Shin Splints

What are Shin Splints?

Shin Splints are the common name for a condition in which the muscles on top of the shin bones – the tibia and the fibula, become tight and as a result cause pain.

It mostly occurs after an increase in activity – either frequency, length or intensity, and can last for an undetermined amount of time depending on various factors such as exercise, rest and strength.

Medial Tibial Stress Syndrome:

Medically, shin splints are referred to as Medial Tibial Stress Syndrome (MTSS). It is caused by overuse and is commonly seen in athletes and military personnel. The cause of MTSS is not known however many factors can cause it including overtraining, poor unsupportive footwear, ankle muscle imbalance, tight triceps surae muscles (calf/soleus) and your back being out of balance.

Typically MTSS presents with a diffuse (wide spread) palpable pain worse after exercise – it is more common in females than males. The pain is usually described as a dull ache that gets better with rest. One reason MTSS is so painful is due to periostitis – the inflammation of the periosteum (covering of the bone) where the muscle attaches.

Specific movements that may cause pain is knee extension – that is the straightening of the leg, as this activated the muscles affected. Inflammation of the Achilles tendon (Achilles tendonitis), the bursa on the back of the heel (retrocalcaneal bursitis), plantar fasciitis (irritation of the plantar fascia), medial arch discomfort, calf pain and cramping, iliotibial band syndrome and Osgood Schlatter’s can also occur at the same time as MTSS.

One of the risks of having MTSS repeatedly or long term is a stress fracture. Signs this has occurred is when pain occurs after activity has finished into cooldown and daily activities. Another sign is when the pain becomes less wide spread and more specific to the inside of the tibia (shin bone) and the from halfway up the shin down after exercise. Imaging such as x-ray and magnetic resonance imaging (MRI) can be used to detect other sources of pain as well as stress fractures.

Treatment:

Treatment of MTSS varies depending on therapist and sport. In the acute, short-term treatment use of compression stockings, anti-inflammatories, rest and either ice or heat depending on the varied evidence. Kinesiology taping uses tape that aims to relieve pain, facilitate proprioception, change muscle activation and correct abnormal movement patterns.

Long term orthotics (inserts) and supportive shoes can be used to try and correct the posture of the foot. Increasing the supination (weight on the outside of the foot), strength of the inverter/evertor muscles and releasing the muscles on the bottom of the foot can also be helpful. Supplements such as vitamin D, calcium for bone health/density and magnesium for muscle fatigue should be taken long term as preventatives.

Manual therapy, such as osteopathy can be beneficial in both the short and long term phases of shin splints/MTSS. Through various techniques such as soft tissue, myofascial release, mobilisation and manipulation treatment is aimed at decreasing muscle tension, improving joint mobility and releasing the fascia of the foot and lower leg.

References

Bhusari, N. and Deshmukh, M. Shin splint: a review. Cereus, 15 (1), e33905. https://doi.org/10.7759/cureus.33905

Guo, S., Lui, P. (2022). Efficacy of Kinesiology taping on the management of shin splints: a systematic review. The physician and sports medicine 50 (5), 369-377. https://doi.org/10.1080/00913847.2021.1949253

Schulze, C. Finze, S., Bader, R., Lison, A. (2014). Treatment of medial tibial stress syndrome according to the fascial distortion model: a prospective case control study. The Scientific World Journal, 790626. https://doi.org/10.1155/2014/790626


Yüksel, O., Ozgürbüz, C., Ergün, M., Işlegen, C., Taskiran, E., Denerel, N., Ertat, A. (2011). Inversion/eversion strength dysbalance in patients with medial tibial stress syndrome. Journal of sports science & medicine 10 (4), 737-742. Inversion/Eversion strength dysbalance in patients with medial tibial stress syndrome – PubMed (nih.gov)

Ozgürbüz, C., Yüksel, O., Ergün, M., Işlegen, C., Taskiran, E., Denerel, N., Karamizrak, O. (2011). Tibial bone density in athletes with medial tibial stress syndrome: a controlled study. Journal of sports science & medicine 10 (4), 743-747. Tibial bone density in athletes with medial tibial stress syndrome: a controlled study – PubMed (nih.gov)

 

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Baker’s Cyst

What are Baker’s Cysts:

Also called popliteal cysts, baker’s cysts occur behind the knee in the popliteal fossa and are fluid filled sacs. They are predominantly asymptomatic and usually discovered during imaging for another unrelated condition.

Symptoms associated with these cysts include knee pain, tightness, and discomfort. Pain worsens with increased activity and decreases range of motion. Inflammation is most visible when the knee is at full extension and least visible at 45 degree flexion.

Lower limb swelling can occur due to the cyst’s impingement of blood vessels and in some cases may present the same as deep vein thrombosis. If the cyst bursts it can cause inflammation/swelling, sharp knee/calf pain and a sensation of water running down the calf. When the cyst busts it can cause nerve entrapment, blood vessel blockage and compartment syndrome.

It is typically diagnosed through physical examination and imaging such as plain radiography, ultrasound and MRI.

Causes:

The knee is a synovial joint where a capsule of synovial fluid cushions between the two bones. Bakers’ cysts can occur when this synovial fluid accumulates and moves between muscle attachments to the knee. This is due to the pressure gradient between the knee joint capsule and fossa moving fluid flow into the fossa.

While more common in adults they can also occur in children. However rather than being caused by a co-morbidity they typically occur when the knee joint capsule herniates.

Commonly occurring in patients aged 35 to 70 years of age or in children 4 to 7 years of age.

Inflammation of the semimembranosus (hamstring) bursa can also cause fluid build up in addition to arthritis, meniscus damage and other degenerative conditions.

Risk factors:

Patients that have a history of trauma to the knee cartilage and meniscus are at greater risk of developing a baker’s cyst. In addition, they commonly occur when patients have degenerative conditions such as arthritis.

 

Treatment:

If the cyst is asymptomatic and is discovered by accident during imaging or another condition no treatment is typically performed.

Conservative treatment involves behaviour modification such as decreasing aggravating activity and taking anti-inflammatories/pain relief.

In children conservative treatment of the cyst is preferred if the site is not painful and the size of the cyst is less than 3 cm. If the cyst is larger than this and presents with pain surgical excision is considered.

Aspiration (drainage) of the cyst can be performed in which a needle is placed through the posterior leg at the popliteal fossa and into the baker’s cyst. From there a syringe is used – this procedure is performed under ultrasound guidance. Corticosteroid injections into the baker’s cyst aiming to decrease the size of the cyst and relieve pain can also be performed. Risks with these interventions include pain, bleeding, infection, tissue damage and cyst recurrence.

Surgical intervention includes arthroscopy where the degenerative tissue is removed. Complete excision of the cyst can also be performed however this is not recommended in patients that have developed the cyst secondary to degenerative conditions.

Our Osteopaths have found that patients report increased range of motion and improved function after treatment.

 

 

References:

Al Khateeb, A. (2024). Bakers Cyst. Baker cyst | Radiology Case | Radiopaedia.org

Fredericksen, K., & Kiel, J. (2021). Bedside ultrasound-guided aspiration and corticosteroid injection of a baker’s cyst in a patient with osteoarthritis and recurrent knee pain. Journal of the American College of Emergency Physicians Open, 2(2), e12424. https://doi.org/10.1002/emp2.12424

Leib, A. D., Roshan, A., Foris, L. A., & Varacallo, M. (2020). Baker’s Cyst. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK430774/

Mansour, M. A., Shehata, M. A., Shalaby, M. M., Arafa, M. A., & Almetaher, H. A. (2021). Baker’s cyst in children: conservative management versus surgical excision according to clinical and imaging criteria. Annals of Pediatric Surgery, 17(1). https://doi.org/10.1186/s43159-021-00071-1

‌Nanduri, A., Stead, T. S., Kupsaw, G. E., DeLeon, J., & Ganti, L. (2021). Baker’s Cyst. Cureus, 13(12). https://doi.org/10.7759/cureus.20403

Patel, C. (29 August 2012). Baker’s Cyst. Baker’s cyst – wikidoc

Van Nest, D. S., Tjoumakaris, F. P., Smith, B. J., Beatty, T. M., & Freedman, K. B. (2020). Popliteal Cysts: A Systematic Review of Nonoperative and Operative Treatment. JBJS Reviews, 8(3), e0139. https://doi.org/10.2106/JBJS.RVW.19.00139

 

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