Anterior shin splints is a term used to describe pain along the shin bone. Shin splints are a common occurrence in athletics and military personnel, but may affect any individual with a hobby or occupation involving extensive walking or running activities.
Anterior Compartment Syndrome - (Anterior shin splints)
Shin splints are among some of the most common lower extremity injuries, especially as far as overuse goes. That said, the term “shin splints” can be very confusing for readers. First, even though many use the term shin splints collectively, there are actually two different shin splints. Anterior shin splints occur on the proximal anterior lateral region of the lower leg. Posterior shin splints, also called medial tibial stress syndrome or MTSS, occur on the distal medial region of the lower leg. Posterior shin splints are the more common of the two. Secondly, because chronic anterior compartment syndrome and shin splints are both overuse conditions, produce symptoms in the same area, and can coexist or cause one another, many fail to make the proper distinctions between the two. Here, anterior shin splints and anterior compartment syndrome will be discussed.
Anatomy As It Relates To Shin Splints And Anterior Compartment Syndrome
Two bones make up the lower leg - the tibia and fibula. The tibia, also called the shinbone, is the larger of the two bones. The fibula is the thinner smaller bone that runs alongside the tibia from the knee to the ankle. Several muscles work with the tibia and fibula bones to provide foot movement.
Muscles in the lower legs are medically divided into compartments. The anterior compartment holds the extensor digitorum longus, extensor hallucus longus, tibilais anterior, and the peroneus tertius muscles. These muscles work with the tibia to bend the foot upwardly (dorsiflexion). The tibialis anterior also has an assisting role in turning the foot inwardly. The anterior tibialis is the muscle most often involved in shin splints.
These muscles are covered in tough connective tissue called fascia. Fascia wraps around the muscles, bone, nerves, and blood vessels (much like a sausage casing) to hold everything in place and form the anterior compartment. The fascia is slightly flexible, which allows for just enough room for the muscle to expand during movement and blood vessels to dilate from increased blood flow during physical exertion.
Anterior Shin Splints And Anterior Compartment Syndrome
Shin Splints
Anterior shin splints are most often attributed to an overuse or inflammation of the anterior tibialis muscle, but can be due to irritation or inflammation of any of the structures within the anterior muscle compartment. As mentioned above, even the inflammation of the compartment itself is now considered part of anterior shin splints by some medical professionals. The overuse and resulting inflammation comes from the repetitive action of the anterior compartment muscles flexing to move the foot upwardly. Certain actions leave a person at risk for anterior shin splints:
* frequent brisk walking
* frequent downhill walking
* suddenly changing the pace; surface; duration, frequency, or intensity (overtraining syndrome); or incline or decline involved in lower limb exercises and walking/running activities
* anterior compartment muscle cramping
* taking up a new activity that requires frequent starts and stops from motion (this places a strain that the anterior compartment muscles are unaccustomed to handling and can cause the affected muscle(s) to become irritated and inflamed)
The symptoms of shin splints are as follows:
* dull or aching pain and tenderness, usually near the muscle/bone attachment site on the front of the tibia.
* pain intensifies when the foot is bent upwardly
* there may be localized, redness, warmth, and swelling
The overuse of the anterior compartment muscles leave the muscles and bones at risk for more serious injuries, such as a tibia stress fracture or chronic compartment syndrome.
Anterior Compartment Syndrome
When the swelling and pressure from muscular damage and irritation from shin splints continue and build inside the anterior compartment, the pressure may become greater than the blood pressure keeping tiny capillaries supplying blood to the muscles in the compartment open. In this event, the capillaries are squeezed in a manner that inhibits blood supply to the muscle tissues. This can cause the muscle to ache and cramp at first, but as the pressure continues to rise, it can squeeze larger blood vessels and nerves. This can cause the leg and foot areas under the compartment to feel cold and numb, swell, and hurt.
Anterior compartment syndrome may also occur after an acute traumatic injury, such as a direct blow to the front of the shinbone. But, is more often a chronic condition from overuse of the anterior compartment structures (as described under anterior shin splints) or from fascia that has become less elastic over time and is no longer able to accommodate muscular expansion during movements. Some refer to the overuse form of anterior compartment syndrome as exertional compartment syndrome (ECS) to distinguish it from its more serious acute counterpart.
Just as in shin splints, the repetitive overuse can cause the muscles and surrounding tissues to swell. If the muscle becomes to big for the surrounding fascia and increases the compartmental pressure, it’s called anterior compartment syndrome. Unlike shin splints, the swelling is great enough to squeeze nerves, veins, and arteries within the compartment. The following symptoms of anterior compartment syndrome distinguish it from shin splints:
* coldness in the lower leg and foot
* the distal lower extremity may change color (usually a pale bluish tint)
* there may be severe dorsiflexion motor function impairment
* the lower leg and foot may feel numb or “dead”
Strengthening Exercises
These Calf Exercises are ideal to build strength and flexibility.
Massage Treatment
These Calf Massage Techniques are of great value in pain relief; circulation stimulation; dispersing blood and fluid accumulations; swelling reduction; and relaxing muscle spasms, especially when used alongside the Sinew Therapeutics liniments and soaks.
ACUTE STAGE SYMPTOMS AND TREATMENT
When there is swelling and inflammation in your calf.
ACUTE STAGE SYMPTOMS:
The acute stage starts the moment an injury occurs and lasts until the swelling and inflammation are gone. The swelling is the result of the blockage of blood, tissue fluids and circulation in the calf because their normal movement has been disrupted by the force of the injury. Just like cars back up behind a traffic jam, causing congestion, exhaust and overheating; blood and fluids back up behind the injured calf, causing pain, inflammation, lumps and swelling.
The sensation of heat is due to the warming action of the blood and fluids overheating in the injured calf as they back up and accumulate. Stiffness and decreased mobility are due to spasms in tendons and ligaments that have contracted reflexively beyond their normal range from the impact of the injury.
As ligaments and tendons stretch and tear, blood from ruptured blood vessels becomes trapped in the local tissues. As the trapped blood clots up, it sticks the tissues together creating adhesions. Adhesions cause pain, inflammation and restricted movement because the layers of tissue that used to slide smoothly across one another now adhere and snap which interferes with normal functioning. It is essential to break up clotted blood as quickly as possible to prevent adhesions and scar tissue from forming.
During the acute stage it is very important to restore normal circulation to the calf, break up clotted blood and stagnant fluids, reduce swelling, and reduce the redness and heat associated with inflammation. By restoring the flow of blood, fluids, and circulation in the calf, then pain is relieved, damaged tissues can regenerate with healthy functional tissue, and the calf can strengthen and regain it's mobility.
ACUTE STAGE TREATMENT:
1. Apply the Sinew Herbal Ice on your calf to reduce redness, swelling, and inflammation while dispersing accumulated blood and fluids to help restore normal circulation to the calf. This first-aid treatment is used in place of ice to significantly speed up the healing process. It reduces the swelling and inflammation more effectively than ice, allowing you to more quickly regain range of motion. Acute Sinew Liniment can be used in-between applications.
Ice is not recommended because it does not help repair damaged tissues and keeps everything in the injured area frozen, causing the stagnation of blood and fluids and the contraction of muscles, tendons and ligaments. In Chinese sports medicine ice is not used and is considered a culprit in injuries that don’t heal well.
2. Massage your calf with Acute Sinew Liniment to relieve pain, reduce swelling and inflammation, break up clotted blood and stagnant fluids, and stimulate circulation of blood and fluids to help cells quickly repair damaged tissues. Sinew Herbal Ice can be used in-between applications.
3. The Sinew Sports Massage Oil is recommended for use before and after exercise, sports and strenuous activity. It warms and stimulates your muscles, increases circulation and relieves tightness, hence improving your performance and helping to prevent injury.
CHRONIC STAGE SYMPTOMS AND TREATMENT
When there is NO swelling and inflammation in your calf.
CHRONIC STAGE SYMPTOMS:
The chronic stage begins once the swelling and inflammation are gone, but you still feel aching pain and stiffness. This is because there are still accumulations of stagnant blood and fluids in your calf that are blocking circulation and blood supply to damaged tissues, creating residual pain, stiffness and weakness. You may actually feel hard nodules like sand in the tissue, indicating accumulation, calcification, and adhesions, which all cause pain, stiffness, and joint instability.
Your calf may feel more sensitive to the cold and ache in cold and damp weather due to impaired circulation. When you move your calf you may hear a clicking or popping sound from the tendons and ligaments slipping very slightly in and out of their natural alignment indicating weakness and joint instability, causing chronic pain and a cycle of reinjury. These symptoms are often the result of failure to treat the injury properly from the outset and overicing.
Increasing circulation and blood supply to the damaged tissues is very important in treating chronic injuries because tendons and ligaments do not have an extensive direct supply of blood. That is why chronic injuries can be slow to heal. Increasing local circulation also prevents cold and dampness from penetrating the injured area, preventing pain and stiffness.
During the chronic stage it is very important to break up remaining accumulations of blood and fluids, and increase circulation and blood supply to the damaged tissues. By increasing circulation and blood flow in the calf, then pain and stiffness is relieved, and the tendons and ligaments can strengthen to restore stability.
CHRONIC STAGE TREATMENT:
1. Massage your calf with Chronic Sinew Liniment to relieve pain and stiffness, strongly stimulate circulation and blood flow to damaged tissues, and promote the healing of overstretched tendons and ligaments. The Sinew Relaxing Soak can be used in-between applications.
2. Soak your calf with the Sinew Relaxing Soak to relax muscles and tendons that are in spasm, ease joint pain and stiffness, and improve range of motion. The Sinew Relaxing Soak is particularly useful if you feel restricted mobility in your calf. The soak can be used by saturating a towel in the liquid and applying it to your calf. Chronic Sinew Liniment can be used in-between applications.
3. The Sinew Sports Massage Oil is recommended for use before and after exercise, sports and strenuous activity. It warms and stimulates your muscles, increases circulation and relieves tightness, hence improving your performance and helping to prevent injury.
