Lower leg pain may be a common finding in runners, symptoms can include temporary pain, swelling and in some cases there is associated numbness.
Exercise-induced lower leg pain is an umbrella term to cover a number of injuries including: chronic exertional compartment syndrome, popliteal arterial entrapment syndrome, medial tibial stress syndrome (MTSS) and tibial stress fractures. Here I have to put together a list of research papers relevant to lower leg pain.
Medial Tibial Stress Syndrome
For an active patient who is suffering from MTSS evidence suggest that in addition to lowering body mass index, patients also may benefit from improving plantar flexion range of motion.(Hamstra-Wright et al. 2015)
Chronic Exertional Compartment Syndrome
In the case of chronic exertional compartment syndrome, rest and conservative interventions usually allow symptoms to resolve. It is very rare that athletes require surgical interventions to manage their symptoms, however in these cases massage therapists should be aware of how they can contribute to post-surgical rehabilitation programs (Flautt et al. 2013 & Schubert 2011). As part of this rehabilitation strategy, there is evidence to suggest that in addition to managing pain and discomfort, massage may also improve tissue healing.
Why Does Massage Therapy Work?
A biopsychosocial framework helps put into context the interconnected and multidirectional interaction between: physiology, thoughts, emotions, behaviors, culture, and beliefs. In terms of clinical responses to massage therapy there are a couple of proposed mechanisms of action, including but not limited to: neurodynamics, contextually aided recovery, neuromodulation, social grooming and mechanotherapy.
The Complex Clinical Picture of Shin Splints
A massage therapy treatment plan should be implemented based on patient-specific assessment findings and patient tolerance. Structures to keep in mind while assessing and treating patients suffering from exercise-induced lower leg pain may include neurovascular structures and investing fascia of:
• Plantar Fascia
• Adductor Hallucis
• Flexor Hallucis Brevis
• Tibialis Anterior
• Metatarsals & Interossei
• Tibialis Posterior
• Flexor Digitorum Longus
• Triceps Surae
More to Explore
Beck, J.J., Tepolt, F.A., Miller, P.E., Micheli, L.J., Kocher, M.S. (2016). Surgical Treatment of Chronic Exertional Compartment Syndrome in Pediatric Patients. Am J Sports Med.
Blackman, P.G., Simmons, L.R., Crossley, K.M. (1998). Treatment of chronic exertional anterior compartment syndrome with massage: a pilot study. Clin J Sport Med.
Braver, R.T. (2016). Chronic Exertional Compartment Syndrome. Clin Podiatr Med Surg.
Brown, C.L., Gilbert, K.K., Brismee, J.M., ... Smith, M.P. (2011). The effects of neurodynamic mobilization on fluid dispersion within the tibial nerve at the ankle: an unembalmed cadaveric study. J Man Manip Ther.
Collins, C.K., Gilden, B. (2016). A non-operative approach to the management of chronic exertion compartment syndrome in a triathlete: A case report. Int J Sports Phys Ther.
Flautt, W., Miller, J. (2013). Post-surgical rehabilitation following fasciotomies for bilateral chronic exertional compartment syndrome in a special forces soldier: a case report. Int J Sports Phys The. (Open Access)
Galbraith, R.M., Lavallee, M.E. (2009). Medial tibial stress syndrome: conservative treatment options. Curr Rev Musculoskelet Med. (Open Access) https://www.ncbi.nlm.nih.gov/pubmed/19809896
Hamstra-Wright, K.L., Bliven, K.C., Bay, C. (2015). Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis. Br J Sports Med.
Joubert, S.V., Duarte, M.A. (2016). Chronic Exertional Compartment Syndrome in a Healthy Young Man. J Chiropr Med.
McKeon, P.O., Fourchet, F. (2015). Freeing the foot: integrating the foot core system into rehabilitation for lower extremity injuries. Clin Sports Med.
Orlin, J.R., Lied, I.H., Stranden, E., Irgens, H.U., Andersen, J.R. (2016). Prevalence of chronic compartment syndrome of the legs: Implications for clinical diagnostic criteria and therapy. Scand J Pain.
Rajasekaran, S., Hall, M.M. (2016). Nonoperative Management of Chronic Exertional Compartment Syndrome: A Systematic Review. Curr Sports Med Rep.
Reinking, M.F., Austin, T.M., Richter, R.R., Krieger, M.M. (2017). Medial Tibial Stress Syndrome in Active Individuals: A Systematic Review and Meta-analysis of Risk Factors. Sports Health. (OPEN ACCESS)
Saeki, J., Nakamura, M., Nakao, S., ... Ichihashi, N. (2017). Muscle stiffness of posterior lower leg in runners with a history of medial tibial stress syndrome. Scand J Med Sci Sports.
Schubert, A.G. (2011) Exertional compartment syndrome: review of the literature and proposed rehabilitation guidelines following surgical release. Int J Sports Phys Ther. (Open Access)
van Zantvoort, A.P., Cuppen, P., Scheltinga, M.R. (2017). Management and patients perspective regarding a common peroneal nerve schwannoma: a rare cause of lower leg pain in a young individual. BMJ Case Rep.
Winters, M., Bakker, E.W., Moen, M.H., ... Weir, A. (2017). Medial tibial stress syndrome can be diagnosed reliably using history and physical examination. Br J Sports Med.