Neurodynamics and Bilateral Shin Pain - Track

Abstract

HISTORY: A 20-year old Division 1 pole-vaulter presented with shin pain (5/10 Numeric Pain Rating Scale - NPRS). She had been diagnosed with medial tibial stress syndrome in the past, but did not have a previous history of stress fractures or other leg pathology. She reported her symptoms occurred every year for the past three years at the beginning of track season and remained constant until the conclusion of the competitive season (average duration of 5 months) irrespective of previous treatments provided. She described her current symptoms being similar to her previous episodes, denied experiencing any neurological symptoms, and reported experiencing increased pain with increased activity. PHYSICAL EXAMINATION: Ecchymosis, swelling, or abnormality was not noticed, but palpation revealed tension over the anterior tibialis, medial gastrocnemius, and peroneus brevis bilaterally. Tenderness to palpation was not present over other soft-tissue or bony structures of the leg and ankle. Ankle and knee range of motion were within normal limits bilaterally. The Calcaneal bump and Squeeze test were negative for fracture. DIFFERENTIAL DIAGNOSIS: 1. Triceps Surae Tightness/Inflexibility 2. Tibial Stress Reaction 3. Compartment Syndrome TESTS AND RESULTS: Not Applicable FINAL WORKING DIAGNOSIS: Medial Tibial Stress Syndrome TREATMENT AND OUTCOMES: 1. Traditional rehabilitative strengthening exercises for the leg and ankle for the first week resulted in a slight decrease in pain for her left leg (3/10 NPRS), but not for her right leg (5/10 NPRS). Patient also reported a score of 21 on the Disablement in Physically Active Scale (DPAS) and a score of 6.33 on the Patient Specific Functional Scale (PSFS) at this time. 2. Neurodynamic intervention (i.e., peroneal slider) was introduced 8 days after initial examination. The patient continued to perform traditional rehabilitative exercises. 3. On Day 10, two days after implementing neurodynamic intervention, the patient reported resolution of her pain bilaterally. 4. On Day 12, patient maintained 0/10 pain rating bilaterally, while reporting scores of 0 on the DPAS and 10 on the PSFS. Patient was discharged to full activity and has remained asymptomatic.