Many people especially runners experience pain down the front of the shin and have either self diagnosed or been to their GP who have given them the diagnosis of "shin splints".
So what exactly is shin splints? many medical professionals use the term shin splints as an umbrella term for pain down the front of the shin either due to lack of real understanding or perhaps just simple misdiagnosis.
This mis understanding is not the fault of the medical professional, but rather because of the vague definition given to shin splints and so shin splints has been used as more of an umbrella term rather than defining it as the specific condition it is. The American Medical Association of Nomenclature of Athletic Injuries state that the term shin splints should be confided to conditions of musculoskeletal origin, However this definition would mean that conditions such as tibial stress fractures, chronic exertional compartment syndrome, Tibialis Anterior strain etc are all put under this umbrella term. Krenner, 2002 on the other hand describes shin splints as micro tears in either the origin or insertion of the tibialis musculature which may also include interosseous membrane pain and tendonitis alongside periostitis, which I believe is a far better and more specific definition.
So how do you know if you have shin splints or Chronic Exertional Compartment Syndrome (CECS). People with CECS can go months if not years before they are properly diagnosed, as some of the symptoms are similar to shin splints i.e. pain usually starts in the front of the shin. However, there are a few other symptoms that will differentiate CECS. First of all pain usually starts at a predictable distance into a run and will gradually get worse the further you try and run. Second, numbness and pins and needles will start to develop if you continue to push through the pain to the point where your entire shin and foot will go completely numb. Stopping will usually relieve the symptoms. Please note: If you experience these symptoms and stopping the activity does not relieve your symptoms within a few minutes then you should seek immediate medical attention.
The rotator cuff is a group of four muscles the supraspinatus, infraspinatus, subscapularis and the Teres minor muscle. These muscles work synergistically to stabilise the humerus in the glenoid or your shoulder joint making sure that the humerus glides perfectly within the joint and preventing the humerus from compressing the structures around the joint. The muscles of the rotator cuff also act as synergists to the bigger surrounding muscles. Unfortunately these muscles are neglected and are rarely exercised well enough or at all by most active individuals. Therefore they become weak and unable to check the force generated by the much larger chest and back muscles leading to dysfunction and later to injury.
Rotator cuff tears (RCT) are a fairly common orthopaedic complaint. Typically people who suffer a RCT are usually from two different camps. First is the degenerative RCT typically affecting people of 60+ years old and the second camp are usually athletes or sports enthusiasts who play racquet sports and especially throwing sports such javelin, water polo and rugby. The causes of a RCT vary from person to person however, for those who are playing sports the cause is usually traumatic or overuse with inadequate conditioning of the shoulder complex. However for the degenerative RCT there are several intrinsic and extrinsic causes.
Intrinsic and Extrinsic Factors
The most widely excepted factor for RCT's is chronic overuse of the rotator cuff that leads to micro-tears within the tendons that overtime build up to cause a rupture of the tendon (usually the supraspinatus). Some researchers believe that degeneration of the rotator cuff is a normal and natural part of ageing. A study back in 1991 found that 97% of 891 tendons examined had signs of degeneration. This would certainly support the ageing theory. However, just because something is normal does not make it optimal. As their is no research that has investigated our modern lifestyles effect on degenerative RCT. In other words how does our lack of exercise, high stress jobs, poor food quailty etc have on our bodies ability to heal itself and prevent things like RCT's. Whilst there are no studies that factor in all the various variables as it would be impossible to quite frankly. There are studies available that single out certain lifestyle choice, such as smoking as well as looking at diabetes and high cholesterol (Essentially the effect of a poor diet/lifestyle) and the increased incidence of RCT. I will link to those papers at the end of this blog.
Sciatica is one of the most common diagnosis given by medical professionals for pain that radiates down the thigh.
So what is sciatica?
True sciatica is classified as pain that radiates down the back of the leg pass the knee and down to the foot. Sciatica is typically caused by a pinching of the sciatic nerve at the intervertebral foramina (the part of the spine where the nerves exit) this pinching can be caused by a number of structures both directly at the exit point of the nerve but also at various stages of the nerves path as it travels down the leg. However, it is usually due to a pinching at the nerve root that causes true sciatic pain.
Common symptoms include
- Pain in one leg that travels down to the foot
- Pain is usually described as sharp, burning or stabbing
- Pins and needles can sometimes accompany the pain
- Walking and movement can be difficult due to the pain
- Sitting often causes pain
- Bending forwards can give some relief
The good news is that sciatica is usually straight forwards to treat and permanent damage is rare. However if the pain begins to radiate into both legs that is accompanied by numbness around the anus and saddle region with incontinence then you should seek immediate medical attention as this is a sign of a condition called cauda equina which is a medial emergency.
How to treat sciatica
How sciatica is treated depends largely on the cause which your osteopath will be able to determine with an examination. but will usually consist of manual therapy and exercise, alongside possible lifestyle advice to prevent it from happening again. Below are several exercises that may give you some relief in the meantime.
If you currently have sciatica symptoms and would like to talk about your pain then I can be contacted on 07500059064 or by email at email@example.com or on facebook messenger.
Yours in Health
Andrew Graves, Osteopth & Sports Therapist
Serving Pontypool, Cwmbran, Usk & Abergvaenny
Andy has been involved in the health & fitness industry for over 10 years, specialising in corrective exercise, injury prevention and rehabilitation of low back, neck and shoulder pain. He also has an interest in the use of Osteopathy for the management of headaches.