SHIN SPLINTS: Physiotherapy management

It is a condition refers to activity- induced pain along the postero- medial or antero- lateral aspects of upper tibia.

CAUSES

1. Musculo- tendinitis (e.g. tibialis anterior tendinitis)
2. Stress fracture of the tibia
3. Periosteitis
4. Increased intra- compartmental pressure
5. Tibio- fibular interosseous membrane irritation

TYPES

Anterior Shin Splints : When there is activity- induced pain in the anterior aspect of upper tibia. It is due to altered biomechanical stresses i.e. hypomobility of gastocnemius muscle and weakness ofTibialis Anteriormuscle.DiagnosisIt is mostly clinical and easily be done by the physiotherapist

Posterior Shin Splint : When the activity- induced pain occurs in the posterior aspect of the upper tibia. It is basically due to strain or tendinitis of the Tibialis Posterior muscle.Generallly, it is precipitated by muscle fatigue after vigorous exercise.

When to contact a Physiotherapist

PAIN- if there is pain with the repetitive activity or after a single episode of vigorous exercise like running or aerobic dancing.With weight- bearing activies and walking. The pain will be felt in the leg- region anteriorly or posteriorly.

FATIGUE- The leg muscle get fatigued easily after a small bout of walking, running or dancing.

FUNCTIONAL LIMITATIONS1. Decreased distance and/or speed of ambulation.2. Unability to participate in the outdoor sports activity.3. Inability to wear unsupported footwear.

Physiotherapy Management

Diagnosis & further course of treatment will be based on the provocative tests according to the parts involved. The author supports the Cyriax' Approach of assessment to establish the diagnosis.'

Protection Phase

P.R.I.C.E. (Protection, Rest, Ice, Compression, Elevation)is the treatment of choice.

• Protection & Rest - Immobilize the part in a cast or a splint with the proper positioning i.i. foot should be slightly planter flexed.
• Ice pack or other therapeutic modalities must be applied as per the requirement.
• Elevate the part while resting to relieve the intrea- compartmental pressure.
• Give Cyriax massage (Cross fibre massage) to the lesion.
• Longitudinal friction massage along the length of the involved muscle.
• Support the arch of the foot through taping.

Return to function phase

• Biomechanical correction- According to the muscle involved, correct the weakness and tightness of muscles to restore the normal biomechanics.
• Mobilization of the upper and lower tibio-fibular joint.
• Train the muscles before involving again in the activities.

Patient's Column

• Getting started- Always starts a new session of running or dancing with a proper conditioning and warm- up session must not be skipped.
• Wear good quality of footwear.
• Allow time for recovery of micro- trauma after the high intensity work- outs.
• Always takes the advice of a Sports Physiotherapistif you encounter leg pain after work-outs.