Tibials Anterior Pain | Case Study
Running season is just
ramping up and though we don't typically think about running having a high rate
of injury, due to its repetitive nature the overall yearly incidence rate
for is actually quite high between 37 and 56% with 50 to 75% of those being
overuse injuries. The muscles about the lower leg and ankle are reported
as victims of this overuse.
This week, I began
working with a collegiate runner who has had pain in his anterior lower leg and
anterior ankle for the last year. Initially, the pain began after a long
run outdoors after a 7 mile treadmill run. The athlete reports the pain when
running that he is usually able to "push through" but does effects
his performance. Palpation revealed tenderness over the tibialis anterior
tendon at the anterior ankle. Palpation along his tibialis anterior
muscle also revealed tenderness and palpable tight bands of muscle eliciting
pain. Palpation of the lateral lower leg revealed tightness of peroneals
without associated tenderness. **see below for more information on the tibialis
anterior.
Ruled out: Stress
fracture, exertional compartment syndrome
Rehab
Strategies: reduce anterior tibial stress by modifying dosage of running
to allow for optimal tissue remodeling, addressing pain and tissue quality,
strengthening the muscle and the tendon, dorsiflexion mobility, education on shoes and lacing,
improving running mechanics.
Along with his normal tapering for a
meet, his first session included multiple needles left in situ with
electrical stimulation for 15 minutes. Two days later, he reports significant
decrease in symptoms. Follow-up will address strengthening of local
muscles and along the kinetic chain, evaluation of running mechanics.
**The tibialis anterior
is the meaty muscle that runs down the front of your shin, just outside of your
tibia. The tendon runs diagonally across the front of the ankle, under
the arch, and inserts on the underside of the foot. Its main functions in
running are to hold the foot up as well as position the foot for good placement
for footstrike.
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References:
Lopes, A. D., Hespanhol
Júnior, L. C., Yeung, S. S., & Costa, L. O. (2012). What are the main
running-related musculoskeletal injuries? A Systematic Review. Sports
medicine (Auckland, N.Z.), 42(10), 891-905.
Dunning, J., Butts, R., Mourad, F., Young, I., Flannagan, S.,
& Perreault, T. (2014). Dry needling: a literature review with implications
for clinical practice guidelines. Physical therapy reviews : PTR, 19(4),
252-265.
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