What are Shin Splints?

 

What are Shin Splints? Shin Splints is a common term used among people to describe a pain in the leg in and around the area of their shin bone. A more specific diagnosis must be made however to successfully treat the symptoms. The traditional clinical use of the term shin splints is to describe medial tibial stress syndrome, pain on the lower inside of the leg. Often people use it as a term to describe pain and swelling of the muscles to the outside of the shin (anterior compartment syndrome) as well.

 

Chronic symptoms of shin splints may lead to stress fractures so symptoms must not be ignored if they continue to persist. Abnormal biomechanics may lead to a greater risk of pain around the shin bone. A high rigid arch effects shock absorption increasing the forces on the bone. In individuals whose arches fall from normal into a flattened position (excessive pronation) overuse, fatigue and excessive pull of the muscles that support the arch can lead to medial tibial stress syndrome, otherwise known as ‘shin splints.’

 

Weakness of the tendons or ankle instability from previous sprains may also contribute to overuse of muscular and tendinous structures leading to shin splints. Tight calf muscles can also lead to shin pain, excessive tightness can prevent normal ankle movement increasing the load on muscles surrounding the shin.

 

A full history and physical examination including biomechanical assessment with reproduction of symptoms is needed to find the true cause of the symptoms, so a progressive rehabilitation programme can be implemented.

 

Treatment may consist of reducing the repetitive training load, stretching and loosening out tight muscles such as the calves and improving strength. If it is a chronic issue, training to improve shock absorption will be required through altering running mechanics. Assessing and treating the origin of the problem is the key to full recovery.

 

Catherine Simpson

MISCP, MSc. Sports Medicine

www.sportsphysioireland.com

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High Hamstring Pain

Runners and sometimes field based athletes can present with lower buttock pain in the clinic. This can reduce performance and be painful carrying out normal daily activities. After assessment, this is usually diagnosed as a proximal hamstring tendinopathy.

A proximal hamstring tendinopathy is when the tendon that inserts into the bony point of the bottom, the ischial tuberosity, gets overused and causes structural changes in the type of collagen present in the tendon. This can cause pain to the bony area, especially with sitting on hard surfaces, in cars, etc.

The main symptoms are:

  • pain on running activities,
  • pain when sitting down, especially on hard surfaces,
  • pain when flexing the hip e.g. putting on a sock.

 

In a clinical setting, the main reasons behind development of the tendon issue is due to overload of the tendon i.e. the tendon has been asked to do too much work for it’s ability to recover. So the typical story of a patient who presents with high hamstring pain is how they felt great during their runs over the preceding weeks and decided to increase the volume or intensity of their runs, or sometimes both! Another factor that may cause the issue to develop is hill running, which causes the hamstring muscles to come under increased eccentric stress, leading to tightened hip flexors, which in turn will contribute to the hamstrings working harder.

It’s important to get the region properly assessed to rule out other pathologies such as: lumbar referral, bursitis of the ischial tuberosity, glute max pain, sciatic nerve irritation, referral from the hip joint.

 

The best solution short term is to reduce and avoid the causing factors until the pain has subsided and get a proper assessment from one of the team to get a good structured rehabilitation programme under way..

 

Thomas Divilly

MISCP CSCS


Chronic Ankle Instability

Chronic ankle instability is an encompassing term used to classify an individual who presents with both mechanical and functional instability of the ankle joint following an initial lateral ankle sprain injury.

 

Mechanical Instability refers to measurable laxity of the ligaments, i.e. ligaments that are less stiff following injury, with some joint restrictions and synovial changes. Functional Instability is the lingering feeling of giving way or unsteady feeling which is generally attributed to neuromuscular and proprioceptive deficits.

 

Research has identified a number of potential reasons for long term issues with ankle instability after a sprain. One theory is that the ankle proprioception, where the joint is in space, is impaired creating an impaired reflex arc of the muscles that help stabilise the ankle joint. Swelling of the joint can cause the feedback system of the ankle joint to also alter and cause long term neuromuscular deficits.

 

So clinically, what can we do to help and reduce this occurring?

 

  • Reduce pain and swelling of the joint
  • Loading in functional tasks as soon as possible e.g. walking, running, cutting
  • Establish baseline strength and power
  • Improve proprioception of the ankle joint
  • Practice tasks that are important to your need
    • Cutting
    • Agility
    • Deceleration
    • Landing/jumping mechanics

 

Thomas Divilly

M.I.S.C.P., C.S.C.S.


Major Injuries in Female Athletes Part 1 – The ACL

The most common cause of prolonged absence from sport is anterior cruciate ligament (ACL) injuries. Although ACL injuries occur in males and female, the incidence within female athletes is much higher.

The ACL is an important ligament within the knee and controls rotational movement. Most ACL tears occur when a person is landing from a jump, pivoting or decelerating suddenly. These non-contact ACL injuries generally occur because of insufficient control around the hip, knee and ankle. ACL tears rarely occur in isolation and there is often associated injury to other structures in the knee.

Lower limb injuries are the most common type of injury in running sports. In these sporting populations muscular injuries are more likely in male athletes, whereas female athletes have a higher incidence of ligament injuries. Possible reasons for higher levels of ACL injuries in females are that:

  1. Females have a wider pelvis creating greater angles of stress between the knee and the hip.
  2. Females tend to have a higher level of flexibility and ligament laxity then male (this is especially true at certain times of the month due to hormone changes).

This results in the joints having the ability to move through a greater range of motion, placing the ligaments under more stress. The muscles around these joints need to be strong enough to control this range of motion during rapid activities and changes in direction.

Looking at this hypothesis, do females need to have more muscular control then males to prevent serious ligament injuries; the answer is most likely yes!

We are now living in an era of injury prevention not just injury management. Basic conditioning programmes such as the FIFA 11+ has been implemented into warmup routines in many different sports. Research is showing that training and improvement of muscle control and joint proprioception is reducing the incidence of ligament injuries most notable ACL injuries in female athletes.

Catherine Simpson MISCP MSc. Sports Medicine


MCL Injuries

We recently seen Karl Lacy tog out and play against Mayo with heavy taping on his leg to protect a recent Medial Collateral ligament (MCL) injury.

The medial collateral ligament is a band of tissue that connects the thighbone to the lower leg and helps prevent the knee from buckiling inwards. It can be injured when twisting or landing or when a standing leg is tackled from the outside forcing it to buckle inwards.

Initial management should be

  • Compress with a bandage
  • Use crutches to take the weight off
  • Apply ice pack

What are the symptoms?

  • Swelling.
  • Pain.
  • Local tenderness on the inside of the joint.
  • Bruising.

Specific tests and scans can diagnose the extent of the damage and the length of time the player will be out of action for. In Karl’s case, he obviously needed more time to regain 100% confidence in his ability the twist and turn to make those turn overs he has been famous for over the past few seasons.

Mild or Grade 1 injuries usually get better in 1 to 3 weeks and may only needhome treatment along with using crutches for a short time.

Moderate or Grade 2 injuries usually get better in about a month. You may need to wear a hinged knee brace and limit how much weight you put on your leg.

Severe or grade 3 injuries may require wearing a hinged brace for a few months, and limiting weight on the leg for 4 to 6 weeks.