Overuse Injuries to the Leg

With spring on our doorstep, several runners invade the streets to make up for lost time. For many of us, this is the beginning of the running season. In any case, there are certain rules to follow if you want to avoid getting injured while practicing the terrific sport that is running. Injuries related to running are numerous, but very often preventable. In this article, we will survey three different overuse injuries in the leg area: periostitis, stress fracture, and chronic compartment syndrome.

Periostitis, or medial tibial stress syndrome, is an inflammation of the periosteum, a tissue enveloping the tibial bone, causing pain on the inner surface of the tibia during running or other sports that involve jumping (track and field, soccer, basketball). It is crucial to take care of it quickly, because if left untreated, it can turn into a stress fracture. Often, the pain will occur at the beginning of physical exertion, then gradually diminish during warm-up, before increasing later during activity when the muscles begin to tire.

A stress fracture is what might be called the beginning of a fracture occurring after repeated impacts rather than a single large impact. In the early stages, it will not be visible on an X-ray, but it can be diagnosed with bone scintigraphy. The mechanism by which a stress fracture occurs is rather simple: the training load is too high, causing bone resorption to be higher than bone reconstruction. A stress fracture differs from periostitis by the presence of pain at night and by a very painful specific spot, while periostitis is characterized by a more diffuse pain.

The mechanism for the occurrence of chronic compartment syndrome is quite different from that of periostitis or a stress fracture. In the leg, the muscles are separated into four compartments, all separated by fascia, a kind of tissue envelope. When the muscles are active, for example during running, they become blood-filled, which, in combination with a decrease in the flexibility of the fascia, can compress the muscles, causing pain in the form of cramps. On the next morning following a running session, stiffness is rather characteristic of chronic compartment syndrome (muscles feeling very sore).

Risk factors for overtraining injuries fall into three categories: anatomical factors, biomechanics or running gait factors, and training factors. According to recent studies, training factors account for more than 60% of overtraining injuries. These include too rapid an increase in the duration, frequency or intensity of the training, a recent change in shoes, a change in the surface on which one runs (especially the hard surfaces) and the fact of always running on the same side of the street.

When it comes to treating this type of injury, rest is a must. Afterwards, it is crucial to properly target the causes of the injury in order to eliminate them. Indeed, these injuries are very often multifactorial, so that, for example, muscle weakness or lack of flexibility in the hip can contribute significantly to a foot problem. Finally, the resuming of activities must be progressive: we are talking an increase of about 10% per week at the maximum. Therefore, patience is key.

Physiotherapy treatments will thus be useful to treat not only pain, but also, and most importantly, to find the factor(s) that led to the injury and to eradicate it or them. The physiotherapist will be able to advise you and guide you in the progression so that you can safely return to your activities.

Félix-Olivier Brochu
Action Sport Physio Laval