Rehabilitation for Runners on Shin Splint - Literature review Example

Aims of rehabilitation Reduce pain and inflammation. Apply heat therapy Apply heat and use a heat retainer or shin and calf support after the initial acute stage and particularly before training. This can provide support and compression to the lower leg helping to reduce the strain on the muscles. It will also retain the natural heat which causes blood vessels to dilate and increases the flow of blood to the tissues.. Taping to support the shin. This can help reduce the stress on the lower leg and reduce pain 2. Identify any biomechanical dysfunction that may be causing the problem. If your feet roll in or over pronates excessively then this can contribute to the strain on the lower leg. The right foot over pronates. The left foot has been corrected by an orthotic device. 3. Improve flexibility and condition of the surrounding muscles. Gentle stretching should be started as soon as pain will allow - the first day of treatment if possible. Using sports massage Apply massage to the muscles but stay away from the bone as this may cause more inflammation. 4. Return to full fitness. When you have gone a week with no pain then you can begin to run again. This should be a gradual process. If you feel pain at any time then go back a step. 5. Further injury prevention Increase training gradually. Do not run too often on hard surfaces. Avoid running a lot on your toes. Ensure you have the correct Wear a shock absorbing insole. If you are unsure about any part of this guide, do not hesitate to contact a therapist for advice Shin Splints INTERMEDIATE TO LATE STAGE REHABILITATION Runners Guide for Fully Rehabilitating the Leg after a Shin Splint CONTRIBUTING FACTORS Factors that might contribute to shin splints include foot: 1. Muscles weak anterior leg muscles feeling tight posterior leg muscles 2. Training errors hard running surface recent increase in running speed or distance 3. Foot Wear unsupportive shoes no heel cushion hard heel 4. Foot Structure fallen arches ---- TREATMENT PHASE 1 Ice 10-15 minutes for 2-3x per day Anti inflammatory drugs Active rest-participate in activity was that does not stress the affected area but maintains cardiovascular fitness. An example would be bike riding. PHASE 2 Continue as above and add: Appropriate shoe orthotics. For example, arch supports may be worn. Posterior leg stretching Gastroc Strecth. Keep involved leg back with the knee straight and heel on the floor. Slowly bend front knee and lean into wall until stretch is felt in the calf of the back leg. Hold for 20 seconds and repeat 5 times. Soleus Strecth. Similar to the gastroc stretch, however keep both knees bent and heels on the floor. Lean into wall until a stretch is felt in the lower calf. Hold for 20 seconds and repeat 5 times. Anterior leg stretching Anterior Tibialis Stretch. In a or sitting position, cross the involved leg over the uninvolved leg. Pull the toes in a direction that will gently stretch the tissue on the top of the. Hold 20 seconds and repeat 5 times. Anterior leg strengthening Toe Taps Sit in a chair with arms resting on thighs. Begin to tap toes by lifting up foot except for the heel and returning it to the floor as fast as possible. You should start to feel the muscles in the front of the ankle working. Continue tapping for 20 seconds and repeat 5 times. PHASE 3 Limited running on treadmill or track surface at low speed, distance, and level plane Patient education: learn to recognize symptoms of shin splints in order to prevent reoccurrence and be able to administer self treatment to the area when symptoms return. PHASE 4 Return to sports Continue with stretch and strengthening of leg and ankle muscles. REFERENCES Sports Injury Clinic. (2008). Shin splints treatment and rehabilitation. 28 July, 2008 (Online). Available at: http://www.sportsinjuryclinic.net/cybertherapist/front/lowerleg/shinsplints/rehabilitation.php Plone Open Source Content Management System. (2007) Physical Theraphy Corner: Shin Splints. 28 July, 2008 (Online). Available at: http://www.nismat.org/ptcor/shin_splints/index.html Literature review: Rehabilitation for Runners Following Shin Splint The leaflet aims to help athletes specially runners on shin splint intermediate rehabilitation. Shin splints are most common among runners, particularly those just starting a running program. If an athlete has a flat arches, his/her feet may have a tendency to roll too far inward (pronate) when running which can contribute to shin splints (Mayo, 2006). It is commonly used as a "garbage can" term to include a variety of exercise-induced leg pathologies but actually represents a very specific problem. It is essentially an inflammatory reaction involving the connective tissue of the leg (called the deep or crural fascia) at its insertion into the inside (medial) or front (anterior) aspect of the leg bone (tibia). Thus "tibial stress syndrome" is the common medical term used to refer to this condition though prefer the term "tibial fasciitis" is more preferred because it specifically implicates the deep fascia as the etiologic anatomic structure involved. This condition needs to be differentiated from other common and uncommon causes of leg pain as the correct diagnosis will dictate treatment (AAPSM). Shin Splints often plague beginning runners who do not build their mileage gradually enough or seasoned runners who abruptly change their workout regimen, suddenly adding too much mileage, for example, or switching from running on flat surfaces to hills (Shiel, 2008). Shin splints are injuries to the front of the outer leg. While the exact injury is not known, shin splints seem to result from inflammation from injury to the posterior peroneal tendon and adjacent tissues in the front of the outer leg (Mayo, 2006). The nature of shin splints most often can be captured in just four words: too much, too soon. Doug McDougal, a 33 year old 2:30 marathoner from Fort Worth, Tex says he always seem to get them when he start up running again after a break," says Doug McDougal, 33, a 2:50 marathoner from Fort Worth, Tex (Shiel, 2008). This experience is mostly true for beginners and seasonal runners. One common cause of shin splints is posterior tibial syndrome (PTS). The pain associated with PTS occurs on the medial (inside) border of the tibia (shin bone). The pain present when you start exercising becomes less severe as you warm up but becomes worse than ever after you stop exercising. Posterior tibial syndrome often occurs in beginning runners, who are unaccustomed to the activity and running surface, but can occur in seasoned athletes when they change running surfaces, exercise in different shoes, or increase their intensity or duration of exercise (Wolfe). Shin splints develop because of overuse of the posterior tibialis muscle in the lower leg near the shin. In most cases, this overuse is related to a sudden increase in the intensity of an athlete's training program suddenly running faster, farther or for longer periods than before. When shin splints first appear, the leg pain tends to start near the end of a training session. However, if the athlete ignores the pain tries to "run through it," symptoms eventually will begin earlier and earlier during training, until they affect the athlete's overall performance (Aetna, 2007). The entire rehabilitation, with its aim to return the injury to full fitness, may take more than a week process depending on the intensity of the injury. The initial treatment is to stop running and do other types of exercise until running is no longer painful. This stage aims to reduce the pain and inflammation (Merck, 2003). NSAID (Non steroidal anti-inflammatory medication) e.g. ibuprofen may help in the early stages. Always check with a Doctor before taking any medication. Do not take Ibuprofen if you have asthma (Sports, 2008). However this stage of rehabilitation will not be included in the brochure. Intermediate rehabilitation includes resting from activities that may cause pain. Stay off one's feet as much as you can. Use crutches if necessary. People using crutches get taken far more seriously and given more sympathy than those who should be on them and hobble out anyway. Most shin pain will not need crutches though. Maintain fitness by swimming or cycling. Take the opportunity to work on upper body strength (Sports, 2008). Running shoes with a rigid heel counter (the back part of the shoe) and special arch supports can keep the foot from rolling onto the outside excessively (Merck, 2003). Apply heat and use a heat retainer or shin and calf support after the initial acute stage and particularly before training. This can provide support and compression to the lower leg helping to reduce the strain on the muscles. It will also retain the natural heat which causes blood vessels to dilate and increases the flow of blood to the tissues. (Sports, 2008). The injured person should not apply ice to an area if he/she has bad circulation. Ice itself should not be applied directly to the skin unless in the form of ice massage (where the ice is constantly moving) or ice burns to the skin can happen (Sports, 2008). Taping the shin is a good way of helping the leg to rest if one cannot avoid being on his/her feet. It will support the muscle attachments at the sore spot on the shin taking some of the pressure and strain off the tissues (Sports, 2008). Intermediate stage also aims to identify any biomechanical dysfunctions that may be causing the problem. Aside from the initial diagnosis this stage must be undergone to rule out any underlying problem. If ones feet roll in or over pronates excessively then this can contribute to the strain on the lower leg. If the foot rolls in then the lower leg will also rotate inwards, making the surrounding muscles work harder than they normally would. In addition the bones of the ankle will not 'lock' properly during the running action, again causing the muscles to take the strain rather than the bones. This can be corrected by orthotic inserts preferably fitted by a sports injury professionals or podiatrist. Off the shelf orthotic inserts and heat moldable inserts are also available and are suitable for most patents although it is best to check with a sports injury specialist or podiatrist. The inserts should be worn at all times. Not just when training. Feet are under tension even when standing - not just when training. In fact, when sprinting you should be on your toes in which case an orthotic insert is not really effective as it controls the heel which is not in contact with the ground. One way of telling if a person over pronate is by looking at his/her footwear. If he/she tend to wear out the inside front of his/her shoes then this is a strong indication that something is not quite right (Sports, 2008). Late stage rehabilitation intends to improve flexibility and condition of the surrounding muscles. Gentle stretching should be started as soon as pain will allow - the first day of treatment if possible. If the pain has gone and the injured person is now able to run then he/she may think the job is done, however if the condition of the lower leg muscles particularly the calf muscles is not improved then the injury is likely to re-occur. Stretch both the front of the leg and the muscles at the back of the leg. Hold stretches for up to 40 seconds and repeat five times. Aim to stretch at least 3 times a day. This is a lot of stretching but will be worth it. Time it on a watch so as not to cheat. Continue stretching daily throughout the rehabilitation phase and long after the injury has healed (Sports, 2008). Exercises to strengthen the injured muscles are useful (Merck, 2003). Sports massage techniques can be very effective for helping to prevent shin pain from returning. Applying deep massage to the muscles at the back of the tibia (shin bone) and the calf muscles will release some of the pressure on the bone itself. Massage should be applied as soon as pain will allow - gently at first. Apply massage to the muscles but stay away from the bone as this may cause more inflammation. Massage can be performed every other day. A day recovery is required between sessions, especially if the massage has been deep. If massage makes the injury worse, then do not massage further (Sports, 2008). To return to full fitness, the patient can begin running when he/she have gone a week with no pain. This should be a gradual process. If pain is felt at any time he/she must go back a step. Running time should be gradually increased. Apply tape to the shin to support it for the first few runs. Ensure to have the correct shoes for ones running style or sport. After every training session apply ice to the shin for about ten minutes, for up to 3 days. Ensure you stretch properly before each training session and after. Hold stretches for about 30 seconds and repeat 5 times. Use massage regularly as this will help prevent the muscles tightening up; hardening and putting strain back onto the lower leg again (Sports, 2008). The leaflet does not focus on the etiology of the injury as it is intended as a guide for intermediate to late stage rehabilitation; however, it does lightly touch on the prevention and some precautionary warnings as it is considerably significant. To prevent shin splint from reoccurring several precautions must be observe. These precautions have been included in the last part of the leaflet. References: Aetna InteliHealth Inc. (2007). Shin Splints. 28 July, 2008 (Online). Available at:http://www.intelihealth.com/IH/ihtIHt=31204&p=br,IHW|st,24479|r,WSIHW000|b,*| American Academy of Orthopaedic Surgeons (2007) Shin Splints. American Academy of Orthopaedic Surgeons(2007). Tips for a safe running program. Mayo Clinic Staff. (2006). Shin Splints. Fitness. 28 July, 2008 (Online). Available at: http://www.mayoclinic.com/health/shin-splints/DS00271/DSECTION=when%2Dto%2Dseek%2Dmedical%2Dadvice American Academy of Podiatric Sports Medicine. What are "shin-splints" and what is the best initial treatment for this condition 01 August, 2008 (Online). Available at: http://www.aapsm.org/ct1297.html Joseph, T (2006) Shin Splints. Medical Encyclopedia. 28 July, 2008 (Online). Available at: http://www.nlm.nih.gov/medlineplus/ency/article/003177.htm Lippincott Williams & Wilkens, edited by William Koopman, et al., 2003. Clinical Primer of Rheumatology Merck & Co., Inc. (2003). Shin Splints.28 July, 2008 (Online). Available at: http://www.merck.com/mmhe/sec05/ch075/ch075c.html National Institutes of Health( 2001).Medline Plus Medical Encyclopedia. Shin Splints Rice University(June 13, 2003). Shin Splints. Saunders, W.B.Co, edited by Shaun Ruddy, et al.,(2000). Kelley's Textbook of Rheumatology Shiel, W. (2008). Shin Splints. MedicineNet.com. 28 July, 2008 (Online). Available at: http://www.medicinenet.com/shin_splints/page2.htm Sports Injury Clinic. (2008). Shin splints treatment and rehabilitation. 28 July, 2008 (Online). Available at: http://www.sportsinjuryclinic.net/cybertherapist/front/lowerleg/shinsplints/rehabilitation.php Thacker SB et al.(2002) The prevention of shin splints in sports: a systematic review of literature. Medicine and Science in Sports and Exercise. January, 2002. 34(1): 32-40. The Plone Open Source Content Management System (2007) Physical Therapy Corner: Shin Splints. 28 July, 2008 (Online). Available at: http://www.nismat.org/ptcor/shin_splints/index.html Wolfe, M. Shin Splints: A common cause of leg pain in athletes. Hughston Health Alert. 28 July, 2008 (Online). Available at: http://www.hughston.com/hha/a.shin.htm Read More