Undiagnosed shin pain - could it be compartment syndrome?

[SocialNutter]

Hi all,

I'm a pretty dedicated runner (training 6 times a week when not injured) and tend to focus on longer distances (half / full marathons) when racing. Last autumn I was off training for a good couple of months with a pain in my shin - about half way down my leg and to the left side of the shin bone as you look at it. I do have a history of shin splints (usually when my shoes are getting old), but this is a very different sort of pain and in a slightly different place. It was painful enough that at it's worse it was painful when I walked. I saw a physio and he suggested it might be compartment syndrome caused by too much hill running (I'd spent a couple of months living in very hilly spain). I rested from running completely for several weeks, gradually returned to training and managed to train for a spring marathon, running 6 times a week without any trouble from it.

Since the marathon I took a few weeks off for a different injury, and have been back training for about 6 weeks now. Before I start my next marathon stretch, I decided to work on speed and train for a 10k instead - so I've still be training 6 times a week, but focusing on shorter, harder runs rather than distance. And the pain is starting to come back. I haven't been hill training (the area I live now is almost completely flat) and it doesn't actually hurt during or after the run - instead the pain sort of 'pulses' when I'm sitting or lying down - possibly several hours after a run, or before I've trained that day at all.

Seeing as it took me out of training for such a long time last year, I'm anxious to get it sorted this time around as soon as possible (my next marathon is Amsterdam in October). I've taken a couple of days off training, removed recovery runs from my routine and am icing the area / using anti-inflammatories - but I can't seem to figure out what's caused the pain this time around or what the problem actually is. Everything I read about compartment syndrome says that to fix the problem I'll need surgery - does this problem sound like compartment syndrome and will I need surgery to correct it?

Many thanks!
Claire

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[Diilan]

Hello,
Interesting case you have there, sounds to me like a bit of MTSS

http://www.google.co.uk/url?sa=t&rct...uOA6smH6IJgUxQ

paste the above into your browser and have a read, the paper is called

Factors Contributing to the Development of
Medial Tibial Stress Syndrome in High
School Runners

A specialist Physio who looks at function and bio mechanics maybe is what you need.
Have you been assessed, get them to look right up the kinetic chain for any compensations like over pronation, weak glutes. You might need to have your gait assessed.
Too much to list in this but there is some starters for you.

If I was you though the first thing I would do is get a good x-ray, as you need to rule out 'stress fractures' lots of hill running, ? poor bio-mechanics leading to altered gait could be the root to your problems.

I wouldn't like to say if it was compartment syndrome nor would I say it was stress fractures, but if I was a gambling man then I'd say the latter

Good Luck, if you live in London look us up, my name is Lee

Physiotherapy & Sports Injury Centres : Advanced Physiotherapy Centres

Just about to sign off and found this >>>>>>>

This is how I would think about this problem;

Medial Tibial stress syndome has been attributed to 2 main causes;
1) Tensional stress from muscular contraction
2) Bending moment stress from the Ground reaction force.

Compartment syndrome can be attributed to muscle overuse or trauma, which causes swelling of the muscle within its sheath.

If we consider this as a biomechanical problem then the muscles that can cause excessive tensional loading to the medial tibia are those that have origins in the medial tibia or the interosseous membrane and are; both long toe flexors. tibialis posterior and soleus.

If these muscles are causing excessive tensional load then it is likely that one or more are also being traumatised by the internal stresses experienced during some activities.

If these muscles are overworked then this is probably due to excessive pronation moments that make resupination difficult and therefore the internal moments for equilibrium are likely to be high. This will of course necessitate excessive muscle tension but also the action that produces high pronation moments will also apply high medial to lateral horizontal GRF. These forces will cause increased bending moments about the tibia that will tend to abduct the lower leg. This will result in tension in the medial aspect and compression in the lateral aspect i.e. stress fractures are likely to occur in the medial borders of the tibia.

Ankle equinus may cause an excessive knee flexion compensation and possibly increased pronation to optimise saggital plane progression and so gastroc efficiency will be reduced and more stress will be induced in soleus and Post tib.

Because of the physical position of the medial muscle origins the tensional forces do also induce a bending moment on the tibia and therefore add to the bending moments of GRF.

I would conclude therefore that it is entirely possible that the two are co- related
and that the appropriate orthoses to alter GRF application would be an integral part of the therapy program.

So see, lots going on so I'd get a good Physio first before shelling out lots on orthotics, it's probably just poor bio-mechanics

Lee...

Hi all,

I'm a pretty dedicated runner (training 6 times a week when not injured) and tend to focus on longer distances (half / full marathons) when racing. Last autumn I was off training for a good couple of months with a pain in my shin - about half way down my leg and to the left side of the shin bone as you look at it. I do have a history of shin splints (usually when my shoes are getting old), but this is a very different sort of pain and in a slightly different place. It was painful enough that at it's worse it was painful when I walked. I saw a physio and he suggested it might be compartment syndrome caused by too much hill running (I'd spent a couple of months living in very hilly spain). I rested from running completely for several weeks, gradually returned to training and managed to train for a spring marathon, running 6 times a week without any trouble from it.

Since the marathon I took a few weeks off for a different injury, and have been back training for about 6 weeks now. Before I start my next marathon stretch, I decided to work on speed and train for a 10k instead - so I've still be training 6 times a week, but focusing on shorter, harder runs rather than distance. And the pain is starting to come back. I haven't been hill training (the area I live now is almost completely flat) and it doesn't actually hurt during or after the run - instead the pain sort of 'pulses' when I'm sitting or lying down - possibly several hours after a run, or before I've trained that day at all.

Seeing as it took me out of training for such a long time last year, I'm anxious to get it sorted this time around as soon as possible (my next marathon is Amsterdam in October). I've taken a couple of days off training, removed recovery runs from my routine and am icing the area / using anti-inflammatories - but I can't seem to figure out what's caused the pain this time around or what the problem actually is. Everything I read about compartment syndrome says that to fix the problem I'll need surgery - does this problem sound like compartment syndrome and will I need surgery to correct it?

Many thanks!
Claire

[nmarman]

compartment syndrome is rare, rare and rare. it is the last diagnosis for shin pain.

can clarify the location "left side of the shin bone as you look at it" who is looking at it?? maybe say the outside (lateral shin) or inside (medial edge).

MTSS is no doubt what you had before "shin Splints" most common cause. caused by flat feet - however old shoes where down and eventually give little support the the inside arch of the foot, hence why this is related to shoes getting old.

your current condition is different and is most likely caused by you changing your running style. in both incidence where you where getting the pain. hill running and speed running a athlete changes there gait. essentially hill running will give little rest to the muscle located in the front of shin and a sudden change in running can cause poor acquisition of technique. running for speed might have forced you to toe off excessively.

get your gait check - job done.

also you can rule out MTSS with a foot analysis and some palpation - easy,

hope it helps

[SocialNutter]

The pain's on the inside of my shinbone (if you were looking at my shin, the left side of it :-) )

I'm going to try and get my gait re-analysed in the next week to see if that helps at all - what's palpation though?