Where? Clinic and marjon basketball court
Description- what happened? One player was complaining of pain in his tibia. He said it has been for around 1 week. I suspected it was possibly tibial stress syndrome, also known as ‘shin splints’ The player was complaining of tightness and throbbing around the border of his tibia and explained that it gets worse when he’s running, especially at the start of training, which is when the pain becomes sharp. However, he doesn’t get pain at rest and the pain eventually goes away during practice.Which means its at an acute stage, as Galbraith & Lavallee, (2009) explains,In the early course of MTSS, pain is worse at the beginning of exercise and gradually subsides during training and within minutes of cessation of exercise. I assessed his shoes as generally worn out shoes can contribute toward this injury (Galbraith & Lavallee, 2009).So I suggested the player invest in more supportive shoes to help with the problem. I then gave the player a soft tissue massage on his gastrocnemius and soleus muscles, and have the player a tennis ball to massage the plantaris muscles of his feet, which he can also regularly do at home, as tightness around these muscles is commonly associated with MTSS (Galbraith & Lavallee, 2009). I then treated the painful areas of his tibia with ultra sound, before using K-Tape to tape his painful tibia before training. I then watched the basketball training. The other therapist took the warm up and afterwards I took the players through the stretch. There were no injuries during practice.
Feelings-what were you thinking feeling? I have shin splints myself and have read a lot about it so I felt fairly confident when treating this player. I felt confident carrying out a massage and ultra sound treatment. The tape wasn’t sticking as the patient had very hairy legs, so I used the before spray which helped it stick down more and really smoothed out the tape for a few minutes to make sure it was stuck down properly.
Evaluation- what was good/bad about the situation? What was bad about the situation was that I wasn’t sure what the differential diagnosis could be. However, I have now read some more about this and have found that according to research from, McClure & Oh, (2019), chronic exertions compartment syndrome (CECS), and vascular etiologies (e.g. functional popliteal artery entrapment syndrome, peripheral arterial disease, etc.) are the differential diagnosis and I will read more about these to find out how I can tell if it may be one of these instead of shin splints.
Analysis- what sense can you make of the situation? I feel the player was feeling pain and wanted to see if there was anything that could reduce this pain. I believe I did a good job at calming the player down and giving him confidence to carry on training.
Conclusion- what else could you have done? From further reading I have now done. It has ben found that ‘decreasing weekly running distance, frequency, and intensity by 50% will likely improve symptoms’ therefore, I am not sure if I should have told the player to not participate in practice. I am going to find out from my supervisors what they suggest. I have now also found that Ice may be applied to the affected area directly after exercise for approximately 15–20 min. So next practice I will make sure the player ices his tibia after practice. From my reading I also found that ‘weakness of core muscles is an important risk factor for lower extremity injuries’ I am going to incorporate core exercises into the regular warm up and try and suggest the player also included core exercises in his regular day activities.
Action plan- if the situation arose again what would you do?
I would carry out the same treatment I did as I believe it was affective.
REFERENCES-
-Galbraith, R. M., & Lavallee, M. E. (2009). Medial tibial stress syndrome: conservative treatment options. Current reviews in musculoskeletal medicine, 2(3), 127-133.
-McClure, C. J., & Oh, R. (2019). Medial Tibial Stress Syndrome. In StatPearls [Internet]. StatPearls Publishing.