yogabook / pathologie / shin splints syndrome

shin splints syndrome, shin splints, medial tibial stress syndrome (MTSS), tibial crest syndrome

Definition of

Pain phenomenon on the inner edge of the tibia, probably mostly tendinitis and/or periostitis (periosteal irritation) on the medial tibia, usually affects the soleus or posterior tibialis area, also flexor digitorum longum and flexor hallucis longus. Possibly also mild compartment syndrome: if you start training again, the muscles grow faster than the fascia adapts (up to 15 times the volume during training compared to rest), which leads to an excessive increase in pressure and compression up to ischemia. The compression-induced blood congestion leads to tissue edema and further increased pressure. Up to 20% of all training absences of runners are due to tibial plateau syndrome. Mostly affects runners, dancers and soldiers. In addition to the classic medial tibial slope syndrome, there is also a lateral form that usually affects the lateral box of the tibialis anterior, which is probably a mild compartment syndrome. The acute form described can become chronic if left untreated and inadequately managed.

ICD M76

Cause

1. Overloading relative to training status, intensive training after a training break
2. Change of footwear or other parameters
3. heel strike too hard
4. Shoes that are too hard (too little cushioning)

Predisposing

– Behavior

1. Use of running spikes
2. Hard footwear
3. Worn running shoes
4. Cross-country skiing in untrained condition, with inadequate footwear or inadequate running style
5. Cross-country skiing on hard surfaces or with hard shoes or on uneven surfaces
6. Change of training, surface, different trainer, etc.
7. Running training with jump components

– Musculoskeletal system

1. Hyperpronation, malpositions of the foot, especially those with pronation
2. Weak, untrained calf muscles
3. Exorotation of the thighs when running (leads to hyperpronation and overloading of the medial structures)

Diagnosis

1. MRI provides good evidence of periostitis in particular
2. Pressure measurement in the muscle compartment
3. Sonography to detect edema and muscle swelling
4. Tests and signs:Hop test, at least 5 cm long tenderness

Symptoms

1. Pain on exertion, the pain is pronounced and tends to be cramp-like, it usually occurs immediately or shortly after the start (in the first 500 m) of training and may or may not disappear. Walking is also painful after the end of training. Decreasing exercise tolerance with repeated exercise
2. Pressure soreness
3. First occurrence often the day after exercise, then immediately after exercise
4. Pressure pain in the deep calf muscles

Complications

1. Flat foot: as the posterior tibialis is very important for tensioning the longitudinal arch of the foot, tibial plateau syndrome must be taken seriously and healed (with rest), otherwise a flat foot may develop
2. Fatigue fractures
3. In compartment syndrome: necrosis with fever and exhaustion, rarely also sepsis

Therapy

1. Treatment is usually conservative, but recurrences are not ruled out
2. in mild cases: Reduce training, avoid running downhill, wear shoes with sufficient cushioning
3. For more severe pain: take it easy before the shock-like demands, switch to bike, ergometer, etc.
4. In the early stages: cryotherapy (ice packs) and curd compresses
5. Physiotherapy, but no manual therapy of the irritated trigger points
6. Taping
7. Inlays if necessary
8. if necessary: Analgesics, anti-inflammatory drugs (ibuprofen, diclofenac))
9. Preventive: stretching before and after running; several times a day if you have symptoms
10. Balance board / MFT disk
11. carefully (!): Walking and running barefoot, running on the beach
12. after the symptoms have subsided: Heat application before training
13. Sports medicine / running advice, running analysis
14. Local injections containing cortisone if necessary
15. Rare: if conservative therapy fails, open or endoscopic surgery with a 4-week break from sport
16. Ointments containing active ingredients (e.g. cortisone) or ointment dressings do not directly reach the deep-seated lymph, they act via the lymph/blood. However, warming ointments can help.

DD

1. Compartment syndrome
2. venous outflow obstruction
3. Fatigue fractures
4. paVK

Asana practice

In addition to analyzing the running technique and examining the foot for kinked feet, flat feet, flat feet, hindfoot valgus and, if necessary, their treatment, it is important to stretch and strengthen the posterior tibialis. As it supinates, plantarflexes and adducts in the ankle joint, it is best stretched with postures that exercise wide dorsiflexion of the ankle joint. Because of the restriction of movement that the biarticular gastrocnemius places long before the soleus or other plantar flexors, stretching through plantar flexion can only be successful if the knee joint is sufficiently flexed. As it also supinates, a pronated or at least non-supinated position of the foot would be desirable.

Malasana comes closest by far to this ideal. Postures such as utkatasana or variations of dog pose head down with one or two bent knee joints are a secondary option without pronation. The head-up dog p ose could in principle be performed with pronation, but the force that can be achieved in the direction of dorsiflexion of the ankle is limited not only by the force of the frontal abductors of the shoulder joint and the palmar flexors of the wrist, but also by the friction of the foot on the surface.

The second measure must be a sustained strengthening of the posterior tibialis. This is also a plantar flexor, but as such it is supported by two overpowering synergists, the soleus and gastrocnemius, so that this movement will not strengthen it sufficiently. The situation is better in the case of supination. Although the triceps surae is synergistic there, the soleus is more of a holding and stabilizing muscle and less of a fast-moving muscle. Here it competes only with the gastrocnemius, and its movement is far more plantarflexing than supinating, so that much can be achieved here for the posterior tibialis. On the one hand, the pure repetitive supination of both feet can be practiced in sufficiently stable symmetrical postures; on the other hand, the postures with a balancing character in particular offer an excellent opportunity due to their constant need to compensate for the small rocking movements of the foot around its longitudinal axis, whereby the tibialis posterior is primarily responsible for one of the two directions, supination. Together with the fubularis brevis and fibularis longus muscles, this forms a system of reins around the respective malleoli, which provides excellent training. This is also very valuable in terms of proprioception. At the same time, it prevents disorders such as tibialis posterior syndrome (PTTD), flat feet and fallen arches or works against their progression.