Tibials Anterior Pain | Case Study

by - 12:11 PM

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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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 : PTR19(4), 252-265.

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