OVERUSE SYNDROMES OF THE LEGS

the pathophysiology of overuse injuries is a local inflammatory response to stress. The of overuses injuries are either intrinsic (malalignment syndromes, muscle imbalances) or extrinsic (training error). A systematic musculoskeketal assessment is necessary in order to differentiate overuse injuries and to clarify to etiological factor.

 

Shin splints:

shin splints ( idiopathic compartment syndrome) is used here to mean an etiological subset of exercise- induced pain: mechanical inflammation due to repetitive stress of the broad proximal portion of any of the musculotendinous units originating from the lower part of the leg or tibia during weight-bearing. Anteriolateral shin splints may occurs secondary to heel contact on hard surfaces, or to wearing a shoe with a hard heel, or to biomechanical abnormalities such a forefoot varus. A muscle imbalance between a weak pre-tibial muscle group and tight gastrocnemius- soleus muscles may result in over activation of these muscles during heel-strike and swing phase..

 

Medial Tibial Stress Syndrome:

Known as tibial periostitis present as exercise- induced pain localized to the distal posteromedial border of the tibia. According to Walker, the clinical distinction between posteromedial shin splints and MTSS is hazy, but the latter is usually more focal and more painful. The precise phthophysiology of MTSS is controversial, but it is most likely periosteal inflammation(periostitis) near the origin of the posterior tibialis or the medial soleus. The soleus muscle syndrome has been identified a a cause of posteriomedial shin splints through cadaver electromyography (EMG) and open biopsy analysis by Michael and Holder.

Examination reveals a well- localized 3- to 6-cm area of tenderness over the posteromedial edge of the distal jone third of the tibia. Active resisted palantar flexion and inversion of the foot reproduce the pain.

 

Tendinitis:

Achilles tendinitis is the most common form of tendinitis seen in athletes. Classification is based on whether more often in men that women, Achilles tendon itself, is involved. Seen with or without peritendinitis ( involving the paratenon )is often associated with repetitive or high- impact sport such as running, basketball or volleyball. When overuse is a contributing factor, there will a characteristic history of gradual onset of pain that may be accentuated by excessive pronation or supination.

Training errors, poor flexibility and weakness of the Achilles tendon have also been implicated as predisposing factors in Achilles tendinitis. As with other overuse injuries, pain is aggravated by activity and and relieved by rest. Dorsiflexion causes pain, and crepitus may be felt along the tendon at the most tender area.

 

Treatment:

your therapist may have to decides to choose appropriate techniques depends on stage of injury or the type of overuse injuries, modality such as stretching,hydrotherapy, friction massage on calcified region of the tendon and joint mobilization may be used to improve mobility of involved joints. Self care such as stretching and strengthening of the involve muscle to create a muscle balance is important part of rehabilitation.