Shin Splints - Medial Tibial Stress Syndrome Shin Splints By Jonathan Cluett, MD - Reviewed by a board-certified physician. Updated April 19, 2016 The term shin splints is a common misnomer in sports medicine. It does not imply a specific diagnosis, rather it is the symptom of pain over the front of the tibia (shin) bone. The pain from shin splints can be due to either problems of the muscles, the bone, or the attachment of the muscle to the bone. Therefore, 'shin splints' is simply the name given to pain over the front of the lower leg . Causes of Shin Splints The symptoms of shin splints can be caused by several conditions. These conditions include: Exercise induced compartment syndrome Shin splints are most commonly due to overuse. When the overuse causes irritation to the tendons and the attachment of these tendons to the bone, the condition is called medial tibial stress syndrome. This is what most people are talking about when they use the words shin splints as a diagnosis.

Medial tibial stress syndrome , or shin splints as most people call this problem, is commonly seen in athletes who suddenly increase their duration or intensity of training. This type of shin splints may also be seen in athletes who have very high demand training levels, such as marathon runners, even if their training levels are not dramatically increased. Some people seem more prone to development of medial tibial stress syndrome, and this can be a source of frustration for these individuals. Everyone has a different body, and each persons body mechanics differ slightly. One factor commonly implicated in causing shin splints is overpronation. Pronation occurs when the foot flattens out when weight is applied. The normal foot should flatten slightly, meaning pronation is a normal foot motion. Overpronation occurs when the foot becomes too flattened out causing the foot to roll inwards. This can cause increased demand on the muscle over the front of the leg and may lead to complaints of shin splints. Making The Diagnosis As mentioned previously, the term shin splints is not actually a diagnosis, but a group of problems that causes a typical pain. Therefore, your doctor with perform a careful medical history and physical examination to determine the cause of the shin splints.

The area of maximal tenderness may be different in patient who have different underlying problems causing shin splints. There are also physical examination tests that can help determine the cause of the shin splints. Patients with medial tibial stress syndrome typically have a dull, aching type of pain on the inside of their tibia bone. On examination, patients with medial tibial stress syndrome will often be tender over this same part of the tibia. Patients may or may not have a small amount of detectable swelling over this part of the tibia. Some specific maneuvers, especially resisted plantar flexion (pushing down of the foot against resistance), typically causes an increase of symptoms. In order to determine the underlying cause of the shin splints your physician may order tests including x-rays, MRIs, or a bone scan. The x-ray can detect fractures, and occasionally detect long-standing stress fractures . MRIs and bone scans are useful tests to determine if there are signs of a more recent stress fracture. The bone scan will detect areas of high bone turnover; these ‘hot’ areas indicate possible stress fractures or other bone problems.

Patients with medial tibial stress syndrome may also have an abnormal bone scan, but there is usually a difference that can be detected to differentiate medial tibial stress syndrome and stress fractures. Treatment of Medial Tibial Stress Syndrome Medial tibial stress syndrome is an overuse injury that will respond to simple, non-invasive treatments. That said, treatment can take time and prevent full athletic activities. This can be a source of frustration for many athletes, but the good news is that with appropriate treatment steps , there is a solution to this condition. Continue Reading Shin Splints (Medial Tibial Stress Syndrome) in Depth - Calf & Shin - PhysioRoom.com £5.99 inc VATRRP £9.49 Save £3.50 Shin Splints Explained Shin Splints is a common term for shin pain during running. It can be a misleading term and most sports medicine professionals try to avoid using it. This is because shin pain and 'Shin Splints' can be due to several different conditions. One of the most common shin conditions that is frequently labelled 'Shin Splints' is Medial Tibial Stress Syndrome.

Medial Tibial Stress Syndrome has been reported to occur frequently in military recruits, distance runners, dancers, football (soccer) players and gymnasts. Medial Tibial Stress Syndrome has been classified into two distinct types, which affect specific tissues on the inside of the shin: Type One This is characterised by a stress reaction on the inside border of the shin bone. A stress reaction is a preceding stage to a stress fracture. Type Two This is characterised by irritation of the outer surface (periosteum) of the inside of the shin bone at the point where the Soleus and Tibialis Posterior muscles attach. Regardless of the type, Medial Tibial Stress Syndrome is largely caused by over-use, with those who run regularly on hard or uneven surfaces being particularly affected. However, there are a number of factors, such as altered foot, knee and hip posture, which can make a person susceptible to the syndrome. Top of Page Shin Splints Signs & Symptoms People suffering from Medial Tibial Stress Syndrome will feel pain on the inner border of the shin (medial Tibial border) during and following exercise.

It is important to distinguish Medial Tibial Stress Syndrome from other causes of shin pain ('shin splints') such as Compartment Syndrome or a Tibial Stress Fracture. This can require a complex run through of investigations, such as bone scans and compartment pressure tests under the supervision of a sports physician or orthopaedic doctor. Wear a compression sleeve to reduce symtoms For the immediate treatment of symptoms Ice Therapy is a very effective form of pain relief (never apply ice directly to the skin). The PRICE protocol - protection, rest, ice, compression and elevation can relieve the symptoms of a painful shin. Ice Packs for a period of twenty minutes every couple of hours may help with the pain, but pain-relieving medication and Anti-Inflammatory Gel may also be necessary. Most patients respond well to non-operative treatment. This involves rest, strengthening and stretching exercises, followed by a gradual return to running after symptoms subside. In order to help prevent recurrence of the condition, a bio-mechanical analysis (an analysis of posture at rest and during walking and running) with a physiotherapist or podiatrist can be very useful.

This will pick up any factors that may be making a person susceptible to Medial Tibial Stress Syndrome, so that they can be corrected before a return to activity. Muscle imbalance and leg length inequality are frequent causes of mal-alignment that can be picked up during the physiotherapy assessment. A common cause of Medial Tibial Stress Syndrome is pes planus (flat feet) or pronated foot position (a lowered arch during running). These would be identified during bio-mechanical analysis. Over pronation is the uncontrolled lowering of the arch of the foot during running. This puts increased strain on the Tibialis Posterior muscle which pulls on the inside of the shin and can produce pain. Arch supporting Orthotics insoles can be very effective in remedying this problem. All cases of pain in the shin should be properly assessed by a chartered physiotherapist or an orthopaedic consultant as shin conditions can be made worse by continuing with exercise. The best way of maintaining fitness during this time is to use non weight bearing exercises in the swimming pool. Running without touching the bottom of the pool while wearing a Buoyancy Belt is a great method of maintaining fitness while allowing the injury to heal.

In cases of shin pain that have been investigated by a doctor and found to be a soft tissue problem, many people find that a Compression Sleeve can be an effective treatment that allows them to run. Compression sleeves work by restricting the pull of muscles in the shin, which can reduce the stresses on the shin during running. Without being a cure for Shin Splints, they can effectively reduce symptoms, allowing runners to get round. In some persistent cases of Medial Tibial Stress Syndrome that are resistant to conservative treatment, surgery may be necessary. Use the Aircast Flat Foot PTTD Brace to correct flat feet & fallen arches As with all over-use injuries, Medial Tibial Stress Syndrome is caused by doing too much, too soon. When beginning or changing an exercise programme, any increases in activity must be gradual. For example, an increase from running 2 miles per day one week to running 10 miles per day the next week cannot be undertaken without putting the body at risk of a number of problems. Maintaining a Running Log can resolve this problem. The amount of stress being placed on the shins can be minimised by wearing good quality, supportive running shoes with Shock Absorbing Insoles .

Medial Tibial Stress Syndrome can be prevented by correcting problems such as flat feet and fallen arches. The Aircast Flat Foot PTTD Brace is a support that uses aircells to lift the arch of the foot, which relieves pressure on the arch and the Tibialis Posterior Tendon. The Aircast Flat Foot PTTD Brace can be used as part of a conservative treatment if fallen arches are thought to be contributing to the shin pain. Shin Splints: Risk Factors, Prevention, and Treatment - Medical News Today Shin Splints: Risk Factors, Prevention, and Treatment Written by Tim Newman Reviewed by William Morrison, MD 4.5 22 Also known as medial tibial stress syndrome, shin splints can be painful and cause disruption to training regimes. However, they are not a serious condition and can be treated with simple home remedies. Shin splints account for an estimated 10.7 percent of injuries in male runners and 16.8 percent of injuries in female runners. Aerobic dancers are among the worst affected and have shin splint rates of up to 22 percent .

Although high impact sportspeople are at a higher risk, even walkers can develop shin splints, especially if they increase their speed or distance quickly. Despite the prevalence of shin splints, the precise mechanisms behind the condition are not known, although many of the main risk factors are now well-documented. In this article, we will look at the causes, diagnosis, and treatment of shin splints. Contents of this article: Prevention Fast facts on shin splints Here are some key points about shin splints. More detail and supporting information is in the main article. Shin splints are pains that run along the lower front of the legs, especially during or after sport Diagnosis of shin splints may involve an X-ray to rule out other causes The best treatment for shin splints is to cease the activity that caused the condition Using the appropriate footwear for sports is essential for preventing shin splints Less fit individuals and smokers are more at risk from this condition What are shin splints? Shin splints are one of the most common sporting injuries. Shin splints are pains along the shinbones that run down the front of the lower leg (the tibia). They are a common occurrence in people who indulge in activities that involve high impact stresses on the feet and legs.

Affected individuals include military personnel, dancers, and runners. Shin splints often occur when training routines are changed and the bones, tendons, and muscle tissues are overworked. Some athletes are tempted to run through the pain, but, in the case of shin splints, this will exacerbate the issue and potentially damage underlying tissues. If possible, a 2-week rest from the particular activity that caused the injury is recommended. Symptoms of shin splints The symptoms of shin splints are: Pain and tenderness along the tibia Potential swelling of the lower legs Initially, the pain will cease when exercise stops, but if the condition worsens, the pain can become constant. Causes of shin splints The exact physiological and anatomical origins of shin splints are not fully understood but are considered to involve a variety of different issues . The causes, however, are relatively clear; shin splints are most commonly associated with repetitive activities that cause stress on the shin bone and the connective tissue that attaches the muscle to the bone. It is theorized that these stresses involve inflammation of the connective tissue that coats the tibia (called the periosteum). This is called periostitis.

Many experts believe that a spectrum of tibial injuries might account for shin splints; some of these could include: Tendinopathy: a disease of the tendon. Periosteal remodeling: bone growth and regeneration. Muscle dysfunction: some muscles may be implicated in shin splints, including the tibialis posterior (inside of the ankle), tibialis anterior (running along the foot and big toe) and the soleus (lower calf). Overpronation as a cause of shin splints As far as anatomy is concerned, ankle overpronation is the greatest cause of shin splints. Overpronation of the ankle occurs when the ankle steadily moves downward and toward the center of the body. The change in position places more of the arch in constant contact with the ground. More weight is placed on the inside of the foot (medial) than the outside edge of the foot (lateral). This abnormal movement causes muscles to fatigue quicker and limits their shock-absorbing abilities.

In a study investigating shin splints in the British infantry , the authors found: "An imbalance in foot pressure with greater pressure on the medial side than on the lateral side was the primary risk factor." Risk factors for shin splints As mentioned, anyone who takes part in activities that involve high impact on the legs can suffer from shin splints. Other factors that increase the risk of shin splints include: Shin splints can normally be treated at home. Smoking and general lack of fitness Sudden increase in exercise intensity Sports played on hard surfaces involving stopping or starting suddenly (like basketball) Activities taking place on uneven ground or slopes Pre-existing muscle imbalance, including weak core muscles Wearing worn-out shoes without adequate cushioning Weak ankles Flat feet , pronation, or high arches Diagnosis of shin splints Physicians can usually make a diagnosis by discussing the patient's medical history and carrying out a physical examination. X-rays may be taken to rule out other issues that might have similar symptoms.

Medical conditions that have similar symptoms to shin splints include: Reduced blood flow in the lower leg (more common in smokers) Leg muscle bulging out of place (muscle hernia) Swelling of muscles causing nerve compression (compartment syndrome) Nerve problems in the lower back (radiculopathy) Stress fractures - small cracks in the tibia Tendinitis - inflamed tendons Effort-induced venous thrombosis - blood clot caused by exertion Popliteal artery entrapment syndrome - muscles and tendons compress a specific artery Treatment of shin splints In the most part, shin splints can be treated with simple home remedies. Remedies for treating shin splints include: Rest and recuperation: switch to lower impact activities such as swimming while the condition heals Keep the legs raised Place ice packs wrapped in towels on the affected area for 15 minutes every few hours until symptoms subside Over-the-counter medication such as ibuprofen, acetaminophen and naproxen sodium can help ease the pain Once the pain has subsided, exercise can be resumed, but it must be built up gradually to prevent a recurrence. If the pain resumes, it is best to stop the activity immediately.

Prevention of shin splints Lessen impact: consider cross-training with lower impact sports like walking or biking. Choose soft surfaces over hard if possible. Begin any new activities slowly and gradually build up intensity. Wear correct footwear: wearing the right shoes for the job is important. For runners, shoes should be replaced every 300-500 miles. Use arch supports (orthotics): these can be helpful, especially for individuals with flat arches. Strengthen the area: try toe raises to strengthen the muscles of the lower leg - slowly rise onto tip toes and back again, repeating ten times. Click the stars to rate this article Shin Splints: Risk Factors, Prevention, and Treatment Public / Patient Everything You Need to Know About Shin Splints | Injury/Pain | EXOS Knowledge | EXOS formerly Core Performance Everything You Need to Know About Shin Splints Jim Brown January 23, 2009 Overview Shin splints, also referred to as medial tibial stress syndrome or tibial pain syndrome, is a term for pain in the front or inner part of the lower leg.

Shin splints are one of the most common sports injuries and can develop in everyone from recreational runners to high school soccer, basketball and tennis players. Shin splints can involve inflamed muscles, tendons, and the thin layer of tissue that covers the bone. Although painful enough to knock you to the sidelines for a while, most cases of shin splints can be effectively treated conservatively with ice, rest, over-the-counter pain relievers and wearing (or changing) shoes that provide more protection for your feet, ankles and lower legs. How it Happens Shin splints happen over a period of time when constant pounding and stress are placed on the bones, muscles, and joints of the lower leg. The result is irritation and inflammation, both of which cause pain. Factors that contribute to shin splints may include: Running downhill – When you run downhill, your foot impacts the ground in a plantar-flexed position (toes pointed down), which puts additional stress on the muscles on the front of your shin, rather than distributing weight evenly through your foot.

Sudden increase in training frequency, duration, or intensity – Anytime you violate the 10 percent rule (do not increase training routines by more than 10 percent a week), there is a risk of injury, including shin splints. Old shoes – As your running shoes wear down, they don’t properly absorb shock and the arch support tends to flatten out. Both shoe problems, combined with flat feet, poor running mechanics, and overuse, aggravate the inflamed tissues of the lower leg. Exercising on hard or inclined surfaces – This places stress on the leg, which can cause inflammation. Previous history of shin splints – Athletes who have had shin splints are more likely to have a recurring problem with them. Failure to rehab a previous bout of shin splints – Returning to normal training too soon is a common problem among all athletes and can easily cause a setback. Flat feet, rigid arches, and over-pronation (ankles roll inward on impact) – These are examples of mechanical malfunctions that could cause pressure to be distributed unevenly on the lower legs. By the Numbers Percentage of running injuries attributed to shin splints. 60 Percentage of overuse injuries that involve the leg.

Who’s At Risk Runners are most susceptible, but shin splints often affect basketball players, tennis players, soccer players, and hikers. Also at risk are jumpers, dancers, military personnel and anyone who walks briskly, runs or jogs on hard or unfamiliar surfaces. Symptoms Pain when foot or toes are bent downward Mild swelling Tenderness (along front or inner part of the lower leg) Pain that (at first) subsides when not exercising; later, continuous pain Initial Treatment Rest (avoid activities that cause pain; cross-train with low impact activities such as pool training, bicycling or elliptical machine training) Ice (15-20 minutes at a time, four or more times a day) Compression (with an elastic wrap or compression sleeve) Elevation (prop your feet and legs up when resting and at night) Over-the-counter anti-inflammatory drugs (aspirin, ibuprofen, naproxen) Arch supports (to cushion the impact and disperse the stress) Seek medical help if pain persists for a week or more Comeback Strategy A doctor may take an X-ray or MRI to rule out a stress fracture or other causes. Rehab may take a week in mild cases and several weeks in severe cases.

When you think the problem is completely gone, take one extra day before resuming normal training. Use a foam roll to break up muscle adhesions and increase blood flow to your peroneals (outside lower leg) and soleus (between the center and outside of your lower leg).

Prehab Incorporate these prehab exercises into your comeback routine: Massage Stick/Tennis Ball – Lower Leg (self massage to the lower leg, focusing on the inside of the shin and deep in the calf) Standing Ankle Dorsiflexion Stretch in Neutral and Internal Rotation (traditional calf stretch while maintaining a good arch position with foot straight ahead and foot turned in with hips square to the wall; often people will turn their feet out and not feel much of a stretch) Eccentric Calf Raises (start with two feet calf raise, maintaining a neutral foot position raising up over 1st/2nd toe, then shift weight to one foot and slowly lower down; hold on to the edge of a counter or a bar or support; 2 sets of 10) Intrinsic Towel Crunches in Plantar Flexion (seated, starting with the ankle in front of your body with ankle plantar flexed on top of a towel; use toes to crunch up towel; 2 sets of 25 How to Avoid This Injury Avoid sudden, dramatic changes in exercise duration, intensity, frequency, and location. Replace running shoes every 300 – 500 miles. Run on softer surfaces.

Consider a pair of off-the-shelf orthotics (shoe inserts) to help prevent overpronation (ankle rolling inward). Cross-train in sports or activities that place less stress on the lower leg, such as walking, cycling, and swimming. Movement Prep Shin Splints Shin Splints on Thursday, 02 May 2013. Posted in Sporting Injuries , Acupuncture Shin Splints is the common term for anterior or medial tibial stress syndrome. It is a common lower leg injury predominantly found in those who participate in running sports. The most common aggravating factors include an increase in training volume, speed work or hill training or a change to a harder training surface. In the non-running population walking on uneven ground for long periods or foot control issues may be aggravating factors.[i] Shin Splints is an overuse injury involving strain and subsequent inflammation of the muscles of the lower leg(tibialis anterior and posterior, extensor digitorum longus and extensor hallucis longus) and their myotendinous insertions onto the tibia, the periosteum of the tibia may also be involved. Pain is usually felt shortly after the onset of activity and is easier with rest.

Pain may last into non-training days once the irritation is more established. In Medial Tibial Stress syndrome the pain is more predominant on the inner aspect of the tibia and involves the tibialis posterior muscle. It is more common in individuals who tend towards excessive pronation issues. In Anterior Tibial Stress syndrome it is the outer border of the tibia that gives the most pain and predominantly involves the tibialis anterior muscle. It occurs more frequently in individuals who have recently increased the level of hill work as the Tibialis Anterior is involved in both dorsiflexion of the foot and as a decelerator for plantar flexion. In a study involving 40 athletes with shin splints, athletic trainers from the University certified in Sports Medicine Acupuncture performed acupuncture twice a week for 3 weeks to assess the benefit to their athletes. Athletes were divided into an acupuncture group, a standard care and an acupuncture and standardized care group. Standardized care included modification of activity, ultra sound therapy, stretching and strengthening exercises in addition to cryotherapy and symptomatic anti-inflammatory medication.

In the acupuncture treatment groups local needling following modern sports medicine protocols targeting irritated tissue and hypertonic muscles combined with traditional acupuncture techniques targeting the affected acupuncture meridians were applied. To assess effectiveness of the intervention the athletes answered questionnaires prior to initial treatment and after each week of treatment. Questionnaires took note of the intensity and duration of pain during and between exercise, in addition to the amount of anti-inflammatory medication the athletes required. The athletes involved in the study did not have compartment syndrome or stress fractures which would involve medical intervention. All athletes noted an improvement in their pain levels regardless of which treatment group they were in however the acupuncture group noted the highest level of effectiveness. The amount of anti-inflammatory medication consumed during the treatment period stayed the same with the standard care group but decreased by 80% in the acupuncture group and 60% in the combined group. Less pain in sporting activities during the week was noted in 100% of acupuncture and combined treatment groups compared to only 31.3% in the standard care group.

[i] In light of this study and generally accepted guidelines for acupuncture treatment of sports injuries it is recommended that those who are interested in acupuncture for their shin pain start with 2 treatments per week for the first 3 weeks and if pain persists once weekly follow ups if necessary. W & Bong, C, (2009), The Acupuncture Handbook of Sports Injuries and Pain, Hidden Needle Press, Boulder [ii]Callison, M, (2002), Study Acupuncture and Tibial Stress Syndrome (Shin Splints), Shin splints - NHS Choices Shin splints Print this page Shin splints is the name for pain in the shins, or the front of the lower legs, usually caused by exercise. They're common in people who do a lot of running or other activities that involve repeatedly putting weight on the legs, such as tennis or basketball. They aren't usually serious, but can stop you from exercising and may get worse if you ignore them. It's important not to run through the pain. They can usually be treated at home and should start to get better within a few weeks.

This page covers: Other causes of lower leg pain Symptoms of shin splints The main symptom of shin splints is pain in the shin bones, which run down the front of your lower legs. The pain tends to: begin soon after starting exercise gradually improve when resting – sometimes the pain may fade while you're still exercising, but it can eventually become constant and continue even when resting be dull and achy to begin with, but may become increasingly sharp or severe and stop you exercising affect both shins be felt over a large part of the shin (an area over 5cm across) – pain in a small area may be caused by a stress fracture instead Sometimes there may also be some swelling. Causes of shin splints It's not always clear what causes shin splints. They're usually brought on by running or repetitive weight bearing on the legs. It's thought this leads to swelling (inflammation) of the tissue around the shin bone.

Several things can increase your chances of getting shin splints, including: a sudden change in your activity level – such as starting a new exercise plan or suddenly increasing the distance or pace you run running on hard or uneven surfaces wearing poorly fitting or worn-out trainers that don't cushion and support your feet properly being overweight having flat feet or feet that roll inwards (known as over-pronation) having tight calf muscles, weak ankles, or a tight Achilles tendon (the band of tissue connecting the heel to the calf muscle) Treating shin splints at home Shin splints can usually be treated at home.

The following may help relieve the pain and allow your legs to heal: rest – stop the activity that causes your shin splints for at least two to three weeks; you can then start gradually returning to your normal activities ice – hold an ice pack against your shins (a bag of frozen peas wrapped in a tea towel works, too) for around 10 minutes every few hours for the first few days; this helps with pain and swelling pain relief – take over-the-counter painkillers, such as paracetamol and ibuprofen , to help relieve the pain if you need to switch to low-impact activities – using a cross-trainer, cycling , swimming and yoga are good ways to keep fit without putting too much pressure on your shins while they heal You can start to return to your usual activities over the following few weeks once the pain has gone. Take care to increase your activity level gradually, building up the time you spend running or doing sports. Make sure you follow the steps to prevent shin splints outlined below to reduce the risk of the pain coming back. When to see your GP It's a good idea to see your GP if your pain doesn't improve despite the treatments mentioned above.

Your GP may: ask about your symptoms and examine your legs to try to work out what's causing your pain refer you for an X-ray or special scan of your legs – an X-ray may be normal, so a more detailed scan may be needed to help with diagnosis or identify other causes of lower leg pain refer you to a physiotherapist – they can assess your injury, show you some exercises, and recommend a suitable programme of activity refer you to an orthopaedic surgeon or a consultant in sport and exercise medicine Preventing shin splints The following measures may help reduce your chances of getting shin splints: wear trainers with appropriate cushioning and support – it may help to speak to an expert at a specialist running shop for advice if you're buying running shoes for the first time run and train on flat, soft surfaces, such as a recreation ground or playing field, whenever possible introduce any changes to your activity level gradually mix high-impact exercises like running with low-impact exercises like swimming warm up before exercising and stretch after exercising – in particular, stretching your calves and the front of your legs may help Speak to a foot specialist called a podiatrist if you have flat feet or your feet roll inwards.

They may recommend supportive inserts for your shoes (orthotics) to reduce the pressure on your shins. Other causes of lower leg pain Pain in the lower legs and shins can also be caused by: stress fractures (tiny cracks in the bone) – the pain often affects one leg, but can affect both, and is usually focused in a small area; there may also be some swelling a sprain or strain – this can cause swelling, bruising and pain that continues during rest a tendon injury – symptoms include pain, stiffness, weakness and a grating or crackling sensation when moving the affected area reduced blood supply to the legs (peripheral arterial disease) – this causes an aching pain triggered by physical activity that fades after a few minutes of rest swelling of the leg muscle (compartment syndrome) – this can cause cramping pain in the muscles that develops gradually during exercise and fades quickly at rest Page last reviewed: 08/11/2016 Shin-splints - Physiopedia, universal access to physiotherapy knowledge.

Shin-splints Search Strategy Databases: VUBis, Pedro, Google scholar, Pubmed, Orthobullets, Runnersworld Search words: “Shin Splints”, “Medial Tibial Stress Syndrome”, “Tibial Stress Syndrome”, “MTSS”, “Posteromedial Tibial Stress Syndrome”, “Anterior Tibial Stress Syndrome”, “Anterolateral Tibial Stress Syndrome”, “Chronic Exertional Compartment Syndrome”, “CECS” Definition/Description The American Medical Association defines shin-splint syndrome as “Pain and discomfort in the lower leg. It is caused by repetitive loading stress during running and jumping, and occurs in 4% to 35% of athletic and military populations. [1] The diagnosis should be limited to musculoskeletal inflammation, excluding stress fractures or ischemic disorders.” Shin-splints is a general term for overuse injuries of the lower leg, and it induced pain along the posteriormedial border of the (distal third) of the tibia over a length of at least 5 cm.

[2] [3] A synonym for shin-splints is medial tibial stress syndrome (MTSS), But Bruckner and Kahn say: “A more descriptive term that accounts for the inflammatory, traction event on the tibial aspect of the leg common in runners is medial tibial traction periostitis or just medial tibial periostitis”. Clinically Relevant Anatomy The pathophysiology of shin splints is more easily understood after examining the relevant cross-sectional anatomy. There are 4 muscle compartments in the leg: A) Anterior: this compartiment contains the tibialis anterior muscle, the extensor hallucis longus, the extensor digitorum longus and the peroneus tertius. The tibialis anterior dorsiflexes the ankle and inverts the foot. The extensor hallucis longus extends the great toe, the extensor digitorum longus extends the other toes and assists in eversion as does the peroneus tertius. B) Deep posterior: this contains the flexor digitorum longus, the tibialis posterior and the flexor hallucis longus. The tibialis posterior plantar flexes and inverts the foot.

The others are predominantly toe flexors. C) Superficial posterior: this is the gastrocnemius and soleus group; predominatly plantar flexors of the ankle. D) Lateral: this compartment contains the peroneus brevis and longus, mainly foot evertors (see figure 3). [4] A dysfunction of tibialis anterior and posterior are commonly implicated, also the area of attachment of these muscles can be the location of pain. [5] Muscle imbalance and inflexibility, especially tightness of the triceps surae (gastrocnemius, soleus, and plantaris muscles), is commonly associated with MTSS . Athletes with muscle weakness of the triceps surae are more prone to muscle fatigue, leading to altered running mechanics, and strain on the tibia. Clinicians should also examine for inflexibility and imbalance of the hamstring and quadriceps muscles. [6] Figure1: Figure 2: [7] Figure 3: [8] Epidemiology /Etiology Shin-splints is most common with running and jumping athletes who made training errors, especially when they overload or when they run too fast for their potential.

This injury can also be related to changes in the training program, such as an increase in distance, intensity and duration. [9] Running on a hard or uneven surface and bad running shoes (like a poor shock absorbing capacity) could be one of the factors related to the casualty. Biomechanical abnormalities as foot arch abnormalities, hyperpronation of the foot, unequal leg length,.. [10] are the most frequently mentioned intrinsic factors. Women have an increased risk to incur stress fractures, especially with this syndrome. This is due to nutrional, hormonal and biomechanical abnormalities. Individuals who are overweight are more susceptible to getting this syndrome. Therefore it is important that people who are overweight, combine their exercise with a diet or try to lose weight before starting therapy or a training program. These people, along with poor conditioned individuals, should always slowly increase their training level. Cold weather contributes to this symptom, therefore it’s important (even more than usual) to warm up properly. [11] Internally a chronic inflammation of the muscular attachment along the posterior medial tibia and bony changes are considered to be the most likely cause of the medial tibial stress syndrome.

[12] Characteristics/Clinical Presentation The main symptom is dull pain located along the second third of the length of the posteromedial tibia. A mild oedema in this painful area may also be present. The symptoms are often bilateral [13] . The pain is caused by repeated loanding and take-off from a hard or uneven surface [14] . This pain worsens at each moment of contact. [15] At first the patient only feels pain at the beginning of the workout, often disappearing while exercising, only to return during the cool-down period. When shin splints get worse the pain can remain during exercise. The most common complication of shin-splints is a stress fracture, which shows itself by tenderness of the anterior tibia. [16] Neurovascular signs and symptoms are not commonly attributable to MTSS and when present, other pathologies such as chronic exertional compartment syndrome (CECS) or vascular deficiencies should be considered as the source of leg pain. Bone scanning shows diffuse uptake in the affected region of the tibia. [17] [18] [19] Diagnostic Procedures The following are two conditions that are sometimes mistakenly diagnosed as shin splints.

Pain on the anterior (outside) part of the lower leg may be compartment syndrome—a swelling of muscles within a closed compartment—which creates pressure. The symptoms of compartment syndrome include leg pain, unusual nerve sensations, and eventually muscle weakness. Pain in the lower leg could also be a stress fracture (an incomplete crack in the bone), which is a far more serious injury than shin splints. The pain of shin splints is also more generalized than that of a stress fracture. Press your fingertips along your shin, and if you can find a definite spot of sharp pain, it's a sign of a stress fracture. Additionally, stress fractures often feel better in the morning because the bone has rested all night; shin splints often feel worse in the morning because the soft tissue tightens overnight. Shin splints are also at their most painful when you forcibly try to lift your foot up at the ankle and flex your foot. [22] Imaging studies are not necessary to diagnose shin-splints, but when a conservative treatment fails, it could be useful to undertake an echo. If the injury has evolved into a stress fracture, an x-ray scan can show black lines.

A triple-phase bone scan can show the difference between a stress fracture and a medial tibial stress syndrome.[7] The MRI can also exclude tumors/edemas. [23] Detmer in 1986 developed a classification system to subdivide MTSS into three types: (i) type I - tibial microfracture, bone stress reaction or cortical fracture; (ii) type II - periostalgia from chronic avulsion of the periosteum at the perios teal-fascial junction; and (iii) type ill – chronic compartment syndrome. In the recent literature. stress fracture and compartment syndrome arc qualified as separate entities. [24] Outcome Measures The MTSS score is a valid, reliable and responsive PROM to measure the severity of MTSS. It is designed to evaluate treatment outcomes in clinical studies. Winters M, Moen MH, Zimmermann WO, Lindeboom R, Weir A, Backx FJ, Bakker EW.Br J. The medial tibial stress syndrome score: a new patient-reported outcome measure. Sports Med. 2015. pii: bjsports-2015-095060.

doi: 10.1136/bjsports-2015-095060. Examination For the physical examination a good palpation of the lower leg will be necessary. The medial ridge of the tibia (origin of the tibialis posterior and soleus muscles) is often tender to palpation, especially at the distal and middle tibial regions. The anterior tibia, however, is usually nontender. Neurovascular symptoms are usually absent. Physicians should carefully evaluate for possible knee abnormalities (especially genu varus or valgus), tibial torsion, femoral anteversion, foot arch abnormalities, or a leg-length discrepancy. Ankle movements and subtalar motion should also be evaluated. Clinicians should also examine for inflexibility and imbalance of the hamstring and quadriceps muscles and weakness of “core muscles”. Core and pelvic muscle stability may be assessed by evaluating patient’s ability to maintain a controlled, level pelvis during a pelvic bridge from the supine position, or a standing single-leg knee bend. Examining patient’s shoes may reveal generally worn-out shoes or patterns consistent with a leg-length discrepancy or other biomechanical abnormalities.

Abnormal gait patterns should be evaluated with the patient walking and running on a treadmill. [25] [26] [27] [28] [29] [30] [31] [32] [33] [34] [35] [36] [37] Pelvic bridge exercise to strengthen gluteal core muscles. Courtesy: R. Michael Galbraith Medical Management Surgical treatment is rarely needed. It is indicated in the athlete who has failed one year's conservative treatment or in whom the condition is recurrent (two or more times). A posterior fasciotomy is the common procedure performed. It consists of one or more fascial incisions to relieve tension or pressure commonly to treat the resulting loss of circulation. They are often not a complete resolution but may improve symptoms of pain and function. Postoperatively patients must follow a graded rehabilitation program similar to that used in non-operative treatment. [38] [39] [40] Other treatment options include ultrasound, extracorporeal shockwave therapy, and steroid injections.

Schulze et al looked at various treatment options from application of local and systemic anti-inflammatory medicaments to physiotherapy with ultrasound, phonophoresis, and local friction. However, they concluded none of these methods has proven to be superior to the others. [41] Physical Therapy Management Shin-splints can be treated conservatively or surgically. Essentially the treatment may focus on: (a) reducing stress; (b) relieving pain; (c) providing alternative programs to maintain fitness; (d) correcting specific etiologic factors and (e) reintegration of the athlete into activity. [11] We will start with a conservative treatment: Acute phase: The conservative treatment of this injury starts with rest. A therapist will recommend you 2-6 weeks of rest. This rest should be strictly applied. Otherwise the symptoms can be worsened. Prolonged rest is not ideal for an athlete, thus other therapies are necessary for a quick and safe return after a period of rest. This rest can be assisted by medication. NSAIDs and Acetaminophen are often used for analgesia. The second thing a therapist will say is to use ice and eventually analgesic gels.

The cryotherapy can be used after exercise for a period of 20 minutes. There are a number of physical therapy modalities to use in the acute phase but there is no proof that these therapies such as ultrasound, soft tissue mobilization, electrical stimulation,.. [42] would be effective. [9] A corticoid injection is contraindicated because this can give a worse sense of health. Because the healthy tissue is also treated. A corticoid injection is given to reduce the pain, but only in connection with rest. [10] For the treatment of shin-splints it’s important to screen the risk factors, this makes it easier to make a diagnosis and to prevent this disease. In the next table you can find them [43] : Intrinsic factors Temperature Subacute phase: The treatment should aim to modify training conditions and to address eventual biomechanical abnormalities. Change of training conditions could be decreased running distance, intensity and frequency and intensity by 50%. It is advised to avoid hills and uneven surfaces. During the rehabilitation period the patient can do low impact and cross-training exercises (like running on a hydro-gym machine).).

After a few weeks athletes may slowly increase training intensity and duration and add sport-specific activities, and hill running to their rehabilitation program as long as they remain pain-free. A stretching and strengthening (eccentric) calf exercise program can be introduced to prevent muscle fatigue. [44] [45] [46] Eccentric calf stretches and strengthening exercises. Courtesy: R. Michael Galbraith Patients may also benefit from strengthening core hip muscles. Developing core stability with strong abdominal, gluteal, and hip muscles can improve running mechanics and prevent lower-extremity overuse injuries. [47] Proprioceptive balance training is crucial in neuromuscular education. This can be done with a one-legged stand or balance board. Improved proprioception will increase the efficiency of joint and postural-stabilizing muscles and help the body react to running surface incongruities, also key in preventing re-injury. [48] Another thing that can help prevent a new or re-injury is to choose good shoes with good shock absorption. Therefore it is important to change your shoes every 250-500 miles, a distance at which most shoes lose up to 40% of their shock-absorbing capabilities.

In case of biomechanical problems of the foot may individuals benefit from orthotics. An over-the-counter orthosis (flexible or semi-rigid) can help with excessive foot pronation and pes planus. A cast or a pneumatic brace can be necessary in severe cases. [49] Manual therapy can be used to control several biomechanical abnormalities of the spine, sacro-illiacal joint and various muscle imbalances. They are often used to prevent relapsing to the old injury. But manual therapy is not the only therapy that can be used; there is also acupuncture, ultrasound therapy injections and extracorporeal shock-wave therapy but heir efficiency is not yet proved. The vast majority of individuals with MTSS have significant improvement, if not complete resolution, of their symptoms with conservative management. Surgery is usually reserved for recalcitrant cases who do not respond with conservative treatment. They are often not a complete resolution but may improve symptoms of pain and function. [50] Case Studies Resources Primary resources: GALBRAITH R.M.

and LAVALEE M.E., ‘Medial Tibial Stress syndrome: conservative treatment options’, Curr Rev Musculoskelet Med.; September 2009, 2(3):127-133. (E) Craig D.I., ‘Medial Tibial Stress Syndrome: Evidence-based Prevention’, J Athl Training, June 2008; 43(3): 316-318. (A) THACKER S.B.,(2002) ‘The prevention of shin splints in sports: a systematic review of literature’ , Medicine & science in sports & exercises, the first of November 2002; 34(1):32-40. (A) PURANEN J. and ORAVA S., (1979) ‘ Athletes’ leg pain’, British Journal of Sports Medcine, Spetmber 1979; 13(3):p.92-97. (C) Secondary resources: Broos P., Sportletsels, Leuven/Apeldoorn: Garant, 1991. (p.22, 179-181).

Kjær M. et al, Sports Medicine; Basic science and clinical aspects of sports injury and physical activity, Oxford: Blackwell Publishing,2003. (p.530-535). Peterson L. and Renström Per, Sports injuries: their prevention and treatment, 3th edition, London: Dunitz, 2001. (p.11,339-342). Reid D.C. et al., Sports injury assessment and rehabilitation, New York/ London/ Melbourne/ Tokyo: Churchill Livingstone,1992. (p.269-280). BECK B., (1998) ‘Tibial stress injuries: an aetiological review for the purposes of guiding management’, Sports Medicine, 1998, 26(4) 265-279. BRUCKNER P. and KHAN K., ‘Clinical sports medicine’, 3th edition,North Ryde: McGraw-Hill, 2007(p.555-575). Chasan N., shin-splints, ( ), 2 February 2009.

Sportsinjuryclininc, shin splints, ( ), online video, last accessed, 13 October 2007. Widmark E., How to indentify, treat and prevent medial tibial stress syndrome, ( ), 2009. Clinical Bottom Line ‘Shin splints’ is a vague term that implicates pain and discomfort in the lower leg, caused by repetitive loading stress. There can be all sorts of causes to this pathology according to different researches. Therefore, a good knowledge of the anatomy is always important, but it’s also important you know the other disorders of the lower leg to rule out other possibilities, which makes it easier to understand what’s going wrong. Also a detailed screening of known’s risk factors, intrinsic as well as extrinsic, to recognize factors that could add to the cause of the condition and address these problems. [51] Recent Related Research (from Pubmed ) Personal Trainer Demographics, Current Practice Trends and Common Trainee Injuries. • Edama M, Onishi H, Kubo M, Takabayashi T, Yokoyama E, Inai T, Watanabe H, Nashimoto S, Koga Y, Kageyama I.

Gender differences of muscle and crural fascia origins in relation to the occurrence of medial tibial stress syndrome. Scand J Med Sci Sports. 2015 Dec 10. doi: 10.1111/sms.12639. • Sobhani V, Shakibaee A, Khatibi Aghda A, Emami Meybodi MK, Delavari A, Jahandideh D.Asian J. Studying the Relation Between Medial Tibial Stress Syndrome and Anatomic and Anthropometric Characteristics of Military Male Personnel. Sports Med. 2015 Jun;6(2):e23811. Doi: 10.5812/asjsm.23811. Epub 2015 Jun 20. • Department of Podiatry, Hackensack University Medical Center, Hackensack, NJ, USA. Electronic address: [email protected] Chronic Exertional Compartment Syndrome. Clin Podiatr Med Surg. 2016 Apr;33(2):219-33.

doi: 10.1016/j.cpm.2015.12.002. Epub 2016 Feb 3. • Franklyn M, Oakes B.World J Orthop. Aetiology and mechanisms of injury in medial tibial stress syndrome: Current and future developments. 2015 Sep 18;6(8):577-89. doi:10.5312/wjo.v6.i8.577. eCollection 2015 Sep 18. References ↑ Yates, Ben, and Shaun White. The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. The American journal of sports medicine. 2004; 32.3: 772-780. (Level of evidence 2B) ↑ Kudo, Shintarou, and Yasuhiko Hatanaka. Forefoot flexibility and medial tibial stress syndrome. Journal of Orthopaedic Surgery. 2015; 23.3: 357. (Level of evidence 1A) ↑ .

(Level of evidence 5) ↑ Batt, Mark E. "Shin Splints-A Review of Terminology." Clinical journal of sport medicine 5.1 (1995): 53-57. (Level of evidence 1A) ↑ Thacker SB, Gilchrist J, Stroup DF, Kimsey CD (2002). 'The prevention of shin splints in sports: a systematic review of literature'. Medicine &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp; Science ↑ Galbraith RM, Lavalee ME (2009). 'Medial Tibial Stress Syndrome: Conservative Treatment Options', Current Reviews in Musculoskeletal Medicine, 2(3), pp. 127-133 ↑ October 14, 2015/ Christye Estes, ↑ Batt, Mark E. "Shin Splints-A Review of Terminology." Clinical journal of sport medicine 5.1 (1995): 53-57. ↑ 9.0 9.1 Galbraith RM, Lavalee ME (2009).

'Medial Tibial Stress Syndrome: Conservative Treatment Options', Current Reviews in Musculoskeletal Medicine, 2(3), pp. 127-133. ↑ 10.0 10.1 Broos P (1991). Sportletsels : aan het locomotorisch apparaat. Leuven: Garant, pp. 179-181. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Reid.2C_1992 ↑ Peterson L, Renström P (2001). Sports Injuries: Their Prevention and Treatment. London: Dunitz, pp. 339-342. ↑ Reid DC (1992). Sports Injury Assessment and Rehabilitation, New York: Churchill Livingstone. ↑ Peterson L, Renström P (2001). Sports Injuries: Their Prevention and Treatment. London: Dunitz, pp. 339-342. ↑ Broos P (1991). Sportletsels : aan het locomotorisch apparaat. Leuven: Garant, pp. 179-181.

↑ Galbraith RM, Lavalee ME (2009). 'Medial Tibial Stress Syndrome: Conservative Treatment Options', Current Reviews in Musculoskeletal Medicine, 2(3), pp. 127-133. ↑ Wilder R, Seth S. Overuse injuries: tendinopathies, stress fractures, compartment syndrome, and shin splints. Clin Sports Med. 2004;23(1):55-81. (Level of evidence 4) ↑ 16. Kortebein PM, Kaufman KR, Basford JR, Stuart MJ. Medial tibial stress syndrome. Med Sci Sports Exerc 2000;32(3 Suppl):S27-33.(Level of evidence 1A) ↑ Antonios G Angoules. Medial Tibial Stress Syndrome in Athletes: Diagnostic and НerapeutLc Approach. Journal of Novel Physiotherapies. 2015;5(2).(Level of evidence 1A) ↑ Wheeless' Textbook of Orthopaedics. Shin Splints / Medial Tibial Stress Syndrome.

Available at: [Accessed 24th Aug 2008]. ↑ . (Level of evidence 5) ↑ . (Level of evidence 5) ↑ Broos P (1991). Sportletsels : aan het locomotorisch apparaat. Leuven: Garant, pp. 179-181. ↑ Moen, Maarten H., et al. Medial tibial stress syndrome. Sports medicine. 2009; 39(7): 523-546. (Level of evidence 3A) ↑ Beck B (1998). 'Tibial stress injuries: an aetiological review for the purposes of guiding management', Sports Medicine, 26(4), pp. 265-279. ↑ Kortebein PM, Kaufman KR, Basford JR, Stuart MJ. Medial tibial stress syndrome. Med Sci Sports Exerc 2000;32(3 Suppl):S27-33.(Level of evidence 1A) ↑ Wilder R, Seth S. Overuse injuries: tendinopathies, stress fractures, compartment syndrome, and shin splints.

Clin Sports Med. 2004;23(1):55-81. (Level of evidence 4) ↑ Moen, Maarten H., et al. Medial tibial stress syndrome. Sports medicine. 2009; 39(7): 523-546. (Level of evidence 3A) ↑ Fredericson M. Common injuries in runners. Diagnosis, rehabilitation and prevention. Sports Med. 1996;21:49–72. (Level of evidence 4) ↑ Galbraith RM, Lavalee ME (2009). 'Medial Tibial Stress Syndrome: Conservative Treatment Options', Current Reviews in Musculoskeletal Medicine, 2(3), pp. 127-133. ↑ Strakowski J, Jamil T. Management of common running injuries. Phys Med Rehabil Clin N Am. 2006;17(3):537–552.(Level of evidence 2A) ↑ Dugan S, Weber K. Stress fracture and rehabilitation. Phys Med Rehabil Clin N Am.

2007;18(3):401–416. (Level of evidence 3A) ↑ Sommer H, Vallentyne S. Effect of foot posture on the incidence of medial tibial stress syndrome. Med Sci Sports Exerc. 1995;27:800–804. (Level of evidence 3A) ↑ Niemuth P, Johnson R, Myers M, Thieman T. Hip muscle weakness and overuse injuries in recreational runners. Clin J Sport Med. 2005;15(1):14–21. (Level of evidence 1A) ↑ Greenman P. Principles of manual medicine. Philadelphia, PA: Lippincott Williams &amp;amp;amp;amp;amp; Wilkins. 2003;3(11):337–403, 489. . (Level of evidence 1A) ↑ Howell J. Effect of counterstrain on stretch reflexes, Hoffmann reflexes, and clinical outcomes in subjects with plantar fasciitis. J Am Osteopath Assoc. 2006;106(9):547–556.

(Level of evidence 1B) ↑ Karageanes S. Principles of manual sports medicine. Philadelphia, PA: Lippincott, Williams and Wilkins. 2005: 467–468. Level of evidence 1A) ↑ Yates B, Allen MJ, Barnes MR. Outcome of surgical treatment of medial tibial stress syndrome. J Bone Joint Surg Am. 2003;85-A(10):1974-80. (Level of evidence 4) ↑ Yates B, Allen MJ, Barnes MR. Outcome of surgical treatment of medial tibial stress syndrome. J Bone Joint Surg Am. 2003;85-A(10):1974-80. (Level of evidence 4) ↑ Holen KJ, Engebretsen L, Grontvedt T, Rossvoll I, Hammer S, Stoltz V. Surgical treatment of medial tibial stress syndrome (shin splint) by fasciotomy of the superficial posterior compartment of the leg. Scand J Med Sci Sports. 1995;5(1):40-3.

(Level of evidence 1A) ↑ Moen M, Holtslag L, Bakker E, et al. The treatment of medial tibialfckLR stress syndrome in athletes; a randomized clinical trial. BMC SportsfckLR Science 2012;4:12 . (Level of evidence 1A) ↑ Beck B (1998). 'Tibial stress injuries: an aetiological review for the purposes of guiding management', Sports Medicine, 26(4), pp. 265-279. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named Thacker.2C_2002 ↑ Dugan S, Weber K. Stress fracture and rehabilitation. Phys Med Rehabil Clin N Am. 2007;18(3):401–416. (Level of evidence 3A) ↑ Couture C, Karlson K. Tibial stress injuries: decisive diagnosis and treatment of ‘shin splints’. Phys Sportsmed. 2002;30(6):29–36.(Level of evidence 3) ↑ DeLee J, Drez D, Miller M.

DeLee and Drez’s orthopaedic sports medicine principles and practice. Philadelphia, PA: Saunders. 2003:2155–2159.(Level of evidence 1A) ↑ DeLee J, Drez D, Miller M. DeLee and Drez’s orthopaedic sports medicine principles and practice. Philadelphia, PA: Saunders. 2003:2155–2159.(Level of evidence 1A) ↑ DeLee J, Drez D, Miller M. DeLee and Drez’s orthopaedic sports medicine principles and practice. Philadelphia, PA: Saunders. 2003:2155–2159.(Level of evidence 1A) ↑ Galbraith RM, Lavalee ME (2009). 'Medial Tibial Stress Syndrome: Conservative Treatment Options', Current Reviews in Musculoskeletal Medicine, 2(3), pp. 127-133. ↑ Galbraith RM, Lavalee ME (2009). 'Medial Tibial Stress Syndrome: Conservative Treatment Options', Current Reviews in Musculoskeletal Medicine, 2(3), pp. 127-133.

↑ Cite error: Invalid <ref> tag; no text was provided for refs named x6 8. Wheeless' Textbook of Orthopaedics. Shin Splints / Medial Tibial Stress Syndrome. Available at: [Accessed 24th Aug 2008]. Lower Leg Injuries and Conditions › Sports Medicine at UConn Health My Team My Injury Imaging My Surgery My Treatment Research Lower Leg Injuries and Conditions Lower leg injuries come in many forms. Forces from foot-strike radiate up the leg. Many of the foot and ankle muscles start in the lower leg. These injuries can be painful and difficult to diagnose and treat. With our expert team of Sports Medicine providers, we are able to diagnose and treat even the hardest problems. The UConn Musculoskeletal Institute offers a comprehensive approach to lower leg problems ï¿½ from diagnosis and treatment to rehabilitation and recovery, including fasciotomies and tendon repairs to state of the art Achilles tendon treatments. The staff includes licensed physical therapists who work closely with the physicians to provide the latest treatments for injuries. We have certified orthotists available if custom orthotics or braces are required.

Our Services Our sports medicine team is able to care for all problems from stress fractures to tendon tears. We have the capability to diagnose and treat all aspects of sports related lower leg injuries in athletes and dancers. This includes the fully trained support staff of our Sports Medicine program. Common Lower Leg Problems Compartment Syndrome Chronic exertional compartment syndrome (CECS) is a condition that can occur from repetitive loading or exertional activities. CECS is usually observed in athletes; long-distance runners, basketball players, skiers, and soccer players. It can occur in any of the four lower leg compartments but the anterior compartment is the most common. CECS is characterized by exercise-induced pain that is relieved by rest. In some cases, weakness and/or numbness occur as well with exercise. The onset of symptoms typically occurs at a specific exercise distance or time interval (e.g., within 15 minutes of initiating a run). Symptoms subside with rest and are minimal during normal daily activities but return when activity resumes. The diagnosis of CECS is one of exclusion, based on the clinical history, the physical examination findings, and the exclusion of various differential diagnoses. Compartment pressure readings with and without exercise are the gold standard for the diagnosis of CECS.

Compartment pressure testing must be performed under sterile conditions. The needle tip location, the depth of penetration, and the knee and ankle position are controlled to obtain reliable measurements. The anterior, lateral, and superficial posterior compartments are relatively easy to test; testing the deep posterior compartment is more difficult. Complications from testing, though low, include bleeding, nerve injury, acute compartment syndrome, and infection. Our method of testing is to measure the resting compartment pressure, exercise the patient until a symptomatic level is reached, and then measure again, at one minute and five minutes post-exercise. The criteria for the diagnosis of CECS in the leg is one or more of the following: A pre-exercise/rest pressure of 15 mm Hg or higher A one minute post-exercise pressure of 30 mm Hg or higher A five minute post-exercise pressure of 20 mm Hg or higher Although the diagnosis of CECS can be made if just one of the above criteria is met, the greater the number of criteria that are satisfied, the greater the confidence level of the diagnosis. Stress Fracture A stress fracture of the lower leg is an overuse injury.

It can be difficult to diagnose due to vague discomfort and generalized pain over the muscles of the lower leg and are often misdiagnosed as shin splints. They come on slowly over time from repetitive trauma to the muscles and bones, often due to overuse. They occurs when muscles become fatigued or overloaded and cannot absorb the stress or shock of repeated impacts and start to break. Fatigued lower leg muscles transfer that stress to the nearby bone and the result is a small crack or fracture in the bones of the lower leg often not seen on plain radiographs (x-rays). Medial Tibial Stress Syndrome (Shin Splints) Medial tibial stress syndrome (MTSS) or shin splints is a common injury that affects athletes who engage in running. This condition is characterized by pain in the lower part of the leg between the knee and the ankle. MTSS is caused by repeated trauma to the connective muscle tissue surrounding the tibia (shinbone). Ignoring this injury may result in a more serious condition such as a stress fracture of the bones. Periostitis Periostitis is a condition caused by inflammation of the periosteum, a layer of connective tissue that surrounds bone.

The condition is generally chronic and needs to be differentiated from stress fracture or shin splints, and is marked by tenderness and swelling of the bone and an aching pain. Correcting underlying hip weakness, running mechanics, improper shoes, and other problems can correct this problem. Popliteal Artery Entrapment Syndrome Popliteal artery entrapment syndrome (PAES) occurs due to an abnormal positioning of the popliteal artery in relation to its surrounding structures. These abnormal positioning can produce extrinsic compression of the popliteal artery and cause vascular damage. Diagnostic delay is common because this problem usually occurs in younger patients, and mimic stress fractures and compartment. Most commonly, PAES is found in young athletes with well-developed muscles, because the exercise and enlargement of muscles adjacent to the popliteal artery exacerbates the consequences of the anomalous relationship between muscle and artery. Mitochondrial Myopathy Mitochondria are responsible for producing most of the energy thatï¿½s needed for our cells to function. A mitochondrial disease can shut down some or all the mitochondria, cutting off this essential energy supply.

The exact symptoms arenï¿½t the same for everyone, because a person with mitochondrial disease can have a unique mixture of healthy and defective mitochondria, with a unique distribution in the body. Because muscle cells and nerve cells have especially high energy needs, muscular and neurological problems ï¿½ such as muscle weakness, exercise intolerance, trouble with balance and coordination ï¿½ are common features of mitochondrial disease. A mitochondrial disease that causes prominent muscular problems is called a mitochondrial myopathy (myo means muscle, and pathos means disease). Despite their many potential effects, mitochondrial diseases sometimes cause little disability. Sometimes, a person has enough healthy mitochondria to compensate for the defective ones, so exercise is the only time symptoms are present. Muscle Cramps (Night Cramps) A muscle cramp is a sudden and involuntary contraction of one or more of your muscles. They can cause excruciating pain. Often harmless, muscle cramps can make it temporarily impossible to use the affected muscle. Long periods of exercise, particularly in hot weather, may lead to muscle cramps. Some medications and certain medical conditions also may cause muscle cramps. Achilles Tendonopathy Achilles tendonopathy is pain in the lower leg along the tendon behind the ankle caused by overuse.

It can lead to thickening of the tendon from improper healing. The pain is slow in onset and eventually will be too painful to exercise and can cause the tendon to rupture. There are many new and exciting treatments to fix this problem. Calf Muscle Tear Calf muscle tears is a sudden pain that occurs in the calf muscle during activity which causes injury to the muscle. This injury is called a calf strain. It occurs when part of the muscles of the calf (gastrocnemius or soleus) are stretched beyond their ability to withstand the tension and tear. This stretching can result in small microtears to the muscle fibers or, a more severe injury, a complete rupture of the muscle fibers. Plantaris Tear Although the plantaris has little importance in the lower leg, there are injuries that can occur, which can cause disability and pain. Tennis leg is a common name for the injury. It is a result of an eccentric load placed on the ankle while the knee is extended, and occurs while running, cutting or jumping. It may be caused by direct trauma to the calf area. Pain and swelling are common in the injury. Achilles Tear Achilles tendon rupture is a common injury that can cause severe disability.

It is often missed in the emergency room due to the swelling. It happens frequently pushing off to cut in the opposite direction in tennis or basketball, but it can happen in any sport with change of directions like soccer or lacrosse. Tendonopathy can predispose people to tears. It happens more often in 30 and 40 year old athletes but can happen at any age after puberty. Treatment can be surgical or non-surgical but it is important to get treatment early.

Question: In humans, ‘medial tibial stress syndrome’ is the medical term for which sporting injury?
Answer: Shin splints