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Surface stiffness and tibialis anterior pain

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Asher, Oct 10, 2014.

  1. Asher

    Asher Well-Known Member


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    Hi there,

    I provided foot care at a 6 day ultramarathon recently (my first time). Runners were on a bitumen track a bit over 1km in length and shin pain was a common symptom. According to these runners, it seemed more of an issue at this event compared to others, the surface stiffness being blamed. There were two main areas of the shin that were sore:

    a) tibilais anterior muscle belly
    b) the lower 1/3 of the shin lateral to the tibial crest

    (It was not MTSS or localised pain on the tibia and didn't seem to be compartment syndrome). I have read that tibialis anterior pain will be worse on a stiff surface as it has to work harder eccentrically.

    Why is that?

    Is it because on a compliant surface there is a tiny amount of forward slide and/or vertical surface compression which acts to decelerate ankle joint plantarflexion (assuming initial contact is heel strike), and therefore slightly lowers the eccentric load on tibialis anterior? Or is there something else?

    Thanks for your help.

    Rebecca
     
  2. Stiffer surface should mean reduced leg stiffness (kleg)

    With a reduced kleg we get increased flexion at the hips, knee and ankle.

    Greater knee flexion will increase angle of tibia and speed at which the tibia moves ( if the runner is travelling at thesame speed) through eccentric contraction the tib ant can help to control the velocity of movement.

    could lead to overuse.

    I would also think the more relative nature of bitumen runner verse normal "bush" running which will have many different surface stiffness, angles etc etc might be something to consider.

    and it could also be the tibia coupling effect ---->increased stj pronation moments -----> increased navicular drop.

    We had a thread re coupling will go find it
     
  3. efuller

    efuller MVP

    At heel contact, the vector from ground reaction force will have a line of action that will create a plantar flexion moment at the ankle joint. The moment is equal to the magnitude of ground reaction force times the lever arm of the force. Both the magnitude and the lever arm could be effected by differences in surface hardness.

    With a harder surface there will be less time to stop the motion of the lower leg and foot. (There was a study by Van den Bogart and Nigg that showed that there was a force spike, with heel contact running that coresponded to deceleration of the lower leg and foot. The deceleration of the rest of the body will be dependent on knee and hip stiffness.) So, to stop the downward momentum of the leg and foot an impulse is needed. Impulse is force x time. With a softer surface the lower amount of force will be applied over a longer period of time. The higher force with stiffer surface will cause a greater acceleration in ankle plantar flexion. This will need a greater force in the anterior tibial muscle to decelerate the foot to prevent foot slap.

    If the surace is soft enough to deform significantly, the center of pressure under the heel could be shifted anteriorly relative to where the center of pressure would be on the stiffer surface. This would reduce the lever arm of ground reaction force and that would reduce the plantar flexion moment at the ankle joint.

    There probably are other possible explanations.

    Eric
     
  4. Asher

    Asher Well-Known Member

    Thank you Eric.

    This wouldn't apply when initial contact is with the forefoot though would it?

    The majority of these runners were heel strikers. They do quite a bit of walking in a 6 day event and I noticed many spend quite a bit of time in that 'grounded running' (no flight phase) I read about here: http://www.runresearchjunkie.com/how-many-who-think-they-dont-heel-strike-actually-do/

    Is there a mechanism that explains more tibialis anterior pain on a stiff surface when initial contact is on the forefoot?

    Rebecca
     
  5. Rebecca:

    I had to look up what "bitumen" means. Translation into US English: Asphalt. I learned something new today about "English":rolleyes:

    Anyway, these runners would definitely have been mostly heel-striking if they are running at ultra-marathon speeds. I doubt that there was a single runner at your race who was forefoot striking for 6 days.

    The anterior tibial muscle pain you speak of is not uncommon in heel-striking runners, especially if they are running long distances on harder surfaces, like bitumen (i.e. asphalt) or concrete and do not have the muscle strength to stand the increased stress on this muscle.

    I would imagine since this was a 6 day ultra-marathon, then most of what you saw was delayed onset muscle soreness of the anterior tibial muscle. Delayed onset muscle soreness generally takes 24-48 hours to reach its peak after the event so, in a 6 day event, these runners were probably very sore unless they had experience running multi-day races, which I imagine very few have. Delayed onset muscle soreness is caused in muscles undergoing eccentric contractions (i.e. while the muscle is contracting, the muscle is lengthening) and is thought to be due to inflammation of the cell membranes within the muscle itself due to it being overstretched (see attached paper).

    The anterior tibial muscle is used during early support phase in heel-striking runners to decelerate foot-slap (i.e. decelerate ankle joint plantarflexion). It's contractile activity will be increased when running on harder surfaces or running in shoes with more stiff rearfoot midsoles. Anterior tibial muscle activity will be decreased in heel-striking runners who wear softer rearfoot midsole shoes (e.g. Hoka One One), who run on softer surfaces (some better treadmills, grass, all-weather track, forest trails, etc). Anterior tibial muscle activity will also be decreased in midfoot/forefoot striking runners and gait retraining has been shown to decrease anterior tibial chronic exertional compartment syndrome symptoms in some runners (Diebal AR, Gregory R, Alitz C, Gerber JP: Effects of forefoot running on chronic exertional compartment syndrome: a case series. Int J Sports Phys Ther. 6(4):312-21, 2011; Diebal AR, Gregory R, Alitz C, Gerber JP: Forefoot running improves pain and disability associated with chronic exertional compartment syndrome. Am J Sports Med, 40(5):1060-1067, 2012).

    Hope this helps.:drinks
     
  6. Asher

    Asher Well-Known Member

    Thanks Kevin, as always.
     
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