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من طرف Monsef Sadaqah الأربعاء ديسمبر 03, 2008 11:48 pmShin splints is a general term used to refer to a painful condition in the shins.[1] It is often caused by running or jumping, and may be very slow to heal. A formal medical term for the condition is medial tibial syndrome.
Two specific conditions:
Overused muscle
One cause is an overused muscle, either as an acute injury or DOMS (delayed-onset muscle soreness). The muscle pain is caused by any activity that involves running, jumping, also sometimes even walking, swimming, roller skating, or other basic physical activity. An individual not accustomed to running may experience pain in the shin muscles the next day even after a single, short bout of intensive running. Sometimes shin splints is also a result of stress fractures in the shin.
Chronic compartment syndrome
A problem which can mimic anterior shin splints is chronic compartment syndrome (CCS). This is a serious problem which can lead to significant loss of function in the lower leg. CCS occurs when swelling within the indistensible anterior compartment of the leg reduces blood flow. This relative lack of blood, ischemia, can cause more swelling and generate a positive feedback loop. In severe cases the result can be acute compartment syndrome (ACS) which requires emergency surgery to prevent ischemic muscle necrosis, muscle death due to lack of blood.
Diagnosis
[color=red]CCS may be the problem if pain worsens steadily during exercise rather than improving as the ligaments and muscles warm. Tingling in the foot is a particular red flag; it indicates compression of the nerve.
If a bone problem is suspected to be causing inflammation of connective tissue, a bone scan can be useful in confirming the diagnosis.
Magnetic resonance imaging has been proposed as a diagnostic technique.[/color]
Causes
Most of these causes are contradicted by the MayoClinic's website;[1] however, the purpose of the muscles of the anterior shin (tibialis anterior) is to dorsiflex the foot (bend the foot upwards at the ankle). Other muscles here include the extensor digitorum longus muscle and the extensor hallucis longus, which move the toes, 2-5 and the big toe respectively, upwards. It may not be obvious why a muscle which raises the toe can be stressed or injured by running, given that it is not responsible for propulsion. The reason is that some runners overstride, and land heavily on the heel with each footstrike (thus, shin splints are a common ailment in military boot camp[4], where trainees march extensively by extending the leg forward and forcefully striking the boot heel on the ground). When this happens, the forefoot rapidly slaps down to the ground. Effectively, the foot, which is dorsiflexed prior to making contact with the ground, is forcefully plantarflexed. This forceful plantar flexion of the foot causes a corresponding rapid stretch in the attached muscles. A reflex in the muscles responds, causing a powerful contraction. It is this eccentric contraction which leads to muscle soreness and possible injury to the muscle, tendon or connective tissue.[citation needed]
It is also commonly believed[who?] that a contributing cause of shin muscle pain in some cases is the relative weakness of the muscles on the anterior of the lower leg compared to those in the calf. In this case, exercises that preferentially strengthen the anterior muscles may help alleviate or avoid shin splints. The shin pain is attributed to a forced extension of the muscle, in this case by the opposing calf muscles which "overpower" the shin.
Acute treatment
The immediate treatment for shin splints is rest. Running and other strenuous lower limb activities, like basketball and other sports which include flexing the muscle, should be avoided until the pain subsides and is no longer elicited by activity. In conjunction with rest, anti-inflammatory treatments such as icing and drugs such as NSAIDs (in particular, NSAID gel) may be suggested by a doctor or athletic trainer. Over-the-counter pain relievers can also be taken, though there is some controversy over their effectiveness. Furthermore, the lower legs may be taped to stabilize and take some load off the periosteum. Finally, using good shoes (ideally compensating for individual foot differences) is important. The shin can be trained for greater static and dynamic flexibility through adaptation, which will diminish the contracting reflex, and allow the muscles to handle the rapid stretch. The key to this is to stretch the shins regularly. However, static stretching might not be enough. To adapt a muscle to rapid, eccentric contraction, it has to acquire greater dynamic flexibility as well. One way to work on the dynamic flexibility of the anterior shin is to subject it to exaggerated stress, in a controlled way, such as walking on the heels. If the muscle is regularly subject to an even greater dynamic, eccentric contraction than during the intended exercise, it will become more capable of handling the ordinary amount of stress. Experienced long-distance runners practice controlled downhill running as a part of training, which places greater eccentric loads on the quadriceps as well as on the shins. A physical therapist, athletic trainer, or doctor should be consulted before engaging in this type of training.
Two specific conditions:
Overused muscle
One cause is an overused muscle, either as an acute injury or DOMS (delayed-onset muscle soreness). The muscle pain is caused by any activity that involves running, jumping, also sometimes even walking, swimming, roller skating, or other basic physical activity. An individual not accustomed to running may experience pain in the shin muscles the next day even after a single, short bout of intensive running. Sometimes shin splints is also a result of stress fractures in the shin.
Chronic compartment syndrome
A problem which can mimic anterior shin splints is chronic compartment syndrome (CCS). This is a serious problem which can lead to significant loss of function in the lower leg. CCS occurs when swelling within the indistensible anterior compartment of the leg reduces blood flow. This relative lack of blood, ischemia, can cause more swelling and generate a positive feedback loop. In severe cases the result can be acute compartment syndrome (ACS) which requires emergency surgery to prevent ischemic muscle necrosis, muscle death due to lack of blood.
Diagnosis
[color=red]CCS may be the problem if pain worsens steadily during exercise rather than improving as the ligaments and muscles warm. Tingling in the foot is a particular red flag; it indicates compression of the nerve.
If a bone problem is suspected to be causing inflammation of connective tissue, a bone scan can be useful in confirming the diagnosis.
Magnetic resonance imaging has been proposed as a diagnostic technique.[/color]
Causes
Most of these causes are contradicted by the MayoClinic's website;[1] however, the purpose of the muscles of the anterior shin (tibialis anterior) is to dorsiflex the foot (bend the foot upwards at the ankle). Other muscles here include the extensor digitorum longus muscle and the extensor hallucis longus, which move the toes, 2-5 and the big toe respectively, upwards. It may not be obvious why a muscle which raises the toe can be stressed or injured by running, given that it is not responsible for propulsion. The reason is that some runners overstride, and land heavily on the heel with each footstrike (thus, shin splints are a common ailment in military boot camp[4], where trainees march extensively by extending the leg forward and forcefully striking the boot heel on the ground). When this happens, the forefoot rapidly slaps down to the ground. Effectively, the foot, which is dorsiflexed prior to making contact with the ground, is forcefully plantarflexed. This forceful plantar flexion of the foot causes a corresponding rapid stretch in the attached muscles. A reflex in the muscles responds, causing a powerful contraction. It is this eccentric contraction which leads to muscle soreness and possible injury to the muscle, tendon or connective tissue.[citation needed]
It is also commonly believed[who?] that a contributing cause of shin muscle pain in some cases is the relative weakness of the muscles on the anterior of the lower leg compared to those in the calf. In this case, exercises that preferentially strengthen the anterior muscles may help alleviate or avoid shin splints. The shin pain is attributed to a forced extension of the muscle, in this case by the opposing calf muscles which "overpower" the shin.
Acute treatment
The immediate treatment for shin splints is rest. Running and other strenuous lower limb activities, like basketball and other sports which include flexing the muscle, should be avoided until the pain subsides and is no longer elicited by activity. In conjunction with rest, anti-inflammatory treatments such as icing and drugs such as NSAIDs (in particular, NSAID gel) may be suggested by a doctor or athletic trainer. Over-the-counter pain relievers can also be taken, though there is some controversy over their effectiveness. Furthermore, the lower legs may be taped to stabilize and take some load off the periosteum. Finally, using good shoes (ideally compensating for individual foot differences) is important. The shin can be trained for greater static and dynamic flexibility through adaptation, which will diminish the contracting reflex, and allow the muscles to handle the rapid stretch. The key to this is to stretch the shins regularly. However, static stretching might not be enough. To adapt a muscle to rapid, eccentric contraction, it has to acquire greater dynamic flexibility as well. One way to work on the dynamic flexibility of the anterior shin is to subject it to exaggerated stress, in a controlled way, such as walking on the heels. If the muscle is regularly subject to an even greater dynamic, eccentric contraction than during the intended exercise, it will become more capable of handling the ordinary amount of stress. Experienced long-distance runners practice controlled downhill running as a part of training, which places greater eccentric loads on the quadriceps as well as on the shins. A physical therapist, athletic trainer, or doctor should be consulted before engaging in this type of training.
