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Download Shin Pain - SPARCC Tucson
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MoMortazavi,MD (520)222-8076 www.sparcctucson.com ShinPain Whatisshinpain? Shinpainisexperiencedonthefrontofthelowerleg,belowthekneeandabovetheankle.Itcanhurtdirectly overtheshinbone(tibia)oroverthemusclesthatareontheinneroroutersideofthetibia.Shinpainisoften referredtoasshinsplints,butnotallshinpainisnecessarilycausedbyshinsplints. Thepainmaycomefromirritationofthemusclesandthetissuesthatconnectthemusclestobone,froma stressreaction/fracture,orfromincreasedpressurearoundthemusclesinthelowerleg.Thefollowingare differenttypesofshinconditions. • Medialstresssyndrome(shinsplints):Occurswhenthemusclesthatattachtotheinnersideofthe shinboneareinflamed.Asimilarprocesscanoccurovertheoutersideoftheleg. • Stressreaction/fracture:Stressreactionisinflammationintheboneandmaybeaprecursortoa stressfracture.Astressfractureisahairlinecrackinoneofthelowerlegbones,thetibiaorfibula. • Compartmentsyndrome:Themusclesinthelowerlegaresurroundedbyconnectivetissueinto compartments.Whenacertaincompartmentisoverusedthemuscleswillbecomepainful. SignsandSymptoms Symptomsincludepainoverthefront,inner,orouterpartsofyourlowerleg.Painmayoccurduringexercise, atrest,orboth. • Shinsplintssymptoms:painandtendernessinabroadareaalongtheedgeoftheshinboneand surroundingmuscleswilloccur.Thispainistypicallyworseatthebeginningofactivityandshortlyafter running,butmayworsentothepointthatitistoopainfultobeginworkoutsatall. • Stressfracturessymptoms:Paindirectlyovertheshinbone.Itwillhurttotouchthepartofthebone thatisfractured.Stressfracturesofthefibulawillcausepainontheoutersideofthelowerleg.This painistypicallyminoratthebeginningofactivityandworsenswithincreasedactivity/movement. • Compartmentsyndromesymptoms:Themusclesinthelowerlegwillbepainful.Thispainalsotends togetworsethelongeranathleteisactiveorrunning.Bloodvesselsandnervesinthelowerlegmay becomeirritatedifthemusclesinthiscompartmentswellduringexercise,causingthefoottobecome weak,numborcold. Howdowetreatshinpain? Treatmentyourhealthcareteamsuggestscouldinclude: • Ice:Applyingicepackstotheshinfor30minutesevery3to4hoursfor2or3daysoruntilthepain goesaway. • Icemassage:FreezewaterinaStyrofoamcup,thenpeelthetopofthecupawaytoexposetheiceand holdontothebottomofthecupwhileyourubiceovershinfor5to10minutes. • Medicine:Anti-inflammatorymedicinemayberecommendedandprescribedbyyourhealthcare provider. • • • • Supportiveshoes:Wearingthepropershoesrecommendedforyoursportisaveryimportantpartof thetreatment.Inrarecases,archsupports(orthotics)mayberecommendedtohelpcorrectoverpronation(whenthearchofthefootcollapses). Rest:Thisisextremelyimportantandthelengthofrestdependsontheseverityofthecondition. Castingandcrutchesmayalsobeapartoftreatmentifthereisastressfracture. Rehabilitationexercises:Physicaltherapistswillguidethepatientthroughwhatstepsshouldbetaken toensureasuccessfulreturntosportsandwillrecommendotheractivitiestohelpthepatientduring recovery. Surgery:Occasionallysurgeryisneededforyoungathleteswithcompartmentsyndrome.Thetissues whichformthecoveringofthecompartmentsareopeneduptoreducethepressureinthe compartments.Rarely,tibialstressfracturesalsoneedsurgery. Everyonerecoversfromaninjuryatadifferentrate.Returntoactivitieswillbedeterminedbyhoweach particularchild’slegrecovers.Ingeneral,thelongersymptomsarepresentbeforetreatmentisstarted,the longeritwilltaketogetbetter.Thegoalofrehabilitationistogetyoungathletesbacktotheirnormal activitiesassoonasit’ssafelypossible.Returningtoosoonyoumayworseninjuries. Whogetsit,andcanitbeprevented? Themostcommoncauseofalloftheseconditionsinyoungathletesisbeingoveractive.Theseshinconditions aremostcommoninrunnerswhoincreasetheirmileageorintensityoftheirrunning,orchangethesurface onwhichtheyarerunning. Othercontributingfactorstothedevelopmentoftheseconditionsincludetightmusclesinthelowerlegand ankle,failuretowarm-upproperlybeforephysicalactivity,impropershoewear,cigarettesmokinganduseof certainmedications. Keystopreventionincludegradualreturntoactivities,propershoewear,properstretchingandwarm-up beforeplay,runningonsoftersurfaces,recognizingsymptomsandstoppingactivityifpaincomesback. References: Children’sHospitalColoradoSportsMedicineProgramforyoungathletes AmericanAcademyofPediatrics AmericanMedicalSocietyofSportsMedicine SPARCCSportsMedicine&ConcussionCare ShinPain ExercisesforShinSplints GeneralStretchingInstructions • Holdfor30-60seconds • Restandrepeat • Do2sessionsperday GastrocnemiusStretch • Standfacingaflatstablesurface • Droponelegbackwhilekeepingthekneestraight,feetforward • Leanforwarduntilstretchisfeltintocalfareaofbackleg SoleusStretch • Standfacingaflatstablesurface • Droponelegbackwhilekeepingthekneebent,feetforward • Sitbackuntilstretchisfeltintocalfareaofbackleg Excursions • Standononeleg • Keepingbackandkneestraight,bendfromthehipsandtouchobjectonground • Returntothestartingposition • Trytotapfor30seconds,restandrepeat StandingBandPullAcross • Standononelegwithbandonopposite • Keepingbackandkneestraight,swingtheotherleginfront ofthebody • StandingBandPullOut • Standononelegwithbandonopposite • Keepingbackandkneestraight,swingtheotherlegoutaway fromthebody • Trytoswingfor30secondseachandrepeat SafetyGuidelines • Stopanyoftheseexercisesiftheyresultinincreasedorchangedpainthatdoesnotimmediately resolve • Allmotionsshouldbecontrolledandneverresultin“jerky”motions ©2002-2009LEED,Inc. SPARCCSportsMedicine&ConcussionCare ShinPain
