Skip to main content

2020 | OriginalPaper | Buchkapitel

4. Unterschenkel

verfasst von : Sven Reuter

Erschienen in: Angewandte Sportphysiotherapie - Untere Extremität

Verlag: Springer Berlin Heidelberg

Zusammenfassung

Unterschenkelbeschwerden betreffen oftmals Läufer und wurden in der Vergangenheit meist unter dem Begriff „Shin Splint“ summiert. Dieses Kapitel gibt einen Überblick über häufige Ursachen von Unterschenkelbeschwerden und deren differenzialdiagnostischen Abgrenzung voneinander. Darüber hinaus werden evidenzbasierte Therapieprinzipien, ausgehend von der zugrunde liegenden Pathologie, vorgestellt.
Fußnoten
1
Derzeit gibt es keine Evidenz/Konsensus für ein bestimmtes Programm.
 
2
Trotz der daraus resultierenden Erhöhung der Belastungszyklen scheint der positive Effekt durch die Reduktion der Größe der Belastung zu überwiegen (Edwards et al. 2009).
 
Literatur
Zurück zum Zitat Barrack MT, Gibbs JC, De Souza MJ, Williams NI, Nichols JF, Rauh MJ, Nattiv A (2014) Higher incidence of bone stress injuries with increasing female athlete triad-related risk factors: a prospective multisite study of exercising girls and women. Am J Sports Med 42(4):949–958PubMedCrossRef Barrack MT, Gibbs JC, De Souza MJ, Williams NI, Nichols JF, Rauh MJ, Nattiv A (2014) Higher incidence of bone stress injuries with increasing female athlete triad-related risk factors: a prospective multisite study of exercising girls and women. Am J Sports Med 42(4):949–958PubMedCrossRef
Zurück zum Zitat Becker J, Nakajima M, Wu WFW (2018) Factors contributing to medial tibial stress syndrome in runners: a prospective study. Med Sci Sports Exerc 50(10):2092–2100PubMedCrossRef Becker J, Nakajima M, Wu WFW (2018) Factors contributing to medial tibial stress syndrome in runners: a prospective study. Med Sci Sports Exerc 50(10):2092–2100PubMedCrossRef
Zurück zum Zitat Bennell KL, Brukner PD (1997) Epidemiology and site specificity of stress fractures. Clin Sports Med 16(2):179–196PubMedCrossRef Bennell KL, Brukner PD (1997) Epidemiology and site specificity of stress fractures. Clin Sports Med 16(2):179–196PubMedCrossRef
Zurück zum Zitat Breen DT, Foster J, Falvey E, Franklyn-Miller A (2015) Gait re-training to alleviate the symptoms of anterior exertional lower leg pain: a case series. Int J Sports Phys Ther 10(1):85–94PubMedPubMedCentral Breen DT, Foster J, Falvey E, Franklyn-Miller A (2015) Gait re-training to alleviate the symptoms of anterior exertional lower leg pain: a case series. Int J Sports Phys Ther 10(1):85–94PubMedPubMedCentral
Zurück zum Zitat Brody DM (1982) Techniques in the evaluation and treatment of the injured runner. Orthop Clin North Am 13(3):541–558PubMed Brody DM (1982) Techniques in the evaluation and treatment of the injured runner. Orthop Clin North Am 13(3):541–558PubMed
Zurück zum Zitat de Bruijn J, Winkes M, van Eerten P, Scheltinga M (2019) Chronic exertional compartment syndrome as a cause of anterolateral leg pain-German version. Unfallchirurg 122(11):840–847PubMedCrossRef de Bruijn J, Winkes M, van Eerten P, Scheltinga M (2019) Chronic exertional compartment syndrome as a cause of anterolateral leg pain-German version. Unfallchirurg 122(11):840–847PubMedCrossRef
Zurück zum Zitat de Bruijn JA, van Zantvoort APM, van Klaveren D, Winkes MB, van der Cruijsen-Raaijmakers M, Hoogeveen AR, Teijink JAW, Scheltinga MR (2018a) Factors predicting lower leg chronic exertional compartment syndrome in a large population. Int J Sports Med 39(1):58–66PubMedCrossRef de Bruijn JA, van Zantvoort APM, van Klaveren D, Winkes MB, van der Cruijsen-Raaijmakers M, Hoogeveen AR, Teijink JAW, Scheltinga MR (2018a) Factors predicting lower leg chronic exertional compartment syndrome in a large population. Int J Sports Med 39(1):58–66PubMedCrossRef
Zurück zum Zitat de Bruijn JA, van Zantvoort APM, Winkes MB, van der Cruijsen-Raaijmakers M, Hoogeveen AR, Teijink JAW, Scheltinga MRM (2018b) Lower leg chronic exertional compartment syndrome in patients 50 years of age and older. Orthop J Sports Med 6(3):2325967118757179PubMedPubMedCentralCrossRef de Bruijn JA, van Zantvoort APM, Winkes MB, van der Cruijsen-Raaijmakers M, Hoogeveen AR, Teijink JAW, Scheltinga MRM (2018b) Lower leg chronic exertional compartment syndrome in patients 50 years of age and older. Orthop J Sports Med 6(3):2325967118757179PubMedPubMedCentralCrossRef
Zurück zum Zitat Brukner P, Khan K (2016) Brukner’s & Khan’s clinical sports medicine. Injuries, fifth edition. McGraw-Hill Education Australia, North Ryde Brukner P, Khan K (2016) Brukner’s & Khan’s clinical sports medicine. Injuries, fifth edition. McGraw-Hill Education Australia, North Ryde
Zurück zum Zitat Buerba RA, Fretes NF, Devana SK, Beck JJ (2019) Chronic exertional compartment syndrome: current management strategies. Open Access J Sports Med 10:71–79PubMedPubMedCentralCrossRef Buerba RA, Fretes NF, Devana SK, Beck JJ (2019) Chronic exertional compartment syndrome: current management strategies. Open Access J Sports Med 10:71–79PubMedPubMedCentralCrossRef
Zurück zum Zitat Craig DI (2009) Current developments concerning medial tibial stress syndrome. Phys Sportsmed 37(4):39–44PubMedCrossRef Craig DI (2009) Current developments concerning medial tibial stress syndrome. Phys Sportsmed 37(4):39–44PubMedCrossRef
Zurück zum Zitat Davis IS, Bowser BJ, Mullineaux DR (2016) Greater vertical impact loading in female runners with medically diagnosed injuries: a prospective investigation. Br J Sports Med 50(14):887–892PubMedCrossRef Davis IS, Bowser BJ, Mullineaux DR (2016) Greater vertical impact loading in female runners with medically diagnosed injuries: a prospective investigation. Br J Sports Med 50(14):887–892PubMedCrossRef
Zurück zum Zitat Diebal AR, Gregory R, Alitz C, Gerber JP (2012) Forefoot running improves pain and disability associated with chronic exertional compartment syndrome. Am J Sports Med 40(5):1060–1067PubMedCrossRef Diebal AR, Gregory R, Alitz C, Gerber JP (2012) Forefoot running improves pain and disability associated with chronic exertional compartment syndrome. Am J Sports Med 40(5):1060–1067PubMedCrossRef
Zurück zum Zitat Edwards WB, Taylor D, Rudolphi TJ, Gillette JC, Derrick TR (2009) Effects of stride length and running mileage on a probabilistic stress fracture model. Med Sci Sports Exerc 41(12):2177–2184PubMedCrossRef Edwards WB, Taylor D, Rudolphi TJ, Gillette JC, Derrick TR (2009) Effects of stride length and running mileage on a probabilistic stress fracture model. Med Sci Sports Exerc 41(12):2177–2184PubMedCrossRef
Zurück zum Zitat Fredericson M, Bergman AG, Hoffman KL, Dillingham MS (1995) Tibial stress reaction in runners. Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Am J Sports Med 23(4):472–481PubMedCrossRef Fredericson M, Bergman AG, Hoffman KL, Dillingham MS (1995) Tibial stress reaction in runners. Correlation of clinical symptoms and scintigraphy with a new magnetic resonance imaging grading system. Am J Sports Med 23(4):472–481PubMedCrossRef
Zurück zum Zitat Gabbett TJ (2016) The training-injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med 50(5):273–280PubMedCrossRef Gabbett TJ (2016) The training-injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med 50(5):273–280PubMedCrossRef
Zurück zum Zitat Hamstra-Wright KL, Bliven KC, Bay C (2015) Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis. Br J Sports Med 49(6):362–369PubMedCrossRef Hamstra-Wright KL, Bliven KC, Bay C (2015) Risk factors for medial tibial stress syndrome in physically active individuals such as runners and military personnel: a systematic review and meta-analysis. Br J Sports Med 49(6):362–369PubMedCrossRef
Zurück zum Zitat Heiderscheit BC, Chumanov ES, Michalski MP, Wille CM, Ryan MB (2011) Effects of step rate manipulation on joint mechanics during running. Med Sci Sports Exerc 43(2):296–302PubMedPubMedCentralCrossRef Heiderscheit BC, Chumanov ES, Michalski MP, Wille CM, Ryan MB (2011) Effects of step rate manipulation on joint mechanics during running. Med Sci Sports Exerc 43(2):296–302PubMedPubMedCentralCrossRef
Zurück zum Zitat Helmhout PH, Diebal AR, van der Kaaden L, Harts CC, Beutler A, Zimmermann WO (2015) The effectiveness of a 6-week intervention program aimed at modifying running style in patients with chronic exertional compartment syndrome: results from a series of case studies. Orthop J Sports Med 3(3):2325967115575691PubMedPubMedCentralCrossRef Helmhout PH, Diebal AR, van der Kaaden L, Harts CC, Beutler A, Zimmermann WO (2015) The effectiveness of a 6-week intervention program aimed at modifying running style in patients with chronic exertional compartment syndrome: results from a series of case studies. Orthop J Sports Med 3(3):2325967115575691PubMedPubMedCentralCrossRef
Zurück zum Zitat Johnell O, Rausing A, Wendeberg B, Westlin N (1982) Morphological bone changes in shin splints. Clin Orthop Relat Res (167):180–184, PMID: 7094461. Johnell O, Rausing A, Wendeberg B, Westlin N (1982) Morphological bone changes in shin splints. Clin Orthop Relat Res (167):180–184, PMID: 7094461.
Zurück zum Zitat Liem BC, Truswell HJ, Harrast MA (2013) Rehabilitation and return to running after lower limb stress fractures. Curr Sports Med Rep 12(3):200–207PubMedCrossRef Liem BC, Truswell HJ, Harrast MA (2013) Rehabilitation and return to running after lower limb stress fractures. Curr Sports Med Rep 12(3):200–207PubMedCrossRef
Zurück zum Zitat Lopes AD, Hespanhol Junior LC, Yeung SS, Costa LO (2012) What are the main running-related musculoskeletal injuries? A systematic review. Sports Med 42(10):891–905PubMedPubMedCentralCrossRef Lopes AD, Hespanhol Junior LC, Yeung SS, Costa LO (2012) What are the main running-related musculoskeletal injuries? A systematic review. Sports Med 42(10):891–905PubMedPubMedCentralCrossRef
Zurück zum Zitat Magnusson HI, Westlin NE, Nyqvist F, Gardsell P, Seeman E, Karlsson MK (2001) Abnormally decreased regional bone density in athletes with medial tibial stress syndrome. Am J Sports Med 29(6):712–715PubMedCrossRef Magnusson HI, Westlin NE, Nyqvist F, Gardsell P, Seeman E, Karlsson MK (2001) Abnormally decreased regional bone density in athletes with medial tibial stress syndrome. Am J Sports Med 29(6):712–715PubMedCrossRef
Zurück zum Zitat Moen MH, Tol JL, Weir A, Steunebrink M, De Winter TC (2009) Medial tibial stress syndrome: a critical review. Sports Med 39(7):523–546PubMedCrossRef Moen MH, Tol JL, Weir A, Steunebrink M, De Winter TC (2009) Medial tibial stress syndrome: a critical review. Sports Med 39(7):523–546PubMedCrossRef
Zurück zum Zitat Moen MH, Holtslag L, Bakker E, Barten C, Weir A, Tol JL, Backx F (2012) The treatment of medial tibial stress syndrome in athletes; a randomized clinical trial. Sports Med Arthrosc Rehabil Ther Technol 4:12PubMedPubMedCentralCrossRef Moen MH, Holtslag L, Bakker E, Barten C, Weir A, Tol JL, Backx F (2012) The treatment of medial tibial stress syndrome in athletes; a randomized clinical trial. Sports Med Arthrosc Rehabil Ther Technol 4:12PubMedPubMedCentralCrossRef
Zurück zum Zitat Mueller MJ, Host JV, Norton BJ (1993) Navicular drop as a composite measure of excessive pronation. J Am Podiatr Med Assoc 83(4):198–202PubMedCrossRef Mueller MJ, Host JV, Norton BJ (1993) Navicular drop as a composite measure of excessive pronation. J Am Podiatr Med Assoc 83(4):198–202PubMedCrossRef
Zurück zum Zitat Nose-Ogura S, Yoshino O, Dohi M, Kigawa M, Harada M, Hiraike O, Onda T, Osuga Y, Fujii T, Saito S (2019) Risk factors of stress fractures due to the female athlete triad: differences in teens and twenties. Scand J Med Sci Sports 29(10):1501–1510PubMedCrossRef Nose-Ogura S, Yoshino O, Dohi M, Kigawa M, Harada M, Hiraike O, Onda T, Osuga Y, Fujii T, Saito S (2019) Risk factors of stress fractures due to the female athlete triad: differences in teens and twenties. Scand J Med Sci Sports 29(10):1501–1510PubMedCrossRef
Zurück zum Zitat Rajasekaran S, Finnoff JT (2016) Exertional leg pain. Phys Med Rehabil Clin N Am 27(1):91–119PubMedCrossRef Rajasekaran S, Finnoff JT (2016) Exertional leg pain. Phys Med Rehabil Clin N Am 27(1):91–119PubMedCrossRef
Zurück zum Zitat Rajasekaran S, Hall MM (2016) Nonoperative management of chronic exertional compartment syndrome: a systematic review. Curr Sports Med Rep 15(3):191–198PubMedCrossRef Rajasekaran S, Hall MM (2016) Nonoperative management of chronic exertional compartment syndrome: a systematic review. Curr Sports Med Rep 15(3):191–198PubMedCrossRef
Zurück zum Zitat Rajasekaran S, Kvinlaug K, Finnoff JT (2012) Exertional leg pain in the athlete. PM R 4(12):985–1000PubMedCrossRef Rajasekaran S, Kvinlaug K, Finnoff JT (2012) Exertional leg pain in the athlete. PM R 4(12):985–1000PubMedCrossRef
Zurück zum Zitat Roberts A, Franklyn-Miller A (2012) The validity of the diagnostic criteria used in chronic exertional compartment syndrome: a systematic review. Scand J Med Sci Sports 22(5):585–595PubMedCrossRef Roberts A, Franklyn-Miller A (2012) The validity of the diagnostic criteria used in chronic exertional compartment syndrome: a systematic review. Scand J Med Sci Sports 22(5):585–595PubMedCrossRef
Zurück zum Zitat Robertson GA, Wood AM (2015) Return to sports after stress fractures of the tibial diaphysis: a systematic review. Br Med Bull 114(1):95–111PubMedCrossRef Robertson GA, Wood AM (2015) Return to sports after stress fractures of the tibial diaphysis: a systematic review. Br Med Bull 114(1):95–111PubMedCrossRef
Zurück zum Zitat Rome K, Handoll HH, Ashford R (2005) Interventions for preventing and treating stress fractures and stress reactions of bone of the lower limbs in young adults. Cochrane Database Syst Rev 2:CD000450 Rome K, Handoll HH, Ashford R (2005) Interventions for preventing and treating stress fractures and stress reactions of bone of the lower limbs in young adults. Cochrane Database Syst Rev 2:CD000450
Zurück zum Zitat Warden SJ, Davis IS, Fredericson M (2014) Management and prevention of bone stress injuries in long-distance runners. J Orthop Sports Phys Ther 44(10):749–765PubMedCrossRef Warden SJ, Davis IS, Fredericson M (2014) Management and prevention of bone stress injuries in long-distance runners. J Orthop Sports Phys Ther 44(10):749–765PubMedCrossRef
Zurück zum Zitat Winkelmann ZK, Anderson D, Games KE, Eberman LE (2016) Risk factors for medial tibial stress syndrome in active individuals: an evidence-based review. J Athl Train 51(12):1049–1052PubMedPubMedCentralCrossRef Winkelmann ZK, Anderson D, Games KE, Eberman LE (2016) Risk factors for medial tibial stress syndrome in active individuals: an evidence-based review. J Athl Train 51(12):1049–1052PubMedPubMedCentralCrossRef
Zurück zum Zitat Winkes M, van Eerten P, Scheltinga M (2020) Deep posterior chronic exertional compartment syndrome as a cause of leg pain. Unfallchirurg 123(Suppl 1):3–7PubMedCrossRef Winkes M, van Eerten P, Scheltinga M (2020) Deep posterior chronic exertional compartment syndrome as a cause of leg pain. Unfallchirurg 123(Suppl 1):3–7PubMedCrossRef
Zurück zum Zitat Winkes MB, Scheltinga MR (2018) Chronic exertional compartment syndrome of the deep posterior lower leg. Br J Sports Med 52(19):1279–1280PubMedCrossRef Winkes MB, Scheltinga MR (2018) Chronic exertional compartment syndrome of the deep posterior lower leg. Br J Sports Med 52(19):1279–1280PubMedCrossRef
Zurück zum Zitat Winters M (2019) The diagnosis and management of medial tibial stress syndrome: an evidence update-German version. Unfallchirurg 122(11):848–853PubMedCrossRef Winters M (2019) The diagnosis and management of medial tibial stress syndrome: an evidence update-German version. Unfallchirurg 122(11):848–853PubMedCrossRef
Zurück zum Zitat Winters M, Eskes M, Weir A, Moen MH, Backx FJ, Bakker EW (2013) Treatment of medial tibial stress syndrome: a systematic review. Sports Med 43(12):1315–1333PubMedCrossRef Winters M, Eskes M, Weir A, Moen MH, Backx FJ, Bakker EW (2013) Treatment of medial tibial stress syndrome: a systematic review. Sports Med 43(12):1315–1333PubMedCrossRef
Zurück zum Zitat Winters M, Burr DB, van der Hoeven H, Condon KW, Bellemans J, Moen MH (2019) Microcrack-associated bone remodeling is rarely observed in biopsies from athletes with medial tibial stress syndrome. J Bone Miner Metab 37(3):496–502PubMedCrossRef Winters M, Burr DB, van der Hoeven H, Condon KW, Bellemans J, Moen MH (2019) Microcrack-associated bone remodeling is rarely observed in biopsies from athletes with medial tibial stress syndrome. J Bone Miner Metab 37(3):496–502PubMedCrossRef
Zurück zum Zitat van der Worp H, Vrielink JW, Bredeweg SW (2016) Do runners who suffer injuries have higher vertical ground reaction forces than those who remain injury-free? A systematic review and meta-analysis. Br J Sports Med 50(8):450–457PubMedCrossRef van der Worp H, Vrielink JW, Bredeweg SW (2016) Do runners who suffer injuries have higher vertical ground reaction forces than those who remain injury-free? A systematic review and meta-analysis. Br J Sports Med 50(8):450–457PubMedCrossRef
Zurück zum Zitat Wright AA, Taylor JB, Ford KR, Siska L, Smoliga JM (2015) Risk factors associated with lower extremity stress fractures in runners: a systematic review with meta-analysis. Br J Sports Med 49(23):1517–1523PubMedCrossRef Wright AA, Taylor JB, Ford KR, Siska L, Smoliga JM (2015) Risk factors associated with lower extremity stress fractures in runners: a systematic review with meta-analysis. Br J Sports Med 49(23):1517–1523PubMedCrossRef
Zurück zum Zitat van Zantvoort APM, Hundscheid HPH, de Bruijn JA, Hoogeveen AR, Teijink JAW, Scheltinga MRM (2019) Isolated lateral chronic exertional compartment syndrome of the leg: a new entity? Orthop J Sports Med 7(12):2325967119890105PubMedPubMedCentral van Zantvoort APM, Hundscheid HPH, de Bruijn JA, Hoogeveen AR, Teijink JAW, Scheltinga MRM (2019) Isolated lateral chronic exertional compartment syndrome of the leg: a new entity? Orthop J Sports Med 7(12):2325967119890105PubMedPubMedCentral
Metadaten
Titel
Unterschenkel
verfasst von
Sven Reuter
Copyright-Jahr
2020
Verlag
Springer Berlin Heidelberg
DOI
https://doi.org/10.1007/978-3-662-62052-6_4