chronic shin pain please help

[Hallamshire Physiotherapy]

Hi
Leg pain at night from my experience is often related to neural hypoxia as you rest your blood pressure drops and the nerve loses its vascularity (a similar thing is seen in CTS at night). Try walking up/down your stairs before you go to bed and see if you sleep better. This will increase the blood perfusion around your nerves in the lower leg and might reduce your night symptoms. That might explain why you were better when you were more active.
A longterm solution will be to have your back assessed by a competent physiotherapist as you might still stand in your pregnancy posture i.e lordotic with posterior sway of your upper trunk. Thus, stressing your lower back and nerve roots. Also check your SLR with adduction of the hip and inv/ev of the foot.

Just a few thoughts. Please tell me how you got on.

Steve
Hallamshire Physiotherapy

[mart30]

Thanks Steve, this makes alot of sense, will get walking up and down the stairs immediately! Will let you know how I get on.

[naveenedin]

hi steve, hallamshire physio,
gud thinking, never realized or to be honest even thought of neural hypoxia. may i ask u, wat prompted u for neural hypoxia, considering the fact she had this pain for 9 years. If you a find a negative hard neuro on this patient, wat would be ur next step. Wat really expalins the chronicity?? We havent checked if her feet is ok or not. anyway, lady reports of decreased pain at the end, which is good.

[Hallamshire Physiotherapy]

Naveenedin

The symptoms at night and history were suggestive of neural hypoxia. I would expect to find some positive neural compliance test, but certainly some loss of movement and altered movement control in the pelvis/lumbar region.

If compiance testing was negative I would still treat the movement dysfunction in the spine and monitor the night symptoms.

Eight years with this problem is not unusual and I see many people with symptoms for 20 years plus and they have often compensated for the original problem by changing movement paterns. This is then reinforced by health professional frightening them by telling them they have 'degenerative' changes in their spine!

Steve
Hallamshire Physiotherapy

[naveenedin]

hello steve,
I appreciate your time, may i ask you a couple of questions.

thanks for your reply. What is the best treatment for neural hypoxia???. you did asked that lady, to go up and down stairs before bed. What exactly does that do. I would imagine it gives more bloodsupply to extremties, but how does tat infleunce into a neural level.

You used night pain in CTS as an analogy to this shin pain. I thought in CTS, night pain is due to stretch of median nerve during stretched(curled up) arm position, hence night splint is used. But you were saying neural hypoxia, explains the night pain in CTS.
Thanks
Naveen

[Hallamshire Physiotherapy]

Naveenedin

Sydney Sunderland (an Australian I think but don't hold that against him!) did work on the blood flow around periperal nerves many years ago and described a 'gradient' of pressure from the artery to the vein around the nerve that must be larger than the pressure in the space that the nerve passes through. Lower the pressure, for example dropping heart rate at night and hypoxia starts. The answer is increase the heart rate to increase blood pressure around the nerve or make the space larger (as in carpal tunnel release). Intesestingly people with high BP dont seem to get carpal tunnel problems as the hogh pressure ensures the nerve always gets perfused.

This patient must have a cardiovascular programme running along side physiotherapy treatment aimed at reducing possible annormal spinal loading caused by pregnancy/poor posture.


I have found this idea useful and it seems to make sense with my clinical reasoning.

[pareeves]

I am reading this thread with interest as I am new to the forum and have been suffering with consistent night time leg pain below the knee every night--strong enough to wake me from sleep. I do notice that if I get up and walk around it subsides, but comes back. I have had vein intervention treatment in Hawaii which helped a lot. I can do whatever I want during the day but my nights are becoming hard to bear. any suggestions for exercise (other than stair climbing because I don't have any) would be appreciated. thanks