Shin Splints Or Anterior Compartment Syndrome

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By John Harmata

askmredgeOne of the most common overuse injuries to the lower legs of skaters is shin splints. Although the term is routinely used, it does not represent a specific clinical pathology, but instead describes chronic shin pain as a result of overuse.

In skaters, shin splints are often accompanied by pain at the beginning of practice that gradually subsides, only to return much later after skating. To say that skating actually caused the shin splints is sometimes hard to determine, especially if the skater is involved in other outside activities such as track, basketball, volleyball, etc.

Masking itself as shin splints is a condition known as anterior compartment syndrome, which sometimes occurs as an acute injury from a direct blow to the lower leg. High-level skaters whose boots are too stiff will often inadvertently land their jumps in such a way that it causes a direct blow to the outside of the leg at a point where the top edge of the boot comes in contact with the leg.

Repetitive overuse of these muscles when jumping causes these tissues to swell, increasing compartmental pressure.

The muscles in this area of the lower leg are enclosed within fascial compartments that separate them from other muscles. Repetitive overuse of these muscles when jumping causes these tissues to swell, increasing compartmental pressure. As a result, the peroneal nerve and tibial artery are squeezed within the compartment; the more pressure within the compartment, the worse the pain will be. Ceasing to jump allows the pain to subside, usually within about thirty minutes as compartmental pressures return to normal. However, immediately upon jumping again, the pain returns.

Anterior compartment syndrome and shin splints are frequently confused with one another because they are commonly felt in the same region of the lower leg. Criteria to determine the difference include:

• Compartment syndrome: reduction of pain within a short period of time after ceasing to jump. Shin splints: pain usually increases after the activity, with delayed onset of soreness.

• Compartment syndrome: usually produces pain with palpation, but only if the compartment pressure is increased, such as immediately following a long jump session. Shin splints: likely to be tender to palpation long after skating has ended for the day.

• Compartment syndrome: less likely to be painful from stretching or manual resistance because neither of these increases the pressure within the compartment. Shin splints: produce pain while stretching and using manual resistance.

Posterior tibial tendon issues can also mimic shin splints, but the distinction is obvious to a physical therapist through evaluation and palpation.

True compartment syndrome is a rare condition, and making the proper diagnosis between the two is extremely important since the treatment strategies differ. Preventing these conditions requires properly fitted boots; good support in the boots (but not too stiff); a correctly mounted blade; routine stretching exercises before skating; and myofascial release with rolling after skating. The use of custom orthotics also is highly recommended.

– Guest Author, John Harmata