Bilateral Lower Leg Pain - Softball

Abstract

HISTORY An 18-year old freshmen softball player presenting with bilateral peroneal pain during running and lateral motions. Pain developed during mid-fall while conditioning for the spring softball season. She reported bilateral burning sensation on the lower leg. She was initially treated with typical modalities and modification of training practices, with no alleviation of the symptoms. PHYSICAL EXAMINATION Examination by the athletic trainer revealed no difference in lower leg appearance, no edema or discoloration. All pain and point tenderness were along the lateral shin. Muscle tightness was noticeable on the soleus and peroneals. Abnormal running mechanics were suspected as a result of the bilateral nature of the pain and inability to alleviate symptoms with normal treatment and training modifications. The athlete was referred to a biomechanist for treatment recommendations. DIFFERENTIAL DIAGNOSIS Shin Splints Compartment Syndrome TEST AND RESULTS The player underwent a biomechanical evaluation to assess running mechanics and make recommendations for functional orthotics. The test revealed a 15% Body Weight (BW) difference between the braking and propulsive forces during running. The right side lateral ground reaction forces were 5% BW higher than the left. The center of pressure path was asymmetrical between right and left sides. The right side showed a shorter path and the left showed a noticeable medial to lateral deviation. FINAL WORKING DIAGNOSIS Compartment Syndrome (resulting from poor biomechanics) TREATMENT AND OUTCOMES The athlete was instructed to ice and cross-train reducing the amount of running until reduction of symptoms. Functional orthotics were designed to address some of the mechanical deficiencies shown in the biomechanics evaluation. A follow-up biomechanical evaluation was performed to address recurring pain on the left during indoor training. At this time the use of the functional orthotics was limited to her running shoes. Due to the identification of developing loading asymmetries two other follow-up biomechanical evaluations were recommended. The first follow-up evaluation was performed prior to her summer break. She was free of lower extremity pain, and her mechanics were improved showing symmetry of loading patterns. She was instructed to continue using the orthotics in her running shoes throughout the summer. The second follow-up evaluation was performed prior to fall training. Her mechanics were symmetrical and consistent with her last evaluation. Treatment of symptoms combined with modification of biomechanics resulted in a pain free return to training and competition during her second season.