Re:과사용증후군 - shin splints

[문형철]

운동선수의 shin splint에 대한 모든 것

하지는 운동을 하는 동안 지속적인 부하를 받기 때문에 많은 질병이 발생!!

panic bird..

 Shin splints

Shin splints, or medial tibial stress syndrome, can be described as a clinical entity characterized by diffuse tenderness over the posteromedial aspect of the distal third of the tibia [137]. In mild cases, pain is present only with exercise; in more severe cases rest pain is present. Shin splints have been reported to account for 12% to 18%of running injuries [43,138–140] and to occur in 4% of all military recruits in basic training [141]. Women appear more frequently affected than men[138,142,143].

- 정강이 통증 또는 내측 경골스트레스 증후군은 경골의 distal 1/3부위의 골막에 미만성 압통을 특징으로하는 임상적 실재임. 

- 가벼운 경우,  통증은 운동을 할때만 발생함. 좀더 심한 경우에는 쉴때도 통증 발생

- 정강이 통증은 달리기 손상의 12-18%를 차지함. 그리고 모든 군인의 4%를 차지함. 여성은 남성보다 쉽게 발생함. 

Medial tibial stress syndrome is to be differentiated from stress fracture and exertional compartment syndrome [144,145]. Although different entities, they may coexist. Plain films are negative (except in cases of previous or coexistent stress fracture). Bone scans will demonstrate characteristic vertical linear increased activity along the tibial periosteum, which differs from the more focal fusiform

increased radiotracer uptake exhibited by stress fractures [123]. Medial tibial stress syndrome is felt by most to represent a periostalgia or tendinopathy along the tibial attachment of the tibialis posterior or soleus muscles[43,108,146,147]. 

- 내측 경골스트레스 증후군은 스트레스 골절과 구획증후군을 구분해야 함.

- 서로 다른 질환일지라도, 그것들은 서로 공존함. 

- x-ray촬영은 음성. bone scan 검사는 스트레스 골절을 잘 진단함.

-  내측경골스트레스 증후군은 후경골근이나 가자미근의 경골부착부를 따라서 발생하는 건병증 또는 골막통증을 표현할 수 도 있음. 

Other proposed etiologies have included posterior compartment syndrome [148,149] and fascial inflammation [147]. Detmer proposed a classification scheme for medial tibial stress syndrome based on etiology. Type 1 included local stress fractures, type 2 periostitis/periostalgia, and type 3 was due to deep posterior compartment syndrome [150].

- 제시되는 다른 원인은 후방 구획증후군과 근막염증을 포함함.

- 더트미어는 내측 경골스트레스 증후군을 위한 원인을 제안함. 

-  type1은 스트레스 골절을 포함. type2는 골막염/골막통증,  type3는 깊은 구획증후군으로 분류함. 

Increased valgus forces on the rear foot and excessive pronation that result in increased eccentric contraction of the soleus and posterior tibial muscles are often contributing causes [146]. Intrinsic factors that may increase valgus forces and pronation include femoral anteversion, genu varum, tibia or forefoot varus, and an excessive Q angle [137]. Other intrinsic factors linked to medial tibial stress syndrome include excessive planus or cavus, tarsal coalition, lower extremity length inequality, and muscle imbalances [151,152]. Extrinsic risk factors include improper shoe wear, a rapid transition in training, inadequate warm-up, running on uneven or hard surfaces, running in cold weather, and low calcium intake[137,153].

- 발뒤측에 증가된 외반 힘과 과도한 회내는 가자미근의 원심성 수축을 증가시켜 후경골근 문제를 야기함. 

- 내인성 요인은 외반힘의 증가와 회내의 증가는 대퇴골 전경, genu varum, tibia or fore foot various, 과도한 q angle

- 외인성 요인은 평발, 첨족, 발뼈의 융합, 하지의 길이차이, 근육의 불균형 등

- 외인성 위험요인은 적절하지 못한 신발착용, 훈련의 빠른 진행, 적절치 못한 웜업, 편평하지 않은 바닥 달리기, 추운날씨에 달리기, 칼슘 섭취 부족 등

Treatment of medial tibial stress syndrome includes relative rest and the correction of any recent transition in training. Hill running and running on uneven surfaces should be avoided. Proper shoe wear is essential to minimize rear foot  valgus and to correct excessive pronation, pes planus, or pes cavus. Orthotics are useful in cases that cannot be controlled by shoe wear alone.

NSAIDS and anti-inflammatory  modalities (ie, iontophoresis and ultrasound) can be useful adjuncts in the rehabilitation of medial tibial stress syndrome. A strengthening and flexibility program should be initiated with the goal of correcting any muscle imbalances. Flexibility of the gastrocsoleus should be emphasized, as well as strengthening (concentric and eccentric), including the foot intrinsics, dorsiflexors, plantarflexors, invertors, evertors, and gluteals. All deficits within the kinetic chain should be corrected [108] . A compressive sleeve may provide symptomatic relief.

Operative therapy (posterior fasciotomy) has been described for the athlete with severe limitations of physical activity, frequent recurrence, or no response to available therapy [150,154] . Surgical treatment for periostalgia has not been uniformly successful and should be reserved for recalcitrant symptoms that have not responded to a well documented treatment program of at least 6 months [108] .