shin splints - Fxs - final Flashcards
muscle involved with
- anterior shin splints:
- posterior shin splints:
- anterior tibialis
- posterior tibialis
most common type of shin splints:
posterior (4-19% in athletes)
risk factors of shin splints
females
high BMI
previous running injury
excessive pronation
- increased navicular drop
- eccentrically controlled by tib post
increased PF ROM (ankle instability)
greater hip ER
does shin splints and shoe wear correlate?
no
pathomechanics for post. shin splints
increased load on tib post. leading to tension on and inflammation of periosteal tissue
symptoms of shin splints
- onset
- worsened with
- no ___
- co existing __
gradual onset of medial shin pain
worsened with exercise and NOT ADLs
no cramping, burning, tingling (these would mean compartment syndrome)
1/3 co existing leg injuries
signs of shin splints
- observation
overstriding leading to greater heel strike
impaired LE control
- excessive pronation
- increased pelvic drop
- increased LE IR
signs of shin splints:
- resisted
weak possibly painful PFs
limited hip ext/abd strength and endurance
weak and painful IV
special test for shin splints:
- single leg hop on heel (+) =
- palpation
P! w < 10 reps - likely stress fx
** Due to PF of tib posst
TTP over postero-medial tibial border > 5 cm or 2 in in length
what do you educate your patient on regarding movement pattern training with shin splints?
NOT changed by strengthening alone
reduce LE IR
decrease heel strike with cueing for shorter/faster steps
what do you educate your patient on regarding shoe wear with shin splints?
light, supportive, cushioned
rotate shoes
change running shoes every 250-500 miles
PT Rx taping/orthotics
- taping:
- orthotic for excessive pronation:
- orthotic for heavy heel striker:
- functional support that allows ankle motion
- severe cases:
- assist tib post
- prefabricated orthotic
- cushioned inserts or gel heel cups
- air cast
- walking boot
when do you use MT for shin splitns
any joint dysfunctions like limited DF
MET primary focus for shin splints
unloading tibia and tib post
PT Rx MET:
- improve hip _____
- improve:
- address
- ext/er/abd strength
- PF & IV strength (gastroc/soleus PF, tib post main invertor)
- spinal stabilization as needed
differential diagnoses of shin splints (3)
stress reaction
stress fx
compartment syndrome
who is more likely to get bone stress injuries?
athletes (correlated w overuse)
female
< 20
** tibia most common bone
runners
areas for bone stress injuries:
- tibia
- fibula
- metatarsals
- runners
- distal region more common
- most common foot injury, most commonly base of 5th MT
what are the 3 zones of injury in metatarsals
zone 1: 90% of fx and mostly sprains
zone 2: most susceptible to AVN
zone 3: due to repetitive stress
risk factors of bone stress injuries
high forces
repetitive jumping/landing
lack of recovery from training
high training load
longer stride length –> greater heel strike
how does bone stress injuries happen
increasing load and frequency without recovery
osteoclastic activity exceeding osteoblastic activity
symptoms of bone stress injuries
worsening pain with ADLs and exercise, may become constant
test that can reproduce bone pain for tibial stress fx
hop test on heels within 10 reps
imaging for bone stress injuries
- radiograph
- MRI
- fx may not appear for 2-6 weeks so not that useful
- gold standard for earlier detection; not reflective of healing
what is the relation of BMD and growth spurts?
BMD decreases just before growth spurts and takes up to 4 years to increase afterwards
PT Rx for bone stress injuries
diet and hormonal limitations due to possible decreased bone mass density
well managed sleep, stress, BMI (low is more concerning)
medications (i.e. antacids)
why would it be common for a 12 year old female to have a bone stress injury?
period of skeletal weakness around or after growth spurt and are dealing with hormonal and skeletal changes which has greater affect on BMD and muscle strength
how do you treat a bone stress injury?
graded unloading to ambulate without pain –> essentially do whatever it takes to move without pain
gradual and progressive return to activity while addressing risk factors and etiologies
prognosis for tibial stress fx
- @ 3 months
- @ 6 months
- BMD lowest at 3 months post fx in both legs –> reinjury to either LE more likely prior to 3 months
- all were at baseline BMD by 6 months
pathogenesis of compartment syndrome
increased swelling with limited fascial extensibility, part. compressing neurovascular structures in the anterior leg compartment
- pressure pushes outward but can’t go anywhere so it comes back in and creates the compression on neurovascular structures
S&S of compartment syndrome
- causes
- primarily ___
- lengthening of ____ adds to _____
recent blunt trauma or over use to ant compartment
primarily cramping, burning, tingling
any lengthening or use of DFs adds to compression and P!
what are the 6 Ps (deciding factors) of compartment syndrome
pain - severe and persistent
palpable tenderness
pulselessness
pallor
paresthesias (deep peroneal n.)
paralysis
what should happen if the 6 Ps of compartment syndrome are unrelenting?
medical emergency due to neurovascular compromise and need for surgical fasciotomy to prevent tissue death
what should happen if the 6 Ps of compartment syndrome are modifiable?
PT directed at source of inflammation and fascial extensibility (exercise, MT)
surgery may be necessary
ankle fx aka Pott’s
- bi-malleolar:
- tri-malleolar:
- distal tibia + distal fibula
- tibia + fibula + post. tibial rim
what is the most common tarsal fx
calcaneus
true or false. midfoot fractures are common
false
rare except navicular
what is the most common region of foot fx
forefoot
