Skip to Main Content




  • Anterior lateral tibial periostitis

  • Anterior lateral tibial stress syndrome

  • Anterior lateral stress fracture

  • Anterior shin splints

  • Anterior tibialis tendonitis




  • 844.9 Sprains and strains of unspecified site of knee and leg




  • S86.919A Strain of unspecified muscle(s) and tendon(s) at lower leg level, unspecified leg, initial encounter




  • 4E: Impaired Joint Mobility, Motor Function, Muscle Performance, and Range of Motion Associated with Localized Inflammation



A 23-year-old man presents with bilateral anterior shin pain. He indicates that 3 weeks earlier he began an exercise program that involves jogging 3 miles per day. The patient also indicates that his new exercise program increased his activity level considerably from the past year, with a lot more jogging. The patient has been wearing a pair of old sneakers while jogging. The pain starts about mile 2 and he has to stop running. The X-ray was negative for a stress fracture.




  • Lower anterior lateral leg pain provoked by activity

  • Pain is localized in the anterior lateral aspects of the tibia

  • Produced by stress or traction that causes microtrauma to the soleus muscle at the origin point of the shinbone

  • Stress-reaction inflammation of the periosteal and musculotendinous fascial junctions

  • Results from repeated activity without proper conditioning or allowing enough recovery time between activities

  • Attributed to muscles of the lower extremities being overloaded or by biomechanical irregularities

  • Recurring dull ache along the anterior lateral aspect of the upper tibia

FIGURE 200-1

Tibialis anterior (L4, 5; deep peroneal nerve). The foot is dorsiflexed and inverted against resistance applied by gripping the foot with the examiner’s hand. (From Waxman SG. Clinical Neuroanatomy. 26th ed. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Graphic Jump Location
Essentials of Diagnosis

  • Diagnosis usually made by clinical examination

  • Pain increases with active dorsiflexion and when the anterior tibialis muscle stretched into plantarflexion

  • Muscle length and strength imbalances, especially a tight gastrocnemius-soleus muscle group

  • Common to see compartment syndrome associated with shin splints

General Considerations

  • Pain with repetitive activity, when the involved musculotendinous unit is stretched


  • Athletes who increase activity intensity and/or duration along with a lack of appropriate recovery between workouts

  • Beginning runners with poor lower-extremity muscle control





  • Tightness in gastrocnemius, soleus, and plantar muscles

  • Pain: Mild to severe with weight-bearing activities and gait

  • Described as a dull ache to lower extremities

  • Point tenderness to tibia at anterior lateral aspect

  • Possible localized swelling

  • Muscle guarding with ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPhysiotherapy Full Site: One-Year Subscription

Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPhysiotherapy

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.