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LOWER LEG PAIN IN BASKETBALL PLAYERS

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LOWER LEG PAIN IN BASKETBALL PLAYERS Powered By Docstoc
					                  DOCTORS, TRAINERS AND CONDITIONING COACHES




                  LOWER LEG PAIN
by Tim Garl
                  IN BASKETBALL
                  PLAYERS
Tim Garl is the Indiana             that occurs during exercise in
                                                                        figure 1
                                                                                                       Figure 1.
                                                                                                       Stretching
                                                                                                       the muscles
                                                                                                       of the lower leg
University’s basketball trainer.    the lower leg.
                                                                                                       and good
He is also the program’s            Typically pain is significant at
                                                                                                       flexibility
Director      of    Basketball      the beginning of training and
                                                                                                       is important
Operations. He has served as        usually decreases once the
                                                                                                       in treating
the Trainer for the USA 1982,       player is warmed up. It may
                                                                                                       and preventing
and    1986      FIBA    World      then intensify, with fatigue, at
                                                                                                       injuries.
Championship Teams, and 1984        the end of activity.
USA Olympic Gold Medal              Symptoms are most commonly
Basketball Team. He is also a       located along the inner
member of the United States         (medial) portion of the tibia in
Olympic, Sports Medicine            the middle third of the bone.
Committee.                          The painful area is often diffu-
                                    se and may move around. Pain
Lower leg pain is common in         subsides after activity however
athletes and is frequently seen     the athlete may complain of         figure 2/3
in basketball players.              aching pain at night.
                                                                                                        Figure 2 and 3.
The conditions causing the
                                                                                                        There are
pain can be soft tissue injury or   The exact cause of the injury
                                                                                                        numerous
involve the tibia or fibula.        has many theories, and fre-
                                                                                                        appliances
                                    quently may have more than
                                                                                                        available that
Soft tissue lower leg pain is       one contributing factor.
                                                                                                        a player can
often referred to in a catch all    These factors may include
                                                                                                        wear to help
term “shin splints” and is tech-    muscle fatigue or imbalance of
                                                                                                        manage the
nically called Medial Tibial        muscles of the lower leg,
                                                                                                        MTSS
Stress Syndrome (MTSS). This        improper or worn footwear,
                                                                                                        symptoms.
condition usually affects athle-    poor flexibility, and overtrai-
tes involved in running and         ning.
jumping activities.                 Training surface may also con-
                                    tribute to the injury (figure 1).
This complaint is frequently
seen in basketball players’.        All of these mechanisms can
It is a result chronic strain or    result in an overload to lower
overuse resulting in miocro-        leg in the form of repetitive
trauma to the muscles and           trauma from weight bearing.
connective tissue, tibia and        Torsion to the tibia from
occasionally the fibula.            muscle/tendon insertions that
                                    contract during running and
It is most commonly seen early      jumping may also contribute
in training where there is          (figure 2 and 3).
increase in activities such as
running and jumping.                One challenge of managing
It may also occur anytime           lower leg pain (MTSS) is deter-
when training is increased          mine the extent of the injury
suddenly in speed and distan-       and identifying proper treat-
ce or when the training surface     ment. The history and charac-
is changed.                         teristics of the pain, such as
                                    length of symptoms, changes
MTSS is characterized by pain       in training routine, other inju-
                                                                                   FIBA ASSIST MAGAZINE | 10 2004 | PAGE 61
                    DOCTORS, TRAINERS AND CONDITIONING COACHES


                                                   ries that might contribute to       Proper footwear must be worn
 figure 4                                          biomechanical errors, painful       for the activity and surface. A
                                                   activity versus pain free acti-     player should attempt to train
                                                   vity, should all be evaluated to    on the softest surface possi-
                                                   help make the correct diagno-       ble, especially when doing
                                                   sis and determine the proper        jumping drills (figure 6 and 7).
                                                   management.                         Emerging thought is that lower
                                                                                       leg injuries exist along a conti-
                                                   Athletes, who present a history     nuum and more serious juries
                                                   of recent change in level or        such as stress fractures, com-
                                                   intensity of training, recent       partment      syndromes      and
                                                   onset of symptoms, diffuse          preiostitis often result from
                                                   pain that is most severe during     complications of mistreatment
Figure 4 and 5.                                    the beginning and end of trai-      or untreated lower leg pain.
Strengthening the muscles of the lower leg is      ning may be suffering from
important part of prevention and rehabilitation.   MTSS or inflammation to the         Stress fracture is the most
                                                   soft tissue of the lower leg(s).    common serious complication
 figure 5                                                                              of overuse injuries in the lower
                                                   Management consists of first        leg and can occur very quickly
                                                   eliminating the insulting acti-     in the athlete with serious trai-
                                                   vity and treating the area for      ning errors.
                                                   acute inflammation.
                                                   Although many therapies exist       Positive signs include local
                                                   for soft tissue inflammation,       tenderness, pain on direct or
                                                   the author finds that ice, rather   indirect percussion, and conti-
                                                   than any thermal modality, pro-     nuous pain during weight bea-
                                                   vides the best relief of symp-      ring.
                                                   toms.
                                                   Anti-inflammatory or analgesic      Imaging studies are usually
                                                   medications may also be used        needed to confirm clinical dia-
                                                   as part of the treatment.           gnosis.
                                                                                       Bone scan has traditionally
 figure 6                                          Examination of the players’         been the standard diagnostic
                                                   footwear is essential to deter-     study.
                                                   mine wear patters and to help       An increasing number of clini-
                                                   identify biomechanical pro-         cians are using Magnetic
                                                   blems.                              Resonance Imaging instead
                                                   High quality footwear is essen-     because of its ability to access
                                                   tial and custom orthotics may       the bone and surrounding soft
                                                   be needed to correct biome-         tissue structures. Standard x-
                                                   chanical errors.                    ray is usually not sensitive
                                                                                       enough to make an early dia-
                                                   Training routine will need to be    gnosis of the micro fractures
                                                   modified, and cross training        to the bone.
                                                   should be incorporated to
                                                   reduce stress.                      Management begins with rest
Figures 6 and 7.                                   Stationary cycling, swimming        to allow the bone to heal and
Some weight machines allow for stretching and      and stair stepper machines are      remodel.
strengthening during the same activity.            all good cardiovascular activi-     Non-weight bearing activity
                                                   ties that can supplement redu-      such as deep water pool
 figure 7                                          ced running.
                                                   Jumping activates, if allowed,
                                                                                       workouts     and      stationary
                                                                                       cycling may be used to keep
                                                   should be done on soft surfa-       the athlete conditioned during
                                                   ces (figure 4 and 5).               this period.
                                                                                       Early management and treat-
                                                   Prevention consists of maintai-     ment of lower all leg pain is the
                                                   ning good flexibility in the        best approach to eliminate
                                                   lower body. Increase training       stress fractures.
                                                   moderately over a period of
                                                   time.                               New studies suggest that elec-
                                                   Strengthening the muscles of        tric and electromagnetic fields
                                                   the lower leg should be part of     or sound waves may help in the
                                                   the training routine.               healing of stress fractures.
PAGE 62 | 10 2004 | FIBA ASSIST MAGAZINE

				
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