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Exercise-induced leg pain in athletes: diagnostic, assessment, and management strategies.
Phys Sportsmed. 2019 02; 47(1):47-59.PS

Abstract

The purpose of this review is to describe and critically evaluate current knowledge regarding diagnosis, assessment, and management of chronic overload leg injuries which are often non-specific and misleadingly referred to as 'shin splints'. We aimed to review clinical entities that come under the umbrella term 'Exercise-induced leg pain' (EILP) based on current literature and systematically searched the literature. Specifically, systematic reviews were included. Our analyses demonstrated that current knowledge on EILP is based on a low level of evidence. EILP has to be subdivided into those with pain from bone stress injuries, pain of osteo-fascial origin, pain of muscular origin, pain due to nerve compression and pain due to a temporary vascular compromise. The history is most important. Questions include the onset of symptoms, whether worse with activity, at rest or at night? What exacerbates it and what relieves it? Is the sleep disturbed? Investigations merely confirm the clinical diagnosis and/or differential diagnosis; they should not be solely relied upon. The mainstay of diagnosing bone stress injury is MRI scan. Treatment is based on unloading strategies. A standard for confirming chronic exertional compartment syndrome (CECS) is the dynamic intra-compartmental pressure study performed with specific exercises that provoke the symptoms. Surgery provides the best outcome. Medial tibial stress syndrome (MTSS) presents a challenge in both diagnosis and treatment especially where there is a substantial overlap of symptoms with deep posterior CECS. Conservative therapy should initially aim to correct functional, gait, and biomechanical overload factors. Surgery should be considered in recalcitrant cases. MRI and MR angiography are the primary investigative tools for functional popliteal artery entrapment syndrome and when confirmed, surgery provides the most satisfactory outcome. Nerve compression is induced by various factors, e.g., localized fascial entrapment, unstable proximal tibiofibular joint (intrinsic) or secondary by external compromise of the nerve, e.g., tight hosiery (extrinsic). Conservative is the treatment of choice. The localized fasciotomy is reserved for recalcitrant cases.

Authors+Show Affiliations

a European SportsCare Network (ESN) - Zentrum für Sportorthopädie , Wiesbaden-Nordenstadt , Germany.b Sports and Exercise Medicine Clinic , Thessaloniki , Greece.c Department of Rehabilitation , Aspetar, Orthopaedic and Sports Medicine Hospital , Doha , Qatar.d William Harvey Research Institute, Centre for Sports & Exercise Medicine , Queen Mary University of London , London , UK.

Pub Type(s)

Journal Article
Systematic Review

Language

eng

PubMed ID

30345867

Citation

Lohrer, Heinz, et al. "Exercise-induced Leg Pain in Athletes: Diagnostic, Assessment, and Management Strategies." The Physician and Sportsmedicine, vol. 47, no. 1, 2019, pp. 47-59.
Lohrer H, Malliaropoulos N, Korakakis V, et al. Exercise-induced leg pain in athletes: diagnostic, assessment, and management strategies. Phys Sportsmed. 2019;47(1):47-59.
Lohrer, H., Malliaropoulos, N., Korakakis, V., & Padhiar, N. (2019). Exercise-induced leg pain in athletes: diagnostic, assessment, and management strategies. The Physician and Sportsmedicine, 47(1), 47-59. https://doi.org/10.1080/00913847.2018.1537861
Lohrer H, et al. Exercise-induced Leg Pain in Athletes: Diagnostic, Assessment, and Management Strategies. Phys Sportsmed. 2019;47(1):47-59. PubMed PMID: 30345867.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Exercise-induced leg pain in athletes: diagnostic, assessment, and management strategies. AU - Lohrer,Heinz, AU - Malliaropoulos,Nikolaos, AU - Korakakis,Vasileios, AU - Padhiar,Nat, Y1 - 2018/11/05/ PY - 2018/10/23/pubmed PY - 2019/8/2/medline PY - 2018/10/23/entrez KW - Leg KW - bone stress injury KW - chronic exertional compartment syndrome KW - functional popliteal artery entrapment syndrome KW - medial tibial stress syndrome KW - nerve entrapment SP - 47 EP - 59 JF - The Physician and sportsmedicine JO - Phys Sportsmed VL - 47 IS - 1 N2 - The purpose of this review is to describe and critically evaluate current knowledge regarding diagnosis, assessment, and management of chronic overload leg injuries which are often non-specific and misleadingly referred to as 'shin splints'. We aimed to review clinical entities that come under the umbrella term 'Exercise-induced leg pain' (EILP) based on current literature and systematically searched the literature. Specifically, systematic reviews were included. Our analyses demonstrated that current knowledge on EILP is based on a low level of evidence. EILP has to be subdivided into those with pain from bone stress injuries, pain of osteo-fascial origin, pain of muscular origin, pain due to nerve compression and pain due to a temporary vascular compromise. The history is most important. Questions include the onset of symptoms, whether worse with activity, at rest or at night? What exacerbates it and what relieves it? Is the sleep disturbed? Investigations merely confirm the clinical diagnosis and/or differential diagnosis; they should not be solely relied upon. The mainstay of diagnosing bone stress injury is MRI scan. Treatment is based on unloading strategies. A standard for confirming chronic exertional compartment syndrome (CECS) is the dynamic intra-compartmental pressure study performed with specific exercises that provoke the symptoms. Surgery provides the best outcome. Medial tibial stress syndrome (MTSS) presents a challenge in both diagnosis and treatment especially where there is a substantial overlap of symptoms with deep posterior CECS. Conservative therapy should initially aim to correct functional, gait, and biomechanical overload factors. Surgery should be considered in recalcitrant cases. MRI and MR angiography are the primary investigative tools for functional popliteal artery entrapment syndrome and when confirmed, surgery provides the most satisfactory outcome. Nerve compression is induced by various factors, e.g., localized fascial entrapment, unstable proximal tibiofibular joint (intrinsic) or secondary by external compromise of the nerve, e.g., tight hosiery (extrinsic). Conservative is the treatment of choice. The localized fasciotomy is reserved for recalcitrant cases. SN - 2326-3660 UR - https://www.unboundmedicine.com/medline/citation/30345867/Exercise_induced_leg_pain_in_athletes:_diagnostic_assessment_and_management_strategies_ L2 - http://www.tandfonline.com/doi/full/10.1080/00913847.2018.1537861 DB - PRIME DP - Unbound Medicine ER -