Sports Medicine: Just the Facts

CHAPTER 88 • RUNNING 523

• Diagnosis
  
  
  1. Lateral pain and crepitus at lateral femoral condyle
     (or insertion at Gerdy’s tubercle)
  
  
  2. Tight ITB on OBER test
  
  
  3. Abductor weakness
  
  
  
  


• Contributing factors
  
  
  1. Varus positioning of knee, tibia, and foot
  
  
  2. Internal tibial torsion
  
  
  3. Excessive supination or pronation
  
  
  4. Tightness abductors, adductors, ext rotators, and
     hip extensors
  
  
  5. Abductor weakness
     •Treatment
  
  
  6. PRICEMM (iontophoresis)
  
  
  7. Dual action strap
  
  
  8. Foam roller exercise for soft tissue work
  
  
  9. Flexibility and strength (hip abductors, adductors,
     rotators, flexors, and extensors)
  
  
  
  


• Consider with persistent symptoms
  
  
  1. Injection (steroid)
  
  
  2. MRI r/o lateral meniscus and other
  
  
  
  

SHIN SPLINTS

• Definition
  
  
  1. Shin splints, or medial tibial stress syndrome, is a
     clinical entity characterized by diffuse tenderness
     over the posteromedial aspect of the distal third of
     the tibia. Shin splints have been reported to
     account for 12–18% of running injuries (James,
     Bates, and Ostering, 1978; Briner, Jr, 1988; Gudas,
     1980; Pinshaw, Atlas, and Noakes, 1984) and in
     4% of all military recruits in basic training
     (Andrish, Bergfeld, and Walheim, 1974). Women
     appear more frequently affected than men.
  
  
  2. Medial tibial stress syndrome is to be differentiated
     from stress fractures and exertional compartment
     syndrome. Although different entities, they may
     coexist. Plain films are negative (except in cases of
     previous or coexistent stress fracture). Bone scans
     will demonstrate characteristic vertical linear
     increased activity along the tibial periosteum,
     which differs from the more focal fusiform
     increased radiotracer uptake exhibited by stress
     fractures.
  
  
  3. Medial tibial stress syndrome is felt by most to
     represent a periostalgia or tendinopathy along the
     tibial attachment of the tibialis posterior or soleus
     muscles. Other proposed etiologies have included
     posterior compartment syndrome and fascial
     inflammation. Detmer proposed a classification
     scheme for medial tibial stress syndrome based on
     etiology. Type 1 included local stress fractures,
  
  
  
  

type 2 periostitis/periostalgia, and type 3 due to

deep posterior compartment syndrome (Detmer,

1986).

• Diagnosis
  
  
  1. Dull ache medial shaft with activity
  
  
  2. Tenderness to palpation along shaft
  
  
  3. Normal neurovascular examination and X-ray
  
  
  
  


• Contributing factors
  
  
  1. Factors that increase valgus forces and pronation,
     which then increase eccentric contraction of the
     soleus and tibialis posterior: femoral anteversion,
     genu varum, tibia and forefoot varus, and excessive
     Q angle
  
  
  2. Excessive pes planus or cavus
  
  
  3. Tarsal coalation
  
  
  4. Leg length inequality
  
  
  5. Muscle imbalances: Inflexibility of plantar flexors;
     weakness of dorsiflexors, plantarflexors, and
     inventors
  
  
  6. Extrinsic risk factors include improper shoe wear,
     a rapid transition in training, inadequate warm-up,
     running on uneven or hard surfaces, running in
     cold weather, and low calcium intake.
     •Treatment
  
  
  7. Flexibility: Gastroc-soleus, tibialis posterior
  
  
  8. Strength: Concentric and eccentric including tibialis
     posterior soleus, tibialis anterior, FH, FDL
  
  
  9. Orthotic to control compensatory pronation
  
  
  10. Shin sleeve
  
  
  
  


• Consider with persistent symptoms
  
  
  1. Bone scan/MRI r/o stress fx
  
  
  2. Compartment testing to r/o compartment syndrome
  
  
  3. Consider lumbar radiculopathy
  
  
  
  

EXERTIONAL COMPARTMENT SYNDROME

• Definition
  1.Chronic exertional compartment syndrome is
  defined as reversible ischemia secondary to a non-
  compliant osseofascial compartment that is unre-
  sponsive to the expansion of muscle volume that
  occurs with exercise. Most commonly seen in the
  lower leg, exertional compartment syndrome in ath-
  letes has also been described in the thigh and medial
  compartment of the foot (Raether and Lutter, 1982;
  Birnbaum, 1983; Mollica and Duyshart, 2002).
  2. There are four major compartments in the leg.
  Each is bound by bone and fascia, and each con-
  tains a major nerve.
  a. The anterior compartment contains the extensor
  hallucis longus, extensor digitorum longus, per-
  oneus tertius, and anterior tibialis muscles, as
  well as the deep peroneal nerve.