The majority of people have probably
heard of this injury referred to as “shin
splints.” However, the term shinsplint is used to describe various overuse injuries affecting both the soft
tissue and bone. One specific type of shin
splint (MTSS) is limited to the lower third of the
inside of the tibia (lower leg). The highest incidence of MTSS occurs in
runners. It typically occurs either late in the season after prolonged activity
or during the initial rigors of pre-season training.
It typically presents with pain
(recurring dull ache) and palpable tenderness along the inside of the lower
leg. Early on, you may experience pain at the beginning of a run, which is
relieved with continued activity, only to recur at the end of the session. Pain
with MTSS is usually relieved with rest. However, as this syndrome progresses
pain may be present throughout activity and rest, which makes it very important
for this type of injury to be evaluated by a health professional in order to
rule out a tibial stress reaction/fracture.
Historically, constant pulling of
the tibialis posterior tendon on the tibia has been the pathology most
suspected in the development of MTSS. Recent research, however, has implicated
facial (the envelope around a group of muscles) traction from eccentrically
contracting flexors of the leg during the mid-stance of running as the most
likely cause. These muscles contract to counteract the pronatory (foot drop)
motion of the foot and to damp the vibrations imposed on the body. This repetitive
traction is what most likely causes the injury.
Some factors contributing to MTSS
are mechanical faults and muscle imbalance such as weakness in the pelvic
stabilizers (glute med) which allows the hip to drop and the knee to drift
inward during stance. This position causes the foot/ankle to pronate.
Mechanical faults are often far removed from the site of injury and require
evaluation of the entire kinetic chain. Research has shown simple exercises
directed at pelvic stability can help correct common mechanical faults which
may lead to injury. Avoidable factors include training errors (too much, too
soon, too often), and improper footwear and training surfaces. Surprisingly,
once symptoms develop, softer running surfaces often aggravate symptoms of MTSS.
Once the injury has been
evaluated and the possibility of stress fracture is ruled out, we recommend a session of Active Release (ART) to reduce the tension and restore
tissue integrity in the affected structures. Medical acupuncture and electric
modalities can be used to help reduce pain and promote healing. A
biomechanical running analysis can be performed to identify functional weakness
in the chain which may be predisposing you to injury and to help prescribe
appropriate exercise. Footwear (shoe type and orthotics) and training program
should also be assessed and tailored to your needs. If all these areas are
addressed, recovery time and recurrence rates can be drastically reduced.
For more information about pain
occurring in the lower leg or help with one of your other injuries contact
Velocity Sports Medicine and Rehabilitation
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