Brief Outline of Tibia Stress Fracture

Tibial Stress Fracture

Repetitive impact activities, such as running and jumping, can cause small cracks in the bone called stress fractures. These most often occur in the weight bearing bone, the tibia, of the lower leg. Athletes with lower bone density, due to dietary issues or genetic predisposition, are more susceptible, as are athletes who train on hard surfaces at increased distance and duration. Women are more susceptible to this injury than men due to bone density deficiency conditions such as irregular or absent menstrual cycles, eating disorders or osteoporosis.

Anatomy and physiology

The tibia (shin bone) is the larger and more medial of the bones in the lower leg. At the proximal end, the medial and lateral condyles articulate with the distal end of the femur to form the knee joint. The tibia tuberosity is a roughened area on the anterior surface of the tibia. The tibia is the weight bearing bone of the lower leg and therefore takes a large amount of the force of impact during running and jumping activities. This force is transferred up the length of the bone. Bones are constantly repairing and rebuilding, leading to the robbing of calcium from one area of the bone to build another, causing a weak area. When the impact is transferred up the shaft and encounters a weak area, due to either calcium deficiency or a prior stress fracture, the bone will crack slightly. Overtime, this leads to a more serious crack or fracture. Fatigued muscles also contribute to the possibility of stress fractures. The muscles are meant to take some of the shock away from the bones but a fatigued muscle is a poor shock absorber.

Cause of Stress Fracture

Repetitive stress on the bone through impact activities such as running or jumping. Low bone density. Muscle fatigue leading to lower shock absorption by the muscles.

Signs and symptoms

Pain with weight bearing, worsens with activity and diminishes with rest. Pain is most severe at the early stage of activity, subsiding in the middle and returning at the end. Point tenderness and some swelling possible.

Complications if left unattended

If left stress fracture unattended, a stress fracture can become a complete fracture and lead to complications such as bleeding and nerve compromise. The pain from an untreated stress fracture may lead to a complete cessation of activity and further injury to surrounding tissues.

Treatment

  • Anti-inflammatory medication.
  • Shockwave therapy
  • Seek medical help if any instability is noted in the lower leg, or inability to bear weight.

Rehabilitation and treatment

During the recovery phase, it is important to maintain fitness levels by using low or non-impact activities such as swimming or biking. Strengthening the muscles of the lower leg will help add extra shock absorption. Warming-up properly and using cross training techniques to limit the impact of the bone will help prevent stress fractures.

Long-term prognosis

Stress fractures generally heal completely with rest. Returning to activity too soon may cause a recurrence. Very rarely surgical intervention may be needed to strengthen the bone at the fracture site.

Call (+65) 6471 2674 (24 Hour) to fix an appointment to see our doctor to treat Tibia Stress Fracture today.

Joint Pain

Brief Outline of Medial Tibial Pain Syndrome – Shin Splints

Shin Splints

Shin splints are a common complaint of runners and other athletes who have just taken up running. Shin splints are actually a term used to cover all pain in the anterior shin area. There are several possible causes. Medial tibial pain syndrome, the most common cause of shin pain, refers to pain felt over the shin bone from irritation of the tendons that cover the shin and their attachment to the bones. Changes in duration, frequency or intensity of running can lead to this condition.

Anatomy and physiology

The tibialis anterior muscle originates from the lateral condyle of the tibia, and inserts into the medial and plantar surfaces of the medial cuneiform bone. Tibialis anterior is responsible for dorsiflexing and inverting the foot and is used frequently during running to toe up with each step. When the muscle and tendon becomes inflamed and irritated through overuse or improper form, it will cause pain in the front of the shin. Repetitive pounding on the lower leg, such as with running, can also lead to pain in the shin.

Cause of Shin Splints

Repetitive stress on the tibialis anterior muscle leading to inflammation. Repetitive pounding force on the tibia, as with running and jumping.

Signs and symptoms

Dull, aching pain over the inside of the tibia. Pain is worse with activity. Tenderness over the inner side of the tibia with possible slight swelling.

Complications if left Shin Splints unattended

If left unattended, shin splints can cause extreme pain and cause cessation of running activities. The inflammation can lead to other injuries, including compartment syndrome.

Treatment

Rehabilitation and prevention

It is important to use low impact activities, such as swimming or cycling, to maintain conditioning levels while recovering. Stretching of the tibialis anterior muscle will help with recovery. To prevent this condition from developing, try alternating high impact activity days with lower impact days. It is also important to strengthen the muscles of the lower leg to help absorb the shock of impact activities.

Long-term prognosis

Medial tibial pain syndrome can be effectively treated with no long-term effects. Only in rare cases does the condition fail to respond to rest and rehabilitation, leading to chronic inflammation and pain. Surgery may be required in those rare cases.

Call (+65) 6471 2674 (24 Hour) to fix an appointment to treat Shin Splints today.

Brief Outline of Calf Strain

Calf Strain

Failing to warm-up properly can lead to muscle strains. The calf muscles are used when taking off during a sprint, when jumping, changing directions, or when coming out of the bottom of a deep squat. These are usually explosive movements requiring forceful contractions of the calf muslces, which can lead to a muscle strain. Strains can result from incorrect foot positioning during an activity or an eccentric contraction beyond the strength level of the muscle.

Anatomy and physiology

The muscles of the calf include the gastrocnemius, plantaris, and soleus, known as the triceps surae. These muscles attach to the foot through the Achilles tendon. The popliteal fossa at the back of the knee is formed inferiorly by the bellies of gastrocnemius and plataris, laterally by the tendon of biceps femoris, and medially by the tendons of semimembranosus and semitendinosus. The calf muscles are responsible for extending the foot, and rising up on the toes. When taking off or changing direction, the calf muscle must contract forcefully. This contraction can cause tearing of the muscle at the attachment of the tendon. An eccentric contraction, a contraction while the muscle stretches, such as landing from a jump, can also cause a tear if the muscle is fatigued or not strong enough to handle it.

Cause of Calf Strain

Forceful contraction of the gastrocnemius or soleus muscle. Forceful eccentric contraction. Improper foot position when pushing off or landing.

Signs and symptoms

Pain in the calf muscle, usually mid-calf. Pain when standing on tiptoes, and sometimes pain when bending the knee. Swelling or bruising in the calf.

Complications if left unattended

Any strain left unattended can lead to a complete rupture. The calf muscle is used when standing and walking, so the pain could become disabling. A limp or change in gait due to this injury could lead to injury in other areas.

Treatment

  • Anti-inflammatory medication
  • Anti-inflammatory injection
  • Physiotherapy
  • Shockwave therapy

Rehabilitation and prevention

As the pain subsides, a program of light stretching may help facilitate healing. When the pain has subsided, strengthening and stretching will help to prevent future injury. Proper warm-up before activities will help protect the muscle from tears. Strong flexible muscles resist strains better and recover more quickly.

Long-term prognosis

Muscle strains, when treated properly with rest and therapy, seldom have any lingering effects. In very rare cases where the muscle detaches completely, surgery may be required to re-attach the muscle.

Call (+65) 6471 2674 (24 hour) to fix an appointment to treat your Calf Strain today.

Brief Outline of Quadriceps Tendinitis

Quadriceps Tendonitis

Quadriceps tendinitis, like other versions of tendinitis, involves inflammation of the tendon. This can be a result of repetitive stresses to the quadriceps, or excessive stress before the muscle is conditioned. Pain just above the patella (knee cap), especially when extending the knee, usually accompanies this injury.

Anatomy and physiology

The quadriceps tendon attached to, and covers the patella, becoming the patellar (tendon) ligament below this and attaching to the tibia. The patella runs in the groove of the femur at the knee flexes and extends, which results in the tendon passing over this bone as well. Repetitive stress can cause inflammation of the tendon, especially under contraction, such as when accelerating or decelerating. Minor tears may also occur int he tendon as well when the stress is too much for the tendon to handle.

Cause of Quadriceps Tendinitis Injury

Repetitive stress to the tendon, e.g. running or jumping. Repetitive acceleration and deceleration, e.g. hurdling or football. Untreated injury to the quadriceps.

Signs and symptoms

Pain just above the patella. Jumping, running, kneeling, or walking down stairs may aggravate the pain.

Complications if left unattended

The quadriceps muscles may become inflamed, and the tendon will become weak if left untreated. This could lead to a rupture of the tendon. A change in gait or landing form can lead to other injuries as well.

Treatment

  • Rest and ice
  • Anti-inflammatory medication
  • Injection
  • Physiotherapy
  • Shockwave

Rehabilitation and prevention

Rehabilitation should include stretching and strengthening exercises for the quadriceps. Activities such as swimming can be helpful to reduce the stress on the tendon during rehabilitation. Return to a normal activity schedule should be delayed until pain subsides completely and strength is restored. Keeping the quadriceps flexible and strong will help prevent this condition.

Long-term prognosis

A full recovery with no long-term disability or lingering effects can be expected in most cases of tendinitis, and surgery is only necessary in extremely rare cases.

Joint Pain

Brief Outline of Thigh Bruise or Contusion

A thigh contusion is actually a deep bruise to the muscles of the quadriceps or hamstrings near the femur. The bruising causes pain and limited flexibility in the muscle. High impact sports such as football or hockey are commonly associated with thigh bruising, but any activity that could result in falling on or getting hit in the thigh can cause a contusion.

Anatomy and physiology

The musculature of the thigh includes the quadriceps, comprising: vastus lateralisvastus medialis, vastus intermedius, and semimembranosus. An impact to any of these muscles squeezes the muscle between the impacting force and the femur. This causes bleeding in the muscle near the femur. This in turn causes the formation of scar tissue that reduces muscle function. The swelling and bruising from the bleeding causes pressure on the surrounding muscle fibres reducing flexibility.

Cause of Thigh Contusion

Impact to the muscle from a blunt surface such as the ground, a helmet, foot etc.

Signs and symptoms

Pain and tenderness over the injured area. Swelling and bruising may be present. Pain with weight bearing and stretching of the muscle.

Complications if left unattended

Myositis offificans, which is characterised by the formation of bony deposits or by ossification in the muscle tissue, can develop from unattended thigh contusions. Muscle ruptures can also occur when a contusion is left untreated and activity is continued.

Treatment

Rest and ice. Anti-inflammatory medication. Physiotherapy.

Rehabilitation and treatment

After the pain subsides it is important to regain flexibility and strength in the injured muscle. Gentle stretching will improve flexibility and help to avoid scar tissue formation. While the muscle is healing, working the surrounding muscles as tolerable may help to speed recovery by increasing blood flow and limit scarring. Use of proper protective equipment during activities and avoiding impact to the thigh will help prevent thigh contusions.

Long-term prognosis

Proper treatment of a thigh contusion will ensure that there are no future complications. Flexibility and strength should return to normal after rehabilitation of the injured muscle.

Joint Pain