Treating Severe Shin Pain In Weeks Without Orthotics
Meet Jessica
Healthy and active 25-year-old female
Painful cramping at the front of both shins for six months
Pain starts and worsens during physical activity, alleviates after rest
Jessica came to see us as she was concerned about her painful cramps during exercise, especially during her social touch rugby games. She was very worried that it could be a blood clot in her leg, as the front of her shins were visibly swelling and bulging during the painful ‘episodes’. She even felt tingling at the tops of her feet occasionally
On Examination
When we examined Jessica, we noticed significant tightness of the muscles at the front of the shin – called the anterior compartment. The role of these muscles is to lift our foot up, so we clear the ground with each step and don’t trip over our toes.
We had Jessica complete a 5-minute run on our athlete-grade Zebris Gait Analysis Treadmill, which caused the muscles in her anterior compartment to noticeably swell.
We observed that Jessica lifted her foot and toes up much more than what is ‘normal’ – or what she needs to. She was also reaching too far out with her contact leg before quickly slapping the foot down on the ground.
Apart from these aspects of her running technique, her foot and leg function were otherwise normal.
Diagnosis – Compartment Syndrome
We diagnosed Jessica with Chronic (Exertional) Compartment Syndrome affecting the anterior compartment of her lower leg (shins)
Compartment Syndrome occurs when swelling or bleeding occurs within a muscle compartment of the leg. These ‘compartments’ are surrounded by a lining called the fascia, which doesn’t naturally stretch or expand. Therefore, any swelling and pressure stays restricted within the compartment and can restrict the blood vessels in the compartment (starving muscles and nerves of oxygen and nutrients) while putting pressure on other muscles in the compartment – causing pain.
There are two types of Compartment Syndrome, Acute and Chronic (Exertional). Acute Compartment Syndrome is usually caused by a serious impact injury and is a medical emergency requiring surgery. Here the pain does not come and go, but stays constant and severe. Chronic Compartment Syndrome is not usually dangerous and is caused by muscles swelling due to overuse (often during physical activity).
The Cause
In Jessica’s case, it was her tight muscles and fascia combined with overworking the muscle group during her gait (excessively lifting the foot up, over-striding, and forcefully slapping her foot against the ground). These combined mechanisms have led to her overusing of the muscles, which demands greater blood supply, leading to swelling and constriction within the compartment
Treatment
We determined the best treatment for Jessica’s compartment syndrome was manual soft tissue therapy to reduce the muscle tightness and also stretch the tight surrounding fascia. We also helped Jessica adjust her running technique, to be lower impact and more efficient. We did this using our in house Zebris Gait Analysis Treadmill, which has 7000 pressure sensors and dual video recording so we can see and understand everything that is happening when she runs – and how to fix it.
Our goal was not only to relieve Jessica’s current symptoms, but also to reduce the likelihood of them affecting her again in the future.
Jessica’s Results
After three weeks of treatment and practicing her new running technique, Jessica was able to finish a touch football game without pain, which she was thrilled about. She found the soft tissue therapy provided immediate improvement for her symptoms and she can now perform this herself regularly to prevent these tissues from tightening again.
