chronic shin pain please help

[mart30]

Hi everyone I was wondering if anyone can help me. I have been having deep throbbing pains in my shins since I was pregnant with my child (9 years). It only seemed to start during my pregnancy I hadnt had any pains like this before. At the time I only felt pain at night time but the pain kept me awake at night, I saw the doctor at the time who didnt seem concerned so I just got on with it. I am still having these pains at night but also when I am resting my legs during the day, i.e I am sitting down. At times the pain can be very severe so much that I cant sleep and sometimes I feel a sharp pain in my left shin that I can pinpoint. I have recently seen a new G.P who diagnosed restless leg syndrome and gave me quinine sulphate. This hasnt helped and I am not confident with his diagnosis because he didnt even look at my legs. Has anyone else come across this? or have any idea whats wrong?
Thankyou in advance

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[naveenedin]

hello there
there are couple of things, i need to know before proceeding. have u got any back pain now or any pain at back along with this shin pain??. if your pain awakes in night, is it really unrelenting pain?? in that case it is serious, any history of breast cancer?? do u had any trauma??, is ur pain after exertion/activity?? is it localized or is it diffuse, i know u said as a constant pain, wat worsens the pain??, Is there anything which makes ur pain better??(ice/heat) do u run or jog?? do u get more pain after activity or during activity??.

During pregnancy its common to get sciatic pain, which is quite different from wat u r saying.. you described pain as throbbing, which is normally expressed for nervy kind of a pain.

If i am going to guess really superficially, then it can be some nervy pain(common peroneal nerve entrapment, or stress fracture( as u can localize the pain) or some activity related pain(runners shin pain)

I know too many questions..

[mart30]

Hi thanks for your reply,

I dont mind about the questions I understand the reasons for them. Well the only thing that seems to ease it is moving about, as soon as I rest I start to feel the pain, I would say it is worse at night and I cant find a position that is comfortable, I need to keep moving about. I havent really had any back problems no, only the throbbing pain in both legs but its been there for 8 - 9 years now, the not being able to get to sleep is the thing that really gets to me, I think I have got used to the pain now if that makes sense. No other red flags and movement seems to ease it. If I think back to about 4 years ago I was running quite alot and it seemed to ease a bit then. I have always been fairly active but probably not as much in the last couple of years.

No history of breast cancer/any serious illness or trauma. At night or at rest there is nothing I find eases it, I just try to keep moving about. I don't really feel it when I am walking about it seems to be when I take the weight off my legs, sit down or lie down.

Could it be serious even though all this time has passed since it first started?. I hope I answered all the questions.

[Hallamshire Physiotherapy]

Hi
Leg pain at night from my experience is often related to neural hypoxia as you rest your blood pressure drops and the nerve loses its vascularity (a similar thing is seen in CTS at night). Try walking up/down your stairs before you go to bed and see if you sleep better. This will increase the blood perfusion around your nerves in the lower leg and might reduce your night symptoms. That might explain why you were better when you were more active.
A longterm solution will be to have your back assessed by a competent physiotherapist as you might still stand in your pregnancy posture i.e lordotic with posterior sway of your upper trunk. Thus, stressing your lower back and nerve roots. Also check your SLR with adduction of the hip and inv/ev of the foot.

Just a few thoughts. Please tell me how you got on.

Steve
Hallamshire Physiotherapy

[mart30]

Thanks Steve, this makes alot of sense, will get walking up and down the stairs immediately! Will let you know how I get on.

[physiobob]

Tend to agree with this approach. It could well be vascular. However after 9 years one would think you might have had some further investigation. e.g. some vascular investigations for the legs and also perhaps an isotopic bone scan. Both would be very useful to look for more local causes in the absence of a lumbosacral issue.

[Hallamshire Physiotherapy]

Mart

Hi
If the problem was vascular I would have thought you would have symptoms with exercise or on weight bearing-not in bed.

Steve
Hallamshire Physiotherapy

[mart30]

To be honest, I have only been to the G.P twice in the 9 years so maybe thats why there have been no further investigations, the first time was just after I had my daughter and the G.P just said it would go away, I didnt bother going back because I didnt want to make a fuss, but I had to in the last month because the lack of sleep was really getting to me this time the G.P said it was restless leg syndrome but like I said he didnt even look at my legs infact he diagnosed then flexed and extended my knee and confirmed diagnosis.. which didnt give me alot of faith in the diagnosis to be honest. Steve's post has made me think alot about it and it all fits, I ran up and down the stairs 20 times! last night and I did sleep better so thankyou.
Additional Comment I forgot:
No, no symptoms with weight bearing only when I take the weight off my legs I start to feel the pain, weight bearing seems to ease it.

[KiwiDPT]

It sounds vascular to me as well. When we stand all our muscles especially those in the lower leg constantly contract and relax as our natural sway occurs to keep us balanced. These contractions can help facilitate the movement of blood, thus helping pump blood into the area and byproducts out. Could be why you feel better standing. Do you mind me asking how old you are and what your weight is? Also any other medical history? Do cuts/blisters heal slowly on your feet? These also can be signs of vascular problems? Definitely get looked at.

[mart30]

Hi I am 29 nearly 30 and weigh 9 stone, I'm 5'2. I havent really noticed any cuts that take a long time to heal to be honest. However come to think of it I had a mild eczema on both lower legs (below the knee) which started in pregnancy as well, I have managed this with cream's so hadnt really noticed it.

[junior_physiotherapist]

..........MMM

intersting case to be follwed up! do please Mart ,tell us of what going with yours pains!

[Hallamshire Physiotherapy]

Mart

From what you say I supect the vascular structures in your legs are okay , so don't rush out and have them removed just yet.

Steve

Hallamshire Physiotherapy

[Canuck Physio]

Hi there,

Muscle pump and vascular pressures (which can be measured) are vital to understanding swelling issues related to pregnancy.

A great idea is to see a Pregnancy specialist Physiotherpist, or get in contact with Doula's or midwives, Lamaze, or La Laichi groups where individuals with similar issues can help or provide a nudge in the right direction for guidance.

Regards

[ginger]

I think Hallamshire is on the money here with a neural interpretation of this long standing problem. The most common cause of pains like these are to be found in the Lumbar spine, specifically at L3. Ongoing protective behaviour in the mid lumbar spine may or may not have it's origins in childbirth , but may persist for many years. Not uncommon also is a state of referred pain that is not matched by pains local to these irritations in the low back. I often see those for whom the only signal is a refered pain. Sounds like you would benefit from finding a physiotherapist with good hands who is capable of mobilising spinal joints. Manipulation or massage will be unlikely to be helpfull.

[naveenedin]

hi steve, hallamshire physio,
gud thinking, never realized or to be honest even thought of neural hypoxia. may i ask u, wat prompted u for neural hypoxia, considering the fact she had this pain for 9 years. If you a find a negative hard neuro on this patient, wat would be ur next step. Wat really expalins the chronicity?? We havent checked if her feet is ok or not. anyway, lady reports of decreased pain at the end, which is good.

[Hallamshire Physiotherapy]

Naveenedin

The symptoms at night and history were suggestive of neural hypoxia. I would expect to find some positive neural compliance test, but certainly some loss of movement and altered movement control in the pelvis/lumbar region.

If compiance testing was negative I would still treat the movement dysfunction in the spine and monitor the night symptoms.

Eight years with this problem is not unusual and I see many people with symptoms for 20 years plus and they have often compensated for the original problem by changing movement paterns. This is then reinforced by health professional frightening them by telling them they have 'degenerative' changes in their spine!

Steve
Hallamshire Physiotherapy

[naveenedin]

hello steve,
I appreciate your time, may i ask you a couple of questions.

thanks for your reply. What is the best treatment for neural hypoxia???. you did asked that lady, to go up and down stairs before bed. What exactly does that do. I would imagine it gives more bloodsupply to extremties, but how does tat infleunce into a neural level.

You used night pain in CTS as an analogy to this shin pain. I thought in CTS, night pain is due to stretch of median nerve during stretched(curled up) arm position, hence night splint is used. But you were saying neural hypoxia, explains the night pain in CTS.
Thanks
Naveen

[Hallamshire Physiotherapy]

Naveenedin

Sydney Sunderland (an Australian I think but don't hold that against him!) did work on the blood flow around periperal nerves many years ago and described a 'gradient' of pressure from the artery to the vein around the nerve that must be larger than the pressure in the space that the nerve passes through. Lower the pressure, for example dropping heart rate at night and hypoxia starts. The answer is increase the heart rate to increase blood pressure around the nerve or make the space larger (as in carpal tunnel release). Intesestingly people with high BP dont seem to get carpal tunnel problems as the hogh pressure ensures the nerve always gets perfused.

This patient must have a cardiovascular programme running along side physiotherapy treatment aimed at reducing possible annormal spinal loading caused by pregnancy/poor posture.


I have found this idea useful and it seems to make sense with my clinical reasoning.

[pareeves]

I am reading this thread with interest as I am new to the forum and have been suffering with consistent night time leg pain below the knee every night--strong enough to wake me from sleep. I do notice that if I get up and walk around it subsides, but comes back. I have had vein intervention treatment in Hawaii which helped a lot. I can do whatever I want during the day but my nights are becoming hard to bear. any suggestions for exercise (other than stair climbing because I don't have any) would be appreciated. thanks

[docsmom]

It has been a couple of years since the original posts, but I'm also looking for more information about shin pain at night. My 22-year-old son has a mitochondrial disease and suffers from various odd pains now and then which never seem to amount to any firm diagnosis other than "it's probably related to his disease." It's never much help to hear this since I don't know how to help him manage the pain or alleviate the problem. For the past week, he has been complaining about his shins hurting, but only in the late afternoon and evening. His leg gets stiff and he can barely walk by bedtime. He winces and cries with the pain. In the morning, he seems much better. I have been trying Acetaminophen, Advil, Aleve, and heating pads in case it's just a cramp. He seems to like the heating pad, but it doesn't seem to be alleviating anything. The Acetaminophen, Advil, and Aleve don't seem to work either. I am reluctant to spend more money on doctors because I never get answers. He is intellectually impaired and isn't much help in describing further details on the complaint. Any help or ideas would be appreciated. Thank you in advance!

[estherderu]

dear docsmom,

Without being able to help you with the diagnostic process I can give you a suggestion.

You could either try massaging his lower back or his feet.
Both are easy to do. You take some oil and rub in the direction that your son likes (check this beforehand)
and you massage/strook repeatedly until you either see the area turn a little red or feel it become nice and warm.

If he doesn't like it... do not do it.
If his feet do not become warm, tend to become white, stop... that is a sign that his body does not find this a good solution.
I wish you both well.

Esther

[workingmom]

These posts are of much interest to me since I started having pain in my legs, most noticeably in my left shin, at night and occasionally when I sit still too long. I am 55 years old, in otherwise good health, fairly low blood pressure, 5'9" tall and 155 lbs. Pain when lying down can be severe -- keeps me up and makes sleeping very difficult. Only way to deal with it that I've found is to get up and walk around which is hard when you're exhausted. Occasionally seems bearable if I lie on my stomach. I have gone to a orthopedic specialist who did an X-ray (nothing looked wrong in my leg; a little loss of cartilege in my spine), an MRI (still nothing) and then tried giving me a cortisone shot in my back. The shot didn't help at all. Pushing on that area of my shin (slightly to my right of the top of my lower leg -- there's no muscle there, just feels like bone) feels a little like a bruise and when my doctor pushed on it a lot, it hurt more. No trauma, to my knowledge. I used to run many years ago, but stopped when my knees (especially my left knee) started hurting and giving out. Doesn't feel at all like shin splints which I did have back when I ran, but this is a different kind of pain and does not hurt at all when I'm active. Please help. My doctor wants to do a bone study and a nerve study and I'm afraid I'll just be paying big bucks on a big deductible for nothing since he's basically stabbing in the dark since he is stumped. Feels like it could be related to my veins which seem a little discolored in that area but don't protude. Any ideas? I just read about running up and down stairs before going to bed, so will start trying that tonight.

[estherderu]

dear workingmom,

I would certainly consider having your veins checked first.
They do not have to protrude..and be visible...
This is not however our area of expertise....

I wish you well...
Esther