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100 m a s s a g e & b o d y w o r k m a r c h / a p r i l 2 0 1 4 technique CLINICAL APPS Denise's Shin Splints By Whitney Lowe Denise has a job in which she sits at her desk most of the day. Fortunately, she has been able to start exercising recently because her company organized a soccer team. Several weeks ago, after their second day of practice, Denise began to experience aching pain in the lower part of her leg. The pain has increased gradually and occurs with each game, continuing for another day or two after the game and then subsiding. The pain is only in her right leg. Denise has tried managing the pain with periodic icing and over-the-counter anti-inflammatory medications, but neither approach has been very effective. Her primary interest is to address the pain so she can continue playing soccer. KEY CONSIDERATIONS First and foremost, it is clear this is a chronic overuse condition that seems directly related to Denise's recent increase in activity levels. Any time there is a sudden and recent change in activity levels, especially without adequate conditioning, it is a red flag for the development of an overuse disorder. Overuse disorders in the lower leg commonly affect the dorsiflexor muscles, as well as the deep posterior compartment group, so let's look at the location and function of these two muscle groups in greater detail. Pain and dysfunction in the dorsiflexor muscle group are generally felt in the anterior shin region and are commonly called shin splints, although that term is used ambiguously. The dorsiflexors play a key role during locomotion and a closer look at their function clarifies why they are so frequently involved in these disorders. We think of these muscles predominantly as dorsiflexors of the foot, because that is their primary role during their concentric contraction. They also have a key role in decelerating the 1 foot and absorbing impact forces during walking or running. Immediately after a heel strike, the dorsiflexors act eccentrically as the foot moves in plantar flexion to slow the momentum of the foot to keep it from slapping down onto the ground (Image 1). This repetitive eccentric load at every foot strike is part of what produces the chronic overuse pain of anterior shin splints. If you are running or walking downhill, the force and effort required to decelerate the foot is even greater. Consequently, you frequently hear of people developing anterior shin splints from a long bout of downhill exercise, like hiking down a mountain. Running also exaggerates the force load these muscles must decelerate. It would certainly fit Denise's clinical picture for her to have an overuse condition from overloading the dorsiflexor muscles. Muscles of the deep posterior compartment are also commonly involved in lower leg overuse disorders. The term shin splints can also apply to problems with the posterior compartment muscles, and may be called posterior shin splints The tibialis anterior activates immediately upon heel strike to prevent the foot from slapping the ground too hard.