bloglovin' and other thoughts

This post really has no physical therapy or fitness content. It's just a verification notice for bloglovin'. However, since I'm posting it I might as well make good use of it so here goes.

First of all, I want to give my condolences to those affect by the bombing at the Boston marathon. Tragic events indeed. I would like to say I find it hard to believe that these senseless acts happen, but it seems too commonplace nowadays. It's such a frustrating thing.

Other than that I started running again today for the first time in quite a while. I will admit that since started my masters (and completing it) I've not been as active as I have been in the past. I'm trying to take the advice that I would give my clients and ease back into things. I did a 2km run today, trying to break in some new shoes, get the feel for things. It was surprisingly cold outside today, I was ill-prepared for that.

What else? I'll be finishing part 3 of my shin splints series. you can read Part1 and Part 2 to catch up if you like. Part 1 was on the nomenclature surround the term "shin splints" and Part 2 was about the common causes. Part 3 will be on the prevention and  treatment of the condition. 

If any of you have suggestions on topics you would like to have covered than by all means contact me or write your suggestions in the comments below. I've made a little departure from writing about fitness lately. This wasn't intentional really, my interests have just been more on the physical therapy and injury side of writing lately. I'll try to give you guys a better mix in the futre. 

Ok, so now that that is covered, the link below is for the bloglovin' thing I had mentioned earlier. Cheers!

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What Are Shin Splints - Part 2

In my previous post I talked about the nomenclature surrounding shin splints. In this post I'll actually get into the nitty gritty of what shin splints are. I'll focus mainly on the most common pathologies, but if you recall from my first post, shin splints can be an all encompassing term for lower leg pain. If you have questions about anything not mentioned in this post then please comment below and I'll answer any and all questions to the best of my ability.

Medial Tibial Stress Syndrome



As I've mention in Part 1, a commonly used synonym for shin splints is Medial Tibial Stress Syndrome (MTSS). As the name suggest, it's classified as a stress along the medial (and distal) third of the tibia.

There are a number of causes of MTSS, one of which is believed to be periostitis of the tibia in response to tibial strain under load. Periostitis is inflammation of the periosteum, which is the membrane that lines outer surface of the bone, and, consequently, which which muscles will connect. Other causes may include remodelling of the perisoteum, and tendinopathy - all of which can be considered a consequence of overuse.

The muscles that are mostly involved are the tibialis posterior, tibialis anterior and the soleus. This explains why pain from MTSS is typically felt along the inferior medial border of the tibia, this is where the belly of the three muscles turn into the more fibrotic tendon and therefor the area of the most stress. As I've mentioned previously, MTSS is typically a consequence of overuse, hence why the areas of greatest pull (tendons) will be the area of greatest pain.

There are also underlying biomechanical reasons why MTSS may be present, and one of the most common being overpronation of the foot. Overpronation places added stress on the tibialis posterior and the soleus because pronation of the foot stretches the soleus and tibialis posterior. This puts them in a less then optimal alignment during running activity. Another somewhat common predisposing factor for MTSS is a narrow tibial diaphyseal width - or in layterms - a teeny tiny middle bit of the shaft of the shin. Unfornately shin width can't really be altered, but overpronation can be. I'll get into this in the treatment section later.

Tendinopathy


Another cause of shin splints is simple tendinopathy. This can expalin why some people experience pain in areas other than that of MTSS. Personally, when I get pain I feel it somewhat laterally, just below the knee. To be a little more precise, I get pain at the origin of the tibialis anterior. This is one of the other more typical areas that people describe when they say they have shin splints. This is also around the area of the origin of extensor digitorum longus. Besides the commonly felt area above, tendinitis may also appear along the anterior surface of the shin where other muscles originate or in the belly of the muscles above.


Other


Depending on the health professional you talk too there may be mother causes of shin splints, or they may classified shin splints differently depending on their personal definition. To me the above two pathologies best describe the pain of shin splints when ruling out stress fractures and compartment syndrome. inflammation of the interosseus membrane may also be a reported cause of shin splints. There are other factors that are considered to be causes or predisposing factors for shin splints. I'll simply list them.

Running downhil
Overtraining on uphill/uneven terrain
Fallen arches/overpronation
Fatigue
Short bursts of sprinting activity
Inappropriate footwear


The take home message from all of this is that shin splints can most often fall into the overuse category of injuries if you consider that compartment syndrome and stress fractures are their own separate pathologies.

In my next post I'll take about prevention and treatment of shin splints.

What do you guys think:

Would you consider shin splints to be predominantly an overuse injury?
Have you experienced shin splints? Tell me about it.
Can you think of any other causes for shin splints?

What Are Shin Splints - Part 1

Tell me if this sounds familiar. You run 3-4 days a week and for the first mile or so you feel fine then the front of your lower legs start to BURN! You push through the pain anyway to finish your run. By the time you get home all you can think about about lying down, or getting a hot bath, anything to sooth the pain in your legs. You've been getting this pain consistently for a while now and it's starting to get to the point where you can no longer run. Chances are you have shin splints. Ok, so not all cases of shin splints are severe enough to prevent you from activity, you may only get them once in a while or during the last leg of a run.


So, what are shin splints?

First of all, there is no splinting of the shin bone (tibia). This name probably derived as an adaption to an early description of the "spike soreness" by Dr. Hutchins in 1913. The term shin splints has been an area of debate, which I find silly, but science minded folk are all about debating terms. Some use it as a generic term for lower leg pain, others feel that it describes specific lower leg pathologies - typically medial tibial stress syndrome (MTSS). There has been a push to not use the term shin splints to describe the pain because of it's non-specificity, but at least it says where the pain is right? The term is so confusing to the best and brightest of us that Batt, ME decided to write an entire review on the matter, and eventually decided that the term exercise related leg pain should be used. Oh how fickle medical professionals can be.

In my opinion, shin splints are an overuse injury, somewhat akin to a tendonitis. So that's not very specific, it doesn't change how I go about treating the issue. I'm still going to analyze your gait, look at your footwear, rule out stress fractures or compartment syndrome and develop an appropriate treatment regime.

Sorry that post was a little bit of a rant. I just don't like getting to caught up on nomenclature when it has little to no effect on treatment. In my next post I'll get into the causes of shin splints.

Stay tuned for continue to Part 2 - Causes of Shin Splints

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References:

Batt ME. Shin splints–A review of terminology. Clin J Sport Med. 1995;5:53–57

Hutchins CP. Explanation of spike soreness in runners. American Physical Education Review.1913;18:31–35