breaking down and becoming weaker, but does not actually contain any fracture.
  • Stress fractures: It will hurt to touch the part of the bone that is fractured. Stress fractures of the fibula will cause pain on the outer side of the lower leg. This pain is typically minor at the beginning of activity and worsens with increased activity/movement.
  • Compartment syndrome: The muscles in the lower leg will be painful. This pain also tends to get worse the longer an athlete is active or running. Blood vessels and nerves in the lower leg may become irritated if the muscles in this compartment swell during exercise, causing the foot to become weak, numb or cold.

When to see a doctor? If stress reaction, stress fracture, or compartment syndrome is suspected.

Diagnostic Testing

If there is concern about a stress fracture, x-rays may be taken. However, not all stress fractures will show up on an x-ray, so if there is enough concern for a stress fracture, magnetic resource imaging (MRI) or a bone (CT) scan may be ordered by your child’s healthcare provider.
If your pediatrician thinks your child may have compartment syndrome, a test that measures the pressure in the lower leg compartments might be done. This is done using a needle attached to a measuring device. This test will be done at rest and then again after exercise.


  • Ice massage: Freeze water in a Styrofoam cup, then peel the top of the cup away to expose the ice and hold onto the bottom of the cup while you rub ice over shin for five to 10 minutes.
  • Medicine: Anti-inflammatory medicine may be recommended.
  • Supportive shoes: Wearing the proper shoes recommended for a sport is a very important part of the treatment. In rare cases, arch supports (known as orthotics) may be recommended.
  • Rest: This is extremely important, and the length of rest depends on the severity of the condition. A walking boot and possibly crutches may also be a part of treatment if there is a stress reaction or stress fracture.
  • Rehabilitation exercises: Exercises focused on strengthening, flexibility, balance, and proper biomechanics will help the athlete return to sport safely following a period of rest. These exercises will also help decrease the risk of re-injury in the future. The goal of rehabilitation is to get your child back to normal activities as soon as it’s safely possible.
  • Surgery: Occasionally surgery is needed for young athletes with compartment syndrome. The tissues that form the covering of the compartments are opened up to reduce the pressure in the compartments.


All kids and young athletes recover from injury at different rates, and returning to activity is determined by how each particular child recovers. In general, the longer symptoms are present before treatment is started, the longer it will take to get better.

Prevention for these injuries include the following:

  • Proper warm-up before physical activities
  • Stretching tight muscles in the lower body, including: calves, hamstrings, quadriceps, glutes, IT band
  1. Foam rolling is a great option, especially over the IT band
  2. Use a lacrosse ball for the tough spots, for example: muscle knots in the glutes or IT band
  • Proper footwear
  • Supportive running shoes
  • Proper fitting cleats
  • Gradual increase in training intensity and return to sport after an off-season

For more information on proper prevention techniques or if you have any questions or concerns please feel free to contact Virginia Winn, MSc, ATC at [email protected].