- Aching along front of shin, at beginning of or after activity
- Pain along inside (medial) part of lower leg
- Generally develops gradually over weeks or months
- May have swelling in lower leg (in area of pain)
Stress Fracture - posterior
- Common, umbrella term used to identify pain along the shin or front of lower leg
- More specific names for this condition are based on the area of the pain and the anatomy involved (see below)
- Injury generally occurs as a result of overuse
Compartment Syndrome - anterior or posterior
- Most often occuring on the tibia (shin bone) and along the bottom third of the lower leg
- Often undetectable on x-ray until 10-14 days after pain starts
Tibial Periostitis - posterior
- The four divisions of muscles in the lower leg (anterior, lateral, posterior-superficial and posterior-
deep) are each covered by thick tissue called fascia that surround the muscles completely
- During exercise, muscle volume increases by 20%, increasing pressure within each compartment. Such pressure
can affect blood vessels and nerves in the lower leg potentially causing pain and damage to tissue and nerves
Medial Tibial Stress Syndrome - posterior
- An inflammation of or trauma to the covering of the bone in shin (periostium)
- Over-exertion causes small tears of the muscle from the covering of the bone (periostium)
- Pain is most pronounced in the lower 3rd of the posterior tibia
- Stress to the muscles along the front medial side of the shin
- Generally occuring along the bottom third of the inside of tibia (shin)
- Pronation is a normal movement of the foot, that allows the arch to flatten to a degree
which helps the body to absorb and adapt to different ground surfaces.
- In analyzing ones gait, first contact is on the heel and outside of the foot; followed by a shift
of the body weight continuing forward, toward the arch and toes.
- If the foot is weak or tired and/or the footwear is not supportive, then the arch can flatten
more than normal, which is excessive pronation.
- Flattening of the arch (excessive pronation) places pressure on the arch and can cause some rotation into
the lower leg. This repetitive movement can cause overuse problems from the foot to the back.
- If excessive pronation occurs from lack of support, then, increased stresses can be placed on the lower leg
and contribute to overuse problems.
TREATMENT/ADVICE GIVEN MOST IN LITERATURE
- Muscular imbalances of lower leg (calf muscles and anterior leg muscles)
- Insufficient shock absorption
- Poor Biomechanics/Improper foot positioning while running
- Worn out or inappropriate shoes
- Sudden increase in exercise or running (too much-too soon)
- Incorrect individual training plan
- Flat Pronated feet
The 3 S's - Stretching, Strengthening and Supporting - along with ICE and REST have been found to
be the simplest and most effective treatment for these injuries.
THE FOLLOWING ARE A FEW HELPFUL EXERCISES. CHECK WITH YOUR
DOCTOR FOR SPECIFICS ON YOUR CONDITION AND WHAT YOU SHOULD, OR SHOULD NOT DO FOR YOUR PROBLEM
- Stretching of the calf (both gastroc and soleus muscles) and achilles tendon.
- Strengthening of the anterior leg muscles (that pull the foot and toes up).
- Supporting the foot with proper shoes and insoles, can prevent and eliminate the vast
majority of lower leg problems due to overuse. This may be a Birkenstock sandel, with a broad base
and contoured footbed, that is low to the ground and conforms to the foot. It may also be a shoe with an upper
that wraps the foot and supports the arch and heel, thus limiting excessive pronation. The vast majority
of footwear have more than enough cushion but very little support for the arch and heel. One of the easiest
and most effective solutions is to add a simple heal over the counter insole that provides a forgiving support
for both the arch and the heel.
- Physical therapy including massage, ultrasound and exercises