Overuse syndromes
Common overuse syndromes include:
- Medial tibial stress syndrome (shin splints)
- Patellofemoral syndrome
- Epicondilitis
- Shoulder impingement syndrome
- Spondylosis
- Spondylolisthesis
- Plantar fasciitis
Lets consider each below.
Medial tibial stress syndrome (shin splints)
This is a common injury of the leg often associated with overuse of the shin area. The underlying pathophysiology is periostitis of the tibia due to tibial strain when under a load, combined with tendinopathies, periosteal remodelling and stress reactions of the tibia. Dysfunction of the anterior and posterior tibial muscles as wella s soleus muscle is implicated.
These pathologies seem to develop as a result of chronic, repetitive loads causing abnormal strain and bending of the tibia. Some authors consider tibial stress fractures on a continuum of tibial stress syndrome.
The condition presents with exertional lower leg pain centered on the posteromedial tibial border in a diffuse manner. When presentation is acute, consider risk of some form of fracture that should be ruled out.
Presentations are most common in females, with a running history of less than 5 years. It is often found along with other lower limb anomalies such as genu varus or valgus, tibial torsion, femoral anteversion, foot arch abnormalities, or leg length discrepancy. Hyperpronation of the subtalar joint is one of the most common and well documented risk factors.
Treatment in acute phase should be RICE (rest is the most important part of this). Decreasing use of the area in such an intense way will help to minimise symptoms, stretching and strengthening exercises can help, as well as wearing proper fitting shoes with good shock absorption. Surgery for recalcitrant cases.
Patellofemoral syndrome
One of the most common disorders of the knee, accounting for 25% of knee injuries seen in a sports medicine clinic. It is defined as knee pain resulting from mechanical and biochemical changes to the patellofemoral joint and usually presents with an ill-defined ache.
Its exact etiology is unknown, but it is likely to be multifactorial leading to a number of contributing factors including:
- Abnormal patellofemoral joint mechanics
- Bony and structural abnormalities
- Tightness of soft tissue structures
- Decreased patellar mobility
- Quadriceps muscle weakness
- Altered lower-extremity alignment and/or motion
- Subtalar joint pronation
- Excessive hip internal rotation
- Hip abductor weakness
- Gait deviation
The normal patella requires balanced forces to limit undue stress on the joint, if the stress exceeds the tissues mechanical strength, microdamage and inflammation along with of course pain, result.