Hawkes Physiotherapy Blog

This next article will detail the vascular and neural type of shin splints. Basically this type relates to compression or damage of the blood vessels or nerves that pass through the lower leg area causing pain in the shin area. The most common type is Compartment syndrome: The lower leg has four compartments, which are separated by inelastic fascial layers, essentially causing confined and compressed space. In these compartments are the muscles, blood vessels and nerves. Below shows what structures are in each compartment: Anterior: Muscles: Extensor hallucis longus, Extensor digitorum, Tibialis anterior and Peroneus tertius Nerves: Deep peroneal nerve Blood vessels: Anterior tibial artery Lateral: Muscles: Peroneus brevis and longus Nerves: Superficial peroneal nerve and proximal portion of deep peroneal nerve Blood Vessels: Peroneal artery Superficial posterior: Muscles: Gastrocnemius, Soleus, Plantaris Nerves: Tibial nerve branches Bloo

This next article will detail the muscle and tendon type of shin splints. If you remember back in the previous article, muscle and tendon often pulled onto the bone causing the bone related shin splints to occur. If the bone is getting overloaded from the pull of the muscle and tendon then there is also a lot of load going through the muscle and tendon too! So essentially, overload of muscle and tendon are the causes of this type of shin splints. Generally the overload of the muscle causes different levels of muscle injury and the overload of the tendon causes tendinopathy, which includes Tendinitis and Tendinosis. What are the types of muscle injury? The following are described by Mueller-Wohlfahrt (2012) and they progress in severity depending on the amount of overload to the muscle. Type 1A: Fatigue-induced muscle disorder:          This is characterised by an increased muscle tone caused by overexertion. Symptoms are commonly aching in the entire muscle

Medial tibial stress syndrome pretty much covers most of the bony component of shin splints. It commonly affects the lower two thirds of the inside border of the tibia. The stress to the bone initially causes periostitis at first, which is inflammation in the lining of the bone. An escalation of this takes it to oedema of the bone marrow inside the bone. The bone gradually weakens and the final stage is a stress fracture. Incidence: Medial tibial stress syndrome in runners has an incidence ranging from 13.6% to 20.0% (Lopes  et al 2012) but other sports such as dancing and football can also get Shin splints. Interestingly stress fracture risk is between 1.5 to 3.5 times more in women than in men (Dugan & Weber 2007). This is thought to be related to bone density being lower in females. How long does it take to resolve? Overall medial tibial stress syndrome took 72 days on average to recovery in novice runners according to Nielsen et al (2014). More specific

What are shin splints? For starters, like many other “diagnoses” , shin splints isn’t a diagnosis it is a group of different conditions that essentially cause shin pain (Batt 1995). So if someone says that you have shin splints you could quite easily say “thanks for the pointless observation that I have shin pain and tell me what I really have!” I’m sure you wouldn’t but it makes my point. So what are the conditions under the heading shin splints then? Most people think of a stress fracture when you say shin splints but this is only one potential issue. There are actually over 30 conditions that come under the umbrella term of ‘shin splints’.  Some are super rare, so not worth discussing in this blog but we will discuss the more common ones in detail over the coming articles. Trust me if we didn't then this article could turn into a novel! It is best to split shin splints up into the structures affected. These are as follows: Bone related Muscle & Te

I often find my patients asking me this question before I have even assessed them: “Do you think that I should get a scan?” My typical response is "no or certainly not yet." They say "but won’t it show exactly what is wrong with me?” The problem is that the scan will show all the issues that you have, but what is relevant or just incidental? You see what is normal? Patients presume that we are all perfect with no abnormalities so a scan will show the single abnormality causing our pain. This simple isn't true. Here are some great examples of this point: In the knee, Cyteval (2008) actually found meniscal (cartilage) tears on MRI scans in 1 in 3 middle aged and elderly people and these individuals had no symptoms or pain at all and would consider themselves normal. A similar finding was also found by Beattie et al (2005), they found that 60% of pain free 20-68 year olds showed abnormalities in at least three of the four regions

You wouldn't believe the amount of patients that I see, who come in and say:  “I've put my back out” or “I’m out of place or alignment” and then ask to be put “back in place”. Then again, maybe this is you? It depends on your experience of Physiotherapy, Osteopathy, Chiropractory. When I proceed to tell patients that these things don’t really happen in the human body, they will say “but such and such says it does and they cracked my back and I was back in place again and my pain went away”. Now I'm not saying that the treatment doesn't help. It does reduce pain & increases range of movement but it didn't crack you back into place for sure! I'm not saying things can't be out of normal anatomical alignment because they can but they generally don't move in and out quickly and sometimes they will never change. A persons alignment is down to lots of factors such as bone size and shape, joint surface contours, ligament shortening or laxit

Now as you all know, at the elite level athletes have Physiotherapists, massage therapists, sports psychologists, strength and conditioning coaches, technical coaches, dietitians etc. etc. etc. Now in the world of elite sport, money and time are less of a problem, meaning all of the above is more possible. But clearly all of this is a necessity otherwise they wouldn't bother. So why do they bother? It improves training, improves performance, faster recovery times, reduces injury risk and gets them back much quicker. Now I'm not saying that all of this should be done to the letter in non elite sport as it wouldn't be possible but I think that elements are required and this is highlighted by what I see everyday. For example: I see runners who just run, nothing else and believe it or not, they get inured. I see athletes who have no recovery time and believe it or not, they also get injured. When athletes get injured they simply rest for a few days and the