This represents one of the broadest umbrella terms for problems experienced within the lower leg.
Under this umbrella falls three different problems that can co-exist with one another, or can be present alone. These are
- Medial Tibial Stress Syndrome (MTSS)
- Tibial stress fracture
- Chronic Compartment Syndrome
Characterised by tenderness or pain along the inside border of the shin bone. Aggravated by running or other load bearing activity. The symptoms can often linger for several hours after exertion dependent on severity.
The pain is thought to originate from the pulling of the muscles facia on the outer surface of the bone (the periosteum). Repetitve trauma causes a greater and greater bone stress reponse, which can lead to inflammation of the periosteum (periositis).
Tibial Stress Fracture
A more focal stress to the weight bearing bone of the lower leg (the tibia) can result in a bone stress response. This diagnosis is not dissimilar to MTSS, however, is no longer just a pathology of the bones surface but affects deeper layers (cortex).
The differntiation between the two conditions is made by;
- The location of symptoms (more focal in tibial stress fracture)
- Night pain (present in tibial stress fracture)
- Duration to settle after run/weight bearing activity (significantly longer if at all with tibial stress fracture)
Chronic Compartment Syndrome
Within the lower leg there are 4 ‘compartments’. Cylinders that run the length of the lower leg, that are created by facia (an inelastic connective tissue). Within these compartments are your muscles, blood vessels and nerves. When muscles are working they require more blood, so will swell within each of these 4 cylinders. Due to the lack of ‘give’ within the facia, if the muscles swell just a little too much each cylinder can end up being too tight. This can cause a reduction in blood supply and pain within the lower leg.
The symptoms are characterised by;
- Tight/cramping type feeling into the lower leg
- Occasionally pins and needles are felt in the lower leg or foot
- Symptoms settle within a short period (less than 20mins) after you stop running