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相信有很多跑友都有这样的经历，尤其是对于菜鸟跑友或是习惯长时间间隔的跑友来说，会出现在跑步的后半程（大约3公里左右）小腿下三分之一左右的位置有撕扯着的疼痛感，很多人描述这种痛感像来自于骨头里一样，伴随着每一次迈步，而且在勾脚的时候更明显。这就是跑者常见的胫骨筋膜炎了。
胫骨筋膜炎发作时的疼痛的感觉在走路的时候会持续但没有跑起来那么明显，说严重不严重有些人甚至可以忍痛继续跑，但是这种不舒服的感觉一定会困扰很多人。它是一种跑步常见的过劳伤（over-use injury），中文叫法有很多版本，比如胫骨筋膜炎，胫前肌肌腱炎，胫腓骨疲劳性骨膜炎，胫骨内侧压力综合症等等。为了方便描述在这里统称胫骨筋膜炎。这种伤痛并不是因为单一原因引起的，事实上很少有运动损伤是会由于单一原因引起。包括跑步时的地面情况，穿的鞋，活动水平，跑步的速度，和骨骼肌肉固有情况以及跑步方式都会是造成胫骨筋膜炎的原因。在这里主要要和大家介绍的是容易导致胫骨筋膜炎的几点重要原因：跑步方式的影响：主要的跑步方式分为前脚掌着地（forefoot strike），足中部着地（midfoot strike）和后脚掌着地(rearfoot strike)三种。首先要声明的是没有哪一种跑步方式是绝对的对或是绝对的错，只有适合不适合。人的结构太复杂根本无法用量化方式来研究出一种方法适合所有人。到底哪种跑步方式是可以最大程度上减少伤病的是无法轻易下定论的，学界也都还在争论。在运动医学领域希望大家不要轻信任何所谓的结果，找到合适自己的方法最重要。回到正题上，其中前脚掌着地是有可能比较容易患上胫骨筋膜炎的跑步方式，具体原因分为以下几条：1、前脚掌着地意味着脚跟和地面没有接触，此时对比两种跑步方式，前脚掌着地时的触地反冲力(ground force reaction)是后脚掌着地时的3倍还要多。前后脚掌着地时的触地反冲力的差别在于，前脚掌着地时触地反冲力较大，而后脚掌着地时触地反冲力的速率较快。在后脚掌着地的时候，脚与地面接触的时间（stance time）要长于前脚掌着地时，时间的加长意味着地面接触力峰值（peak normal force）减少，后脚掌着地的跑法在这方面有可能比前脚掌着地更有优势。2、另一个前脚掌着地会增加患病风险的原因是前脚掌着地时足内翻的现象明显减少。足内翻（在适当的范围内）是一个很重要减少跑步时地面反作用力的人体天生的机制，因为它增加了脚和地面接触的时间。如果一直都是前脚掌着地跑，5公里下来无形当中就比后脚掌着地的人减少了很多脚与地面接触的时间，再加上本身前脚掌着地的反作用力就大，就可见其后果。3、最后一个前脚掌着地会增加胫骨筋膜炎患病风险的原因是，前脚掌着地时小腿肌肉长时间处于紧张状态，而大部分这些肌肉都附着于小腿骨内后方，在长期紧张状态下不断拉扯着和骨头连接的位置。这就是为什么好多人觉得疼起来像骨头疼一样的原因。而且，一般有胫骨筋膜炎的患者，都会有小腿酸痛的症状，很难讲不是因为错误的跑步姿势引起的。不足的髋膝运动幅度：我们知道由胫骨筋膜炎有可能会导致应力性骨折，而加速这个过程的很致命的一个原因就是在跑步过程中髋关节和膝关节的运动幅度（尤其是屈曲）不足。所谓膝关节屈曲就是弯小腿，髋关节屈曲就是提大腿。好比说身体各部位情况完全一样的两个人，跑步时脚蹬踏的力量也完全一样，髋膝屈曲度较小的人受到的来自地面的反冲力就会比较大。有专家表示，用比较大幅度的膝关节屈曲动作来跑步，可有效减少下肢收到的地面垂直作用力，并且教授躯干和头部收到的冲击。小腿前后肌肉力量悬殊：大部分人正在进行的包括市面上流行的训练小腿肌肉的教程都是比较关注小腿后方的肌肉，我们觉得跑步能锻炼到的也是小腿后群肌肉，很少有人关注前群肌肉。殊不知我们每迈一步这个勾脚的动作，都是由小腿前群肌肉收缩完成的。有很多人拥有强壮的小腿就觉得自己可以跑得快跳得高，但是大部分人所说的强壮的小腿指的都是小腿后群肌肉。胫骨筋膜炎很重要的病因就是小腿前群肌肉太弱，根本经不起像跑步这种频繁勾脚绷脚动作的重复，于是不断拉扯筋膜，产生炎症。如果肌肉力量足够，完全不会拉扯到筋膜，也没有疼痛了。根据可能的病因分析，跑友们自己可以采取简易的治疗方法缓解伤痛：1、冰敷在发生症状后停止跑步，立刻冰敷痛处可以明显减轻疼痛感。2、牵拉小腿前群/后群肌肉（1）牵拉胫骨前肌，跑后一次15s，共三次（2）牵拉小腿后群肌肉，跑后一次15s，共三次3、锻炼小腿前群肌肉4、佩带护具与胫骨筋膜炎配套的护具叫胫骨套（shin splint brace），它的原理就是基于用一个外力强行减少小腿肌肉对于骨头的撕扯，相当于把肌肉更牢固的“困”在骨头上，减少撕扯，减轻疼痛。5、肌内效贴布肌内效贴布的原理是通过外力把肌肉和筋膜强行拉出空挡，不会在运动时再产生肌肉和筋膜拉扯的情况，也就是说增加肌肉和筋膜之间的运动空间来减少疼痛。图示是最常见的一种针对筋骨筋膜炎的贴法，有肌贴经验的朋友可以采取这种方法。6、通过牵拉增强髋膝关节运动幅度股直肌牵拉，跑后一次15s，共三次股内侧头肌牵拉，跑后一次15s，共三次髂腰肌牵拉，跑后一次15s，共三次
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青少年常见小腿疼痛——胫骨内侧应力综合征
Shin SplintsShin splints is the common name often given to pain at the front of the lower leg. Usually symptoms occur at the front inside of the shin bone but can arise from a number of causes.We explain the symptoms, treatment and rehabilitation of medial tibial stress syndrome to cure and prevent it recurring.SymptomsPain over the inside lower part of the tibia or shin bone.There may be pain at the start of exercise which often eases as the session continues only to come back worse later in the training session or afterwards.Symptoms are often worse the next morning.Swelling or lumps and bumps felt along the inside of the bone.Pain may also be triggered when the toes and foot are bent downwards.Occasionally in severe cases reddening of the skin over the inside of the leg from inflammation may be seen.What is shin splints?Shin splints is a common term which can include a number of diagnosis or causes and is not an actual injury or diagnosis in itself. It is the name athletes often give to pain along the inside of the shin bone.Medial tibial stress syndrome&or medial tibial traction periostitis is a more accurate description of what is going on as traction forces from the muscles of the lower leg pull on the periosteum or sheath surrounding the bone.Other diagnosis:Stress fracture&is a hairline fracture of the tibia bone. Symptoms are similar but pain is often more acute or sharp along the inside of the shin and does not ease off with exercise but gets worse.Chronic compartment syndrome&is where the muscles of the lower leg swell up too big for the sheath surrounding them. An aching type pain comes on gradually with exercise and is relieved with rest.Popliteal artery entrapment&is more likely to feel like calf pain and gets worse with exercise and dimished when plantar flexing the foot (pointing the foot and toes down).See more detail on&shin pain diagnosis.Risk factorsOver training or overuse is the most likely cause, however a number of factors can increase the likelihood of this occuring:Biomechanical factors such as overpronation and over supination of the feet. Overpronation occurs when the foot rolls inwards too much flattening the arch of the foot and causing the lower leg to rotate inwards. This in turn increases the stress on the soft tissues of the lower leg resulting in pain and inflammation. Over supination is where the foot rolls outwards too much during the time the foot is in contact with the ground. If you think you have suspected biomechanical issues then a professional can do&gait analysis&tests either with a treadmill or using force plates to determine this and whether corrective orthotic inserts for your shoes are needed.Inadequate footwear such as the wrong type of shoe for your running style or running shoes that are just too old and have lost their support and cushioning can cause injury. Over pronators may require a running shoe with a firmer midsole on the inside to reduce the amount of rolling in. Supinators usually require a neutral shoe with plenty of cushioning. A specialist running shop can advise.Increasing training too quickly, running on hard surfaces, on your toes as in sprinting and generally doing too much too soon will increase the risk of injury.Poor flexibility at the ankle can cause increased stress on the soft tissues, muscles and tendons of the lower leg when running.TreatmentTreatment for shin splints involves reducing pain and inflammation, identifying and correcting training and biomechanical problems and restoring muscles to their original condition.Stage 1 - Relieve symptomsRestAvoid running, jumping or any other activities which make symptoms worse. Switch to swimming, cycling, cross trainer, rowing machines, step machines and other non impact equipment.IceApply ice or cold therapy for 10 minutes at a time every hour initially reducing frequency to 3 or 4 times per day as symptoms improve. The tissues are very superficial so ice does not need to be applied for longer than 10 minutes. Do not apply ice directly to the skin as it may burn. Either wrap ice in a wet tea towel or use a commercially avaialble cold pack.TapingShin splints taping can instantly relieve symptoms in most patients. The simple taping technique supports the muscles of the lower leg by pulling them towards the shin bone reducing traction forces at the most painful part.Insoles & shoesWearing shock absorbing insoles in shoes particularly if you run or walk on hard surfaces in poorly cushioned shoes will help reduce the shock on the lower leg. Switch to wearing softer training shoes rather than hard leather work shoes if possible until symptoms go.MedicationA doctor may prescribe anti-inflammatory medication e.g. ibuprofen to help reduce pain and inflammation. Although this should not be relied on as a long term solution or excuse not to rest. Asthmatics should not take Ibuprofen.Play&expert interview initial treatment videoStage 2 - Correcting risk factorsSimply resting until the pain goes is not usually enough and the injury is likely to occur once normal training is resumed. In addition to correcting any biomechanical causes such as over pronation of the foot, the muscles of the lower leg should be stretched, relaxed and made strong enough to cope with the demands placed on them.ExercisesExercises to stretch the muscles of the lower leg are important, in particular calf stretching exercises will stretch the tibialis posterior muscle which is often associated with shin splints. Calf stretching exercises should be done both with the knee straight and bent.Calf stretch straight leg - To stretch the larger of the calf muscles lean against a wall with the back leg straight keeping the heel pushed into the floor. A stretch should be felt at the back of the lower leg. If a stretch cannot be felt then move the heel further back. Hold for 20 seconds then relax and repeat 3 times. If the athlete has particularly flexible calf muscles then a more advanced version of the calf stretch can be done on a step.Calf stretch bent leg - To to stretch this muscle the knee must be bent to relax the overlying Gastrocnemius. The patient should stand facing a wall with the foot of the calf to be stretched at the back. The knee of the back leg should be bent towards the wall, keeping the heel on the floor. A stretch should be felt in the lower part of the back of the calf. hold this position for 30 seconds and repeat 3 times. A more advanced version of this stretching exercise is to place the forefoot or the front leg on the wall keeping the heel on the floor and gently push the front knee towards the wall.Massage & myofascial releaseSports massage techniques to the deep muscles at the back of the lower leg may help by reducing the strain applied by tight muscles but avoid the inflamed periostium close to the bone. Any tight knots, lumps and bumps should be identified and gently manipulated with soft tissue massage techniques. Massage techniques should include sustained pressure along the lenth of the muscles as well as transverse frictions.Play&sports masage videoHeatApplying heat and using a heat retainer or shin and calf support after the initial acute stage and particularly during training can provide support and compression to the lower leg helping to reduce the strain on the muscles. It will also retain the natural heat which causes blood vessels to dilate and increases the flow of blood to the tissues to aid healing. As a rule of thumb, heat to warm up before exercise and cold therapy after exercise to reduce pain and inflammation.Orthotic insertsIf you do have a biomechanical problem with the foot then a firmer orthotic type insole may be more beneficial. A professional practitioner or podiatrist can perform&gait analysis&to determine if you overpronate or oversupinate and prescribe orthotic inserts to correct any biomechanical problems. A cushioned three quarter length insert is often most appropriate.SurgeryIf all conservative treatment fails then surgery is an option, although this is rare.
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