ANTERIOR COMPARTMENT SYNDROME (SHIN SPLINTS)

The lower leg is comprised of three distinct compartments, each having muscles, nerves, arteries and veins in them.  When one compartment gets injured via overuse or acute trauma to the area, the swelling in the area does not dissipate into the other two compartments.  This causes the structures in that specific compartment to get compressed and squeezed.  The compartment of the lower leg that is most affected in soccer players is the anterior compartment, which is located on the inside of the shin.  The muscle that is mostly involved is tibialis anterior.

How does it occur?
Anterior Compartment Syndrome occurs due to:

• An impact or blow to the area.  This causes bleeding within the compartment and the swelling that follows can cause severe pain and dysfunction of the lower extremity.
• A muscle tear in the area, causing bleeding and swelling.
• Swelling of the tissues in the area due to overuse.
• Very tight calf (gastrocnemius and soleus complex) muscles
• Over pronation of the ankle/foot
• Running on the toes too much

SYMPTOMS that athletes need to watch for:

• A sharp pain on the inside of the leg. This may be accompanied by swelling in the area.
• There may be weakness in the muscle group when resisted forces are applied to try and pull the foot upwards towards the head.
• Typically, the pain is associated only when the player runs, but it can hurt also at rest. 
• Tenderness in the area with palpation.  
• Pointing the foot towards the ground increases the pain.

This condition can become very serious and disabling.  If the foot begins to go numb or have pins and needles in it, go directly to a doctor or hospital emergency room.

PREVENTION:

1. Play on a soft surface as often as possible.  Synthetic turf and hardwood gym floors are not recommended for prolonged use.
2. Stretch the calf, hamstrings and quadriceps every time at a training session or game.
3. Limit swelling by using ice and compression following any type of trauma to the site.

TREATMENT:

1. Stretch the calf (gastrocnemeis/soleus complex) regularly.
2. Ice and compress the area of trauma regularly.
3. Electrical stimulation, ultrasound, and infrared laser, to the area in an effort to promote blood flow.
4. Contrast baths (hot/cold) in order to promote blood flow.
5. Wear a compression sleeve to the area.
6. Tape the ankle to help with the pronation factor and lower leg for compression.
7. Take some type of anti-inflammatory medication.
8. Sport massage by a sports physiotherapist or massage therapist.
9. Stop activity until the condition clears up or a sports physiotherapist suggests you start running.
10. Be assessed by a health professional to see if orthotics (with a small heel lift to allow the calf muscle not to always be stressed) will be useful.
11. Pool running and cycling are good alternate aerobic activities. 

OTHER ASSOCIATED PROBLEMS:

It is imperative that a health professional assess the problem since other ailments may be the problem like stress fractures, leg length discrepancy, or tumour.

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