Low Leg Pain

Shin Splints with Underlying Posterior Tibial Tendinitis: A Case Report
William M. Austin, DC, CCSP, CCRD


Objective
:
To discuss treatment protocols for a recreational middle-distance runner who suffered from anterior shin splints complicated by an underlying posterior tibial tendinitis, who was unable to train to his full capacities, and who turned to chiropractic care when standard medical protocols proved ineffective.


Methods
:
A multifaceted treatment approach was used. Foot Levelers’ custom-made, flexible orthotics -- to support the skeletal alignment in a more appropriate range for weightbearing posture -- provided increased heel-strike shock absorption and enhanced afferent-motor response. Manipulation of the navicular, cuboid, and metatarsal heads was administered. Ice massages were recommended, and evertors and invertors were strengthened with low-tech resistive exercises.


Results
:
After 3 weeks of care, the patient was able to resume running at a moderate pace and distance (2-3 miles every other day) and after 6 weeks, he was running 40 miles per week without pain and was released from care.


Discussion
:
It is not unusual for the chiropractor, especially the sports-minded practitioner, to be consulted for the vague pain and nonspecific symptoms accompanying the gradual onset of a stress reaction to the soft tissues and/or bone. These conditions can be effectively managed if identification is early and an appropriate treatment program is followed. Ultra-lightweight, flexible orthotics can play a major role in preventing many overuse injuries in runners and joggers.


Conclusion
:
When assessing overuse injuries, it is imperative to look for intrinsic as well as extrinsic factors. Addressing one without the other in the treatment regime may lead to unsatisfactory or only short-term results. However, correcting or supporting the faulty biomechanics often makes the difference in providing long-term relief of symptoms and return to activities of daily living, including intense athletic training programs.

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