Splints
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Shin splits are typical categorized as an overuse leg injury. This is because they are usually seen in runners and athletes who increase their running or activity. It is a pain on the lower part of the leg located next to the shinbone (tibia). It is caused by stress on the shinbone and tissue that attaches the muscle to the bone. Another name for shin splints is medial tibial stress syndrome. Shin splints are very common in both new and experienced runners. They can be caused by many different factors but luckily most people experience a full recovery after the proper shin splint treatment plan.
The pathophysiology of shin splints is irritation of the periosteum (the outer layer of the cortical bone) and swollen muscles due to excess running or walking. Most common causes iinclude: overpronation which causes the arch in the foot to collapse and puts extra stress on the legs; poor shock absorption which increases tibial shock (stress to the bone and the muscles decelerating the body progression. Another common reason is excessive vertical oscillation during running. Typically runners who increase their mileage are at the most risks for shin splints. They can also be caused by running downhill, on uneven or hard surfaces, or from wearing old worn out shoes or simply wrong shoe for their foot type. Another source of shin splints is poor biomechanics. Whatever the reason there is many effective forms of rehab that can help heal shin splints and prevent them in the future.
The first sign of a shin splint is pain below the knee on the front outer part of the leg. The pain usually starts while doing an activity such as running. The amount of pain can range. Sometimes runners can continue through the pain and other times the pain is so extreme they need to stop. The symptoms also include tenderness and soreness on the inner part of the leg, moderate swelling, and sometimes the feet begin to feel numb because the swollen muscles begin to irritate the nerves. These symptoms can occur in both new and experienced runners.
Shin splints can have similiar symptoms as stress fracture of anterior compartment syndrome.Clinical evaluation and radiologic evaluation may be necessary in severe cases.
The diagnosis of a shin splint starts with a physical exam and thorough look at the patient’s history. If the doctor suspects stress fractures a MRI or X-ray will be prescribed. Typically the pain is in the front outer edge of the leg, right around the tibia bone. Sometimes there is also swelling around that area. These signs are all used to help diagnose shin splints. Also used to diagnose the cause of the shin splint is gait and running analysis. These tests are important for finding causative biomechanical faults and preventing shin splints in the future.
If you start to experience signs of shin splints the first step is to rest and take a few days off from activity. Also icing the shin for 10 minutes after activity can help keep the swelling down and reduce pain. You can still be active but only with low impact activities such as swimming or biking. Replacing old running shoes could help solve the problem in mild cases. With mild cases taking anti-inflammatory medications along with icing and rest can heal the shin splints but in order to prevent them from coming back proper strengthening and stretching need to be done. In more severe cases that involve stress fractures of the tibia a more involved treatment needs to done. When biomechanics are the cause then the type of treatment needs to be very specific to the patient and their biomechanical faults. Computerized gait and running analysis may be necessary.
Also extracorporeal shockvawe therapy has proven to be an excelent choice for this condition. High frequency sound waves such as shock waves have regenerative effect to chronicly overused soft tissue especially at soft tissue bone interface. It acts by bringing new blood vessels to the area of chronic blood supply deficit.
The severity of the injury will determine the recovery rate and progress. Typically people have full recoveries from shin splints, if the right treatment plan is followed and preventive measures are taken.
There are a few simple things you can do to prevent shin splints. The simplest thing to do is get a proper pair of running shoes which match your foot type. Cross-training with low impact sports such as swimming can also reduce the chances of shin splints. Adding strength training and eccentric stretching to your regular workout routine can prevent them as well. There are specific exercises which runners should perform on regular basis in order to keep muscle balance in the foot and the leg. Most importantly the Increase in milage should be do e gradually so that tissue loading rates are not exceeded.
and a faulty diagnosis can make treatment a total waste of time.
Failure to accurately diagnose a condition in its early stages can lead
to chronic problems and sometimes devastating results.
Diagnostic musculoskeletal sonography (MSUS) provides the perfect tool for the rehab practitioner. Yet many doctors and physical therapists have no experience with MSUS, are unaware of its advantages, and have no idea how to use it as a diagnostic tool.
Below is a prime example of how ultrasound can take the guesswork out of diagnosis.Successful Treatment
A bad physical therapy experience is one of the primary causes of unnecessary surgery.
We have equipped our clinic with the latest research-grade technology to arrive at objective and accurate diagnoses, and to objectively measure our patients’ progress.
Most importantly, we are the only facility in the US where structural medical diagnosis is reflected in functional treatment, and vice versa.
In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.
Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.
The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.
Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup
Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)
Complete tear of rectus femoris
with large hematoma (blood)
Separation of muscle ends due to tear elicited
on dynamic sonography examination
