Overuse Syndromes: Nonoperative Management

What is it? An overuse syndrome is a local inflammatory response to stresses from microtraumas. These microtraumas include faulty alignment, muscle imbalances or fatigue, changes in exercise or functional routines, improper footwear for the functional demands placed on the feet or a combination of several of these factors.

Causes? This syndrome occurs because of continued demand placed on the tissue before it has properly healed, causing the pain and inflammation to continue. A common cause that leads to overuse issues is abnormal pronation of the subtalar joint. The abnormal pronation could be related to a variety of causes like excessive joint mobility, leg-length discrepancy (one leg longer/shorter than the other, femoral anteversion, external tibial torsion, genu valgum (knock knees), or muscle flexibility and strength imbalances.

Related Pathologies and Etiology of Symptoms

• Shin Splints: The term used to describe activity-induced leg pain along the inner and outer edges of the proximal two-thirds of the tibia (shinbone). This pain is felt as a result of the inflammation of the muscles, tendons and bone tissue around the tibia. It may include different pathological conditions such as tendinitis (inflammation or irritation of a tendon), stress fractures of the tibia, periosteitis (inflammation of the membrane covering a bone) increased pressure in a muscular compartment, or irritation of the interosseous membrane.
• Anterior shin splints: Experienced when the anterior tibialis muscle is overused. A decrease in mobility of the gastrocnemius and soleus muscle, a weak anterior tibialis muscle, as well as foot pronation are all associated with anterior shin splints.
• Posterior shin splints: A decrease in mobility of the gastrocnemius and soleus muscle, a weak and inflamed posterior tibialis muscle, along with foot pronation are all associated with posterior medial shin splints. Vigorous exercise such as running or dancing can cause muscle fatigue, which can trigger the problem.

Common Impairments and Functional Limitations/Disabilities

• Pain with repetitive activity, palpation of the affected site, stretching the involved musculotendinous region and with resistance of the involved muscles
• Pain with weight-bearing activities and walking
• Muscle length-strength imbalances; especially in the gastrocnemius and soleus muscle groups
• Abnormal foot posture
• Functional limitations from this impairment can cause a decrease in length of time the individual can stand, decreased distance or speed that the individual can travel and restriction of sport or recreational activities

Management and Protection in a Clinical Setting

While the tissues are inflamed, the physiotherapist will prescribe rest and specific modalities to treat the syndrome. It is also possible to immobilize the area in a cast or splint to help with alleviating some of the stress.

• What to expect in the clinic:
  • Applying physiotherapy techniques to massage the muscles in the affected region
  • Use of machines that emit electrical stimulation to help reduce pain
  • Using active range of motion techniques to assist with hypomobility
  • Learning about ways to avoid or modify activity that provokes the pain
  • Using supportive taping to relieve pain symptoms
  • Using therapeutic exercises to increase flexibility and overall muscle performance

If symptoms become more severe, the physiotherapist will examine the entire lower extremity as well as the foot to look for abnormal alignment or muscle flexibility and strength imbalances. It is important to discuss what triggers the pain during the initial consultation in order to help eliminate or modify these actions to prevent further recurrences.

At Home Management and Protection

• Use proper foot support (comfortable shoes, orthotics, insoles)
• Allow time for rest and recovery after high-intensity workouts
• Before intense exercise, use gentle repetitive warm-up activities, followed by specifically stretching the tight muscles
• Adding at home exercises into your daily routine as instructed by your physiotherapist

Improving Shin Splint Pain through Exercises

• Warm up
  • Warming up will increase blood flow in the working muscles an enhance conduction of nerve impulses.
  • It should always be completed for 5-10 mins before an exercise bout and the best way to warm up for someone with shin splints is a stationary cycle it will help limit the impact on the ground so pain will be reduced.
• Stretching
  • Hamstring Stretching
    • Stretching muscles in this area will significantly increase flexibility if not performed it can increase tightness limiting dorsiflexion of the ankle and increase stress during the walking cycle
    • Standing Hamstring Stretch
      • Standing on one leg while placing the stretching leg forward on a raised surface simultaneously bending forward at the waist
      • The spine should not flex
      • Hold for 30s, both legs, 2x/day
    • Supine Hamstring Stretch
      • Lying down on the back near a doorway place the stretching leg on the wall while the other leg rests flat on the floor
      • 30s, 3 reps, 15s break between stretches (both legs)
    • Gastrocnemius Stretching
      • Heel Drop: Stand in upright position with the stretched leg on an elevated step and drop the heel down
      • Lunge Stretch on Wall: Standing staggered away from a wall place the affected leg to the rear keeping the heel down, lean forward with both hands on the wall the leg should be extended, and the ankle should be dorsiflexed
      • Seated Gastroc Stretch: Sit down with legs in front of the body the athlete will put a towel or rope around the fore foot and pulls both ankles towards themselves
      • all stretching should be held for 30s, for 3 repetitions, with a 15s break between reps
    • Soleus Stretching
      • Important note when stretching this muscle, the patient should be flexing the affecting leg if it was extended, they would be stretching the gastrocnemius
      • Athlete will be close to a wall while legs are staggered, back straight, and palms of the hands on the wall, bend the legs slightly allowing the buttocks to drop, lean into the wall and feel the stretch in the lower calf
      • 3 reps, 15s break
    • Ice Massage
      • Fill a Styrofoam cup with water and let it freeze, break off the first bit of the cup so that the ice can protrude out of the cup then apply the ice to a painful area in a circular motion. It should be continued until the area is numb to the touch then stop, the numbness lasts 7-10 mins. This can be done multiple times a day.

Make sure you book your appointment today and get assessed by our physiotherapist now at 905 997 4333