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ABSTRACT
RELATIONSHIP OF A SHOCK—ABSORBING SURFACE AND SELECTED

PRECONDITIONING EXERCISES TO THE DEVELOPMENT OF SHIN
SORENESS IN HIGH SCHOOL FEMALE SIDE-HORSE VAULTERS

BY

Deeann Louise Cramer

The purpose of the study was to determine the effects of
selected preventive measures on the development of shin soreness in
high school female side-horse vaulters. Specifically, precondition-
ing exercises for the lower leg and a shock-absorbing running surface
were studied.

Four regularly scheduled high school physical education classes
were randomly assigned to four treatments: (a) Group A - the control
group had no preconditioning and ran on a concrete floor; (b) Group
B - an experimental group had no preconditioning but ran on a
tumbling mat; (c) Group C - an experimental group received the pre—
conditioning treatment but ran on the concrete floor, and (d) Group
D - an experimental group received the preconditioning treatment and
ran on the tumbling mat.

The preconditioning treatment was administered to groups C and
D for a period of two weeks. All four groups then participated in
daily vaulting activities for three weeks. Groups A and.C ran on the

concrete floor while groups B and D ran on the mat. At the conclusion

Deeann Louise Cramer
of the five-week period, all subjects who had developed shin soreness
were identified and interviewed. A 2 x 2 Chi-square contingency
analysis was used to treat the data. The results showed that,
within the limits of this study, neither a shock—absorbing running
surface nor preconditioning of the lower leg are significantly

related to the incidence of shin soreness.

RELATIONSHIP OF A SHOCK-ABSORBING SURFACE AND SELECTED
PRECONDITIONING EXERCISES TO THE DEVELOPMENT OF SHIN

SORENESS IN HIGH SCHOOL FEMALE SIDE-HORSE VAULTERS

BY

Deeann Louise Cramer

A THESIS

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of ’

MASTER OF SCIENCE

Department of Health, Physical Education, and Recreation

1976

TABLE OF CONTENTS
Chapter Page

LIST OF TABLES O O O O O O I O O O O O O O O O O O O O O O O O 0 iv

: TIE PROB IE“ 0 O 0 O O O O 0 O O O O O O O O 0 O O O I 1
Need for the Study. . . . . . . . . . . . . . 5
Statement of the Problem. . . . . . . . . . . 5
Research Hypotheses . . . . . . . . . . . . 6
Research Plan . . . . . . . . . . . . . . . . 6
Limitations . . . . . . . . . . . . . . . . . 8
II REVIEW OF LITERATURE . . . . . . . . . . . . . . . . 10

Suggested Diagnoses . . . . . . . . . . . . 10

Stress Fracture. . . . . . . . . . . . ll
Anterior Tibial Syndrome . . . . . . 14
Muscle or Tendon Strain. . . . . . . 16

Inflammation . . . . . . . . . . . . . 19
Myositis. . . . . . . . . . . . 19

Fibrositis. . . . . . . . . . 20

Enthesitis. . . . . . . . . . . 20

Periostitis . . . . . . . . . . 21

Tenosynovitis . . . . . . . . 22

Current Status. . . . . . . . . . . . . . . . 23
Symptoms. . . . . . . . . . . . . . . . . . . 25
Precipitating or Contributing Factors , , , , 26
Treatment . . . . . . . . . . . . . . . . . . 29
Prevention. . . . . . . . . . . . . . . . . . 32
Running Mechanics . . . . . . . . . . . . . . 33

III RESEARCH METHODS . . . . . . . . . . . . . . . . . . 36

Subjects. . . . . . . . . . . . . . . . . . . 36
Independent Variables . . . . . . . . . . . . 37
Preconditioning Treatment. . . . . . . 37
Surface Treatment. . . . . . . . . . . 37
Assignment of Treatments. . . . . . . . . . . 37
Administration. . . . . . . . . . . . . . . . 38
Schedule of Treatments. . . . . . . . . . . . 39
Daily Records . . . . . . . . . . . . . . . . 40
Collection of Data. . . . . . . . . . . . . . 40
Identification of Positive Cases . . . 40
Adjustments. . . . . . . . . . . . . . 40
Data Analysis . . . . . . . . . . . . . . . . 41

ii

Chapter

IV

APPENDIX

REFERENCES

RESEARCH RESULTS . . . . . . .

Findings of the Study .
Discussion. . . . . . .

SUMMARY AND CONCLUSIONS. . . .

Conclusions . . . . . .
Recommendations . . . .

DESCRIPTION OF PRECONDITIONING

iii

Page
42

42
43

45

46
47

48

SO

Table

LIST OF TABLES
Page
Schedule of Treatments . . . . .1. . . . . . . . . . 39

Effect of Preconditioning Treatment on the
Development of Shin Splints. . . . . . . . . . . . . 42

Effect of Surface Treatment on the Development
Of Shin Splints. I O .0 O O O O 0 ~ 0 O O O O O O O O O 43

iv

CHAPTER I

THE PROBLEM

"Shin splints" is a lay term commonly used to describe a con-
dition of the lower leg which is characterized by pain in the tibial
region following repeated bouts of walking, running, or jumping.
This condition is relatively common in athletic activities where
running and jumping are involved (e.g., track, cross country,
tennis, basketball). The symptoms are relieved by rest and aggra-
vated by continued activity. Although generally recognized as a
minor injury, untreated cases of shin splints may reach a level of
such intense pain that performance capacity is significantly reduced.

The literature dealing with the subject of shin splints or
shin soreness in athletes has been focused primarily on attempts to
identify the exact nature of the condition. Historically, these
diagnostic efforts have been characterized by much disagreement and
confusion which, until recently, has caused this condition to be
regarded as a vague and generalized syndrome.

In a presentation to the American Medical Association in 1966,
Paul and Soderberg (37) discussed numerous proposed explanations for
shin soreness. Among the major theories considered were: stress
fracture of the tibia and fibula, anterior tibial syndrome (partial

to complete necrosis of the contents of the anterior tibial

2
compartment), and numerous types of inflammatory conditions affecting
muscles, tendons, connective tissue and bone.

A questionnaire administered by Paul (37) in 1962 to a group
of athletic trainers, physical education instructors, and orthopedic
surgeons revealed that the anterior tibial syndrome theory was sup-
ported by a number of orthopedists while most athletic trainers were
of the opinion that shin splints are caused by a strain of the
tibialis anterior or posterior or by inflammation of the interosseous
membrane. The majority of athletic trainers named hard surfaces
and under-conditioning as the probable causes of this condition.

Another survey by Drake (18) was designed to "provide a col-
1ective opinion on shin splints which reflects the thinking of
experienced trainers." The results of his questionnaire were similar
to Paul's findings with most trainers attributing shin splints to
strain or inflammation of the posterior tibialis, anterior tibialis,
interosseous membrane, or a combination of these. Various treatment
methods were suggested by respondents but moist heat and rest were
recommended by most.

In 1966 the American Medical Association (A.M.A.) published the
first restrictive definition of shin splints (43). This authori-
tative step changed its status from a nonspecific syndrome to that
of a distinct clinical condition which could be distinguished as a
separate entity from other non-traumatic conditions of the lower leg
having similar symptoms. The A.M.A. definition described shin splints

as

3

"pain and discomfort in the leg from repetitive running

on hard surfaces or forcible, excessive use of foot

flexors; diagnosis should be limited to musculotendinous

inflammations, excluding fracture or ischemic disorder."

Slocum (39) attempted to clarify this condition further in
light of the diverse theories previously suggested. Based on the
A.M.A. definition, he listed several criteria for the correct diag-
nosis of shin splints: the lesion must lie within the plantar
flexors or extensors of the foot; it must lie at the origin, belly
or musculotendinous junction of these muscles (distal tendinous
involvement excluded on the basis of anatomical location): there
must be a history of aching pain following repetitive walking or
running; classic signs of mild inflammation usually are present at
the site of the lesion; pain may be elicited on either flexion or
extension of the foot; and conditions resulting from direct trauma
or recognized disease entities are excluded.

Slocum observed that the real problem in diagnosing shin splints
arises from the great similarit, between its symptoms and those of
certain other non-traumatic conditions brought on by overexertion.
Several of these were specifically mentioned. In cases of stress
fracture of the tibia or fibula (a disease process involving the
cortex of the bone), Slocum noted that x-rays would reveal a :tress
fracture if sufficiently advanced. He advised that stress fracture
should be suspected when normal treatment for shin splints fails to
relieve the symptoms. Acute anterior tibial syndrome requires early
diagnosis as it may develop rapidly to a point of surgical emergency.
According to Slocum, its symptoms differ from those of shin splints

in that pain covers the entire anterior tibial compartment and

4
intensifies over several hours despite rest and normal treatment.
In the case of chronic anterior tibial syndrome, he pointed out that
pain is recurrent throughout the entire season rather than only at
the beginning, and pain and tenderness are felt over the entire
anterior tibial compartment. walking is not painful. Primary
arterial occlusion and acute peroneal syndrome both have similar
symptoms but are relatively rare in athletics. Slocum also noted
that fascial hernias and tenosynovitis are somewhat similar but can
usually be distinguished from shin splints without difficulty due
to the location of the pain or other unique symptoms.

Relative to this more discriminating diagnosis, Slocum sug-
gested several techniques for the treatment and prevention of shin
splints. The purpose in treatment of this condition, according to
Slocum, is to relieve the strain on the plantar flexors by supporting
the arch and reducing the degree of dorsi-flexion. He recommended
several methods: heel to forefoot taping of the arch; sponge
rubber arch supports, heel lifts, or padding under the forefoot;
providing adequate rest to the affected muscles; and application
of physical therapy measures to increase circulation and eliminate
edema.

Slocum's suggestions with respect to preventive techniques
included: use of stretching exercises to attain normal flexibility
of the calf muscles and plantar flexors; use of muscle strengthening
exercises to prevent sudden overload to these muscles: correction of
mechanical defects in gait; use of proper coaching techniques;

avoiding hard running surfaces: and use of shock absorbing shoes.

5
Although shin soreness or "shin splints" continues to be a
nagging problem for many athletes, some progress has been made in

recent years in diagnosing and dealing effectively with it.

Need for the Study

 

As indicated in much of the literature, shin splints are found
to occur frequently in a number of different athletic events.
Although the condition is considered a minor injury, it has damaging
potential for the athlete. If left untreated, shin splints even-
tually may become so painful that the performance level of the
athlete is significantly reduced. The treatment recommended by the
majority of physicians, trainers and coaches is rest. However, the
application of this treatment creates two additional problems for
the athlete and his coach: loss of participation in competition and
a reduction in his level of conditioning. Although the importance
of these subsequent effects will vary with respect to the length of
rest required, they are undesirable side effects.

The most desirable approach to the problem of shin splints
would appear to lie in the development of an effective preventive
program. In reviewing the literature, no studies were found which
dealt with this aspect of shin soreness in athletes. It was felt
that such a study would be of definite value to coaches of athletes

who participate in activities where shin splints commonly occur.

Statement of the Problem

 

The purpose of this study was to determine the effects of

selected preventive measures on the development of shin soreness in

6
female side-horse vaulters. Specifically, the effects of a program
of preconditioning exercises and the effects of a shock-absorbing

surface were studied.

Research Hypotheses

 

This study was designed to test the following three research
hypotheses: (a) preconditioning exercises can be used to reduce
the incidence of shin soreness in inexperienced female side-horse
vaulters at the high school level: (b) a shock-absorbing surface
will reduce the incidence of shin soreness in inexperienced female
side-horse vaulters at the high school level; and (c) the beneficial
effects of preconditioning exercises and a shock-absorbing Surface

will be synergistic.

Research Plan‘

An available sample of 109 female high school physical educa-
tion students was used for the study. The subjects were naive
with respect to the specific experimental variables, and it was
assumed that variations in fitness levels and inherent physical
ability were randomly distributed.

Based on the review of literature, two frequently recommended
preventive measures were chosen as independent variables: precon-
ditioning of the lower leg and the use of a shock-absorbing running
surface. Three exercises were selected to comprise the precondi-
tioning treatment (see Appendix). These exercises were chosen on
the basis of current diagnostic evaluations of shin splints and were
designed to strengthen and increase the flexibility of the specific

muscles most frequently involved. A 60' x 6' x 2" tumbling mat was

chosen as a suitable shock-absorbing running surface. The classroom
floor was tile over concrete.

Four regularly scheduled physical education classes were
assigned randomly to one of four treatments: (a) Group A - the
control group had no preconditioning and ran on the regular class-
room floor; (b) Group B - an experimental group had no precondition-
ing but ran on the tumbling mat: (c) Group C - an experimental group
received the preconditioning treatment but ran on the regular class-
room floor; and (d) Group D - an experimental group received the
preconditioning treatment and ran on the tumbling mat. Careful
attention was given to maintaining uniformity between groups with
respect to the instructions given and the time of participation in
various phases of the study. All subjects received basic vaulting
instruction. No attempts were made to improve inherent running
techniques. The subjects participated in bare feet or stocking
feet and vaulted five times daily during the final three weeks of
the study.

The study was conducted during a regularly scheduled five-week
gymnastics unit and was administered by the investigator in her
normal capacity as a physical education teacher. During the first
two weeks, Groups C and D participated in a daily program of
selected preconditioning exercises in addition to a general warm-up
prior to work on other pieces of apparatus. Groups A and B were
given only the general warm-up which included no exercises involving
the lower leg.

During the final three weeks of the study, Groups C and D con—

tinued the daily conditioning treatment. All four groups

8
participated in daily vaulting practice with standardized instruc-
tions. Groups B and D used the mat for their approach runs, whereas
Groups A and C ran on the bare floor.

Accurate attendance records were kept. Thirteen subjects who
were absent more than 50% of the time were deleted from the study
as were six subjects who had previous vaulting experience. The
final sample consisted of 90 subjects with 23 in Group A, 28 in
Group B, 13 in Group C, and 26 in Group D.

Although the subjects were unaware that a study was in progress,
some volunteered complaints of shin soreness prior to the conclusion
of the experiment. Records were kept of these complaints. In addi-
tion, private interviews were conducted after the final session to
further identify any subjects who had experienced shin splints.

The data were treated with a 2 x 2 Chi-square contingency analysis
to determine if the incidence of shin splints was dependent upon the

factors of preconditioning and running surface.

Limitations

 

1. Since the four research groups were available samples, they
were of unequal size at the beginning of the study. The removal of
previously trained and high absence subjects further contributed to
the variance in size.

2. Because the investigator had no control over the activities
of the subjects outside of the classroom, the possibility must be
considered that some of the subjects may have received significant
preconditioning due to various activities such as cheerleading,

marching, skating, etc.

9

3. Close supervision of warm-up and preconditioning exercises
by the investigator insured consistent participation by all subjects.
However, the degree of effort put forth by each subject during these
exercises and the vaulting activities could not be controlled.

4. Much variation in running and jumping technique was observed
among the subjects; however, no effort was made to change these
techniques beyond the normal vaulting instruction. Although the
literature revealed that faulty mechanics may be an important
factor in the development of shin splints, it was assumed that such
cases were randomly distributed and no attempt was made to control
this factor during the study.

5. Although cases of excessive absence were deleted from the
study, it was recognized that the absences of retained subjects
also carried limitations of varying degree.

6. Because of the inflexible structure of the physical educa-
tion curriculum, the duration of the preconditioning treatment was
limited to two weeks.

7. Although the selection of specific exercises used in the
preconditioning treatment was based on investigative findings,
the arbitrary nature of the choice must be regarded as restrictive.

8. The application of the results of this study are limited

to similar groups of high school females.

CHAPTER II

REVIEW OF LITERATURE

In reviewing the literature, no studies could be found which
dealt with preventive programs for shin soreness in athletes.
However, several studies and articles by physicians, athletic
trainers and other investigators regarding the nature of the "shin
splint syndrome" served to provide information which was pertinent
to this study.

An examination of the literature revealed that the term "shin
splints" has been used rather loosely in reference to many conditions
of pain or soreness in the lower leg following exertion where direct
trauma was not involved. The condition was found to occur most
frequently in sports which involve a great deal of repetitive
running, walking, or jumping such as track, basketball, ballet
dancing, cross country, gymnastics and tennis. Its symptoms
generally have been recognized as a dull aching pain along the
tibia which is most noticeable immediately following a workout.

At first this pain is relieved by rest, but later it becomes almost

continuous.

Suggested Diagnoses

 

Attempts to accurately diagnose shin soreness have resulted in

a history of confusion and disagreement which has left the problem

10

ll
of treatment and prevention in a state of some uncertainty. In
1962, Paul (37) distributed a limited questionnaire toiorthopedic
surgeons, athletic trainers and professional sports educators in an
attempt to discover more about the causes and diagnosis of shin
splints. His results showed that six orthopedists felt that shin
splints are related in some way, either specifically or nonspe—
cifically, to the anterior tibial syndrome; two thought it is
caused by tenosynovitis; several attributed the symptoms to muscle
strain and/or rupture; and one thought it is due to fracture. Most
trainers gave multiple Opinions which identified the tibialis
posterior, tibialis anterior, interosseous membrane or a weak longi-
tudinal arch as suspected locations of the injury. Since the middle
1950's numerous theories have been advanced in response to the

mystery of shin soreness in athletes.

Stress Fracture

 

Devas (12) defined a stress fracture as "that fracture which
occurs in the normal bone of a normal individual undergoing normal
activity and with no injury." Based on his studies of numerous
cases of stress fracture, he attempted to show that shin soreness
or "shin splints" in athletes is caused by a particular type of
stress fracture of the tibia involving only one cortex of the bone
which is not apparent in X-rays until a later stage. This makes
early diagnosis very difficult (13).

The symptoms begin slowly with a dull, aching pain usually at
the end of a run. The intensity of the pain increases gradually

over a period of time until it becomes so severe that running must

12
be discontinued. Early in its development, the pain is relieved by
rest, but it returns with the resumption of activity. As the condi—
tion progresses, rest no longer relieves the pain and running must
be stopped indefinitely. The pain usually is felt in the lower
front part of the leg. Tenderness can be found on the medial
tibial border but not necessarily where the pain is felt. It may
be possible to reproduce the pain by "springing" the tibia, thus
opening the fracture.

Devas (13) identified the usual sites of stress fracture in the
tibia as the lower third in athletes, the middle third in ballet
dancers and the upper third in military recruits. He further
observed that, since stress fractures rarely develop into complete
fractures, immobilization is not necessary as long as the individual
ceases the precipitating activity and uses supportive strapping
techniques.

In explaining the probable mechanism of stress fractures,

Devas (l3) referred to an earlier study by Devas and Sweetnam (14)
on stress fracture of the fibula, a condition that is quite common
in athletes. Fifty cases of stress fracture of the fibula were
investigated. The symptoms included pain posterior to the fibula
with tenderness and swelling just above the lateral malleolus. The
onset of these symptoms was found to be gradual in most cases.

With the aid of radiographs, Devas and Sweetnam (14) studied
the muscular actions of the lower leg in normal, healthy subjects.
These showed that with the plantar flexors in strong contraction,

there is a close approximation of the tibia and fibula. The point

13
of greatest stress appears to be near the inferior tibiofibular
joint, which is the most frequent site for stress fracture.

In a very early study by Burrows (7) on fatigue (stress)
fracture of the fibula, similar symptoms were observed. Burrows
reported finding a high incidence of this condition among track
men, most commonly in the lower third, and used the term "runners
fracture" to describe it. He attributed this injury to activities
involving repetitions of the same resisted movement.

In his work on various overuse syndromes in athletes, Corrigan
(10) stated that stress fractures result from overuse and repeated
strain. He cited the work of Armstrong and Tucker (2) in describing
the mechanism of the fracture as a whipping action on the bone
resulting from the repeated pull of large muscle groups. He noted
that continued strain causes an extension of the crack, while rest
permits healing and the formation of a callus at the site.

In his most recent article on the subject, Devas (12) identi-
fied two types of stress fracture: compression fracture and oblique
fracture (caused by the bending or bowing out of the bone). He
indicated that training helps in prevention because the bone will
become stronger with use. Devas concluded that stress fracture is
the cause of all shin soreness of the tibia in athletes with the
sole exception of anterior tibial syndrome.

In reviewing Devas' theories, Paul and Soderberg (37) pointed
out that their investigation of shin soreness in athletes at the
University of Iowa failed to support his view. Over a period of

several years, all University of Iowa athletes who complained of

l4

pain in the tibial region were X-rayed two weeks to four months after
the onset of pain. Stress fracture was found in only one case.

O'Donaghue (34) observed that stress fracture is a condition
which may be easily mis-diagnosed as shin splints. Dolan (15) noted
that ossification of the tibia is not complete until approximately
21 to 25 years of age and warned that epiphyseal fractures should
be suspected, especially around the ankle and near the top and front

of the shin, in young people.

Anterior Tibial Syndrome

 

This condition was first described in 1943 by Vogt (44) and
numerous cases of anterior tibial syndrome (A.T.S.) have been
studied by others since that time (25,31,33,36). Few of the reports
have dealt with athletes, however. Craig (11) held that A.T.S. is
a condition often mistaken for shin splints. He stated that A.T.S.
usually results from a blow to the leg which causes swelling of the
muscles in the anterior tibial compartment. This swelling causes
a reduced blood supply to the area because of restriction of the
anterior tibial artery.

A distinction was made by Mozes (33) between what he termed the
"functional form" where no vascular lesions are found and the
"anatomical form" where arterial lesions are present. He described
eight cases which had vascular obstruction proximal to the anterior
tibial artery. He further stated that A.T.S., which is begun by
a sudden vascular obstruction, runs an acute clinical course leading
to necrosis of the contents of the anterior tibial compartment. He

found that most of the cases which he considered to be of the

15
functional form resulted from overexertion in young people who were
untrained for sustained work such as army recruits.

In his discussion of the Overuse Syndrome in athletes, Corrigan
(10) made reference to the possibility that overuse of muscles in
the anterior tibial compartment may lead to A.T.S. and possible
necrosis. A similar condition involving the peroneal compartment
was reported by Lunceford (30) who stated that continuous and pro-
longed exertion on a hard floor produces edema of the muscles with
accumulation of metabolites in a closed space. The result is
diminished blood flow to the muscles.

In their review of this condition, Paul and Soderberg (37)
indicated that the term A.T.S. had grown to include any condition
in which the clinical picture is dominated by ischemia of the
anterior tibial muscles. While posing the possibility that shin
splints might represent a very mild form of ischemic necrosis, Paul
and Soderberg made a clear distinction between the two syndromes.

"With athletes, the pain in shin splints may be relieved

within a few minutes by rest or may continue as mild

to moderately severe during exercise only. However,

the pain from the A.T.S. persists despite rest and within

a few hours becomes severe. This is followed by redness

of the overlying skin and tenderness on pressure over

the underlying muscles. The muscles feel firm, and

slight local edema can be demonstrated. Constitutional

signs are absent except for slight rise in temperature."

Slocum (39) noted that an acute case of A.T.S. had never been
reported in a professional athlete. In his discussion of differen-
tial diagnosis he placed great emphasis on the serious nature of
A.T.S. Slocum pointed out that while the occurrence of A.T.S. is

quite rare in athletics, the rapid progression of symptoms to the

point of irreparable damage makes early diagnosis essential.

16
Although the early Symptoms are similar to those of shin splints,
there are important differences. The pain appears early and extends
over the entire anterior tibial compartment rather than being pre-
dominantly near the muscle attachment. The overlying fascia become
stiff and hard and extremely tender. Glossiness of the overlying
skin, fever, loss of muscle power, and partial loss of sensation in
the toes indicate the beginning of necrosis.

In the chronic form, according to Slocum, the condition may be
mistaken for recurring shin splints, although there are important
distinctions in the symptoms. The symptoms are chronic rather than
limited only to the beginning of the sports season, they occur at
certain given levels of activity, pain and tenderness are present
over the entire anterior tibial chamber, and walking is not painful.
Slocum suggested that the probable cause of chronic A.T.S. is an
anterior tibial compartment which is too small to permit the increased
muscle bulk resulting from high levels of activity. Its correct
diagnosis would be necessary to keep activity within a comfortable
range. Mavor (31) also noted the similarity of symptoms in the
case of chronic A.T.S. and stress fracture and indicated that x-rays

may be necessary to confirm the diagnosis.

Muscle or Tendon Strain

 

A strain is an injury to a tendon or muscle resulting from
trauma caused by excessive use or stress. No appreciable hemorrhage
is present in the ordinary strain, and almost any muscle in the body

can be affected. Lloyd's (29) study of 234 athletes who participated

17
in running events in the 1959 British Empire Games showed that
approximately 28% suffered some form of muscle or tendon strain.

Paul and Soderberg (37) described two types of muscle strain:

"One is an injury to the muscle fibers themselves caus-

ing pain and localized tenderness. The major portion

of the pain is produced by an active resisted isometric

contraction. Far less pain is produced by passively

putting the muscle on stretch. The other type of

strain may involve any partion of the vast connective

tissue framework of the entire muscle. The symptoms

are pain and tenderness. The major portion of the

pain is elicited by passively putting the muscle on

a stretch. Far less pain is elicited by an active

resisted isometric contraction."

In his text on athletic injuries, Litton (28) supported the
theory that shin splints represent a "muscle strain, an avulsion of
small groups of muscle fibers of the tibialis anterior from their
origin on the tibia." His description of the antagonistic function
of the tibialis anterior with respect to the gastrocnemius and
soleus in normal gait provides support for this theory. He suggested
that the tibialis anterior is strained while acting to check the
strong contractions of the calf muscles. He further pointed out
that

"It has been demonstrated that shin splints are relieved

when the function of the gastrocnemius and soleus is

restricted by strapping at the lower end of the calf

muscle mass. Strapping reduces the effectiveness of

muscular contraction thus reducing the force required

to oppose it, therefore there is less strain on the

tibialis anterior."

Paul and Soderberg (37) suggested that muscle soreness is an
entirely different problem in that pain does not develop until some

hours after exercise. If exercise is undertaken, the soreness will

disappear only to return after completion of the exercise.

18

Craig (11) described two major conditions which could be authori-
tatively referred to as shin splints. In one instance, shin splints
are attributed to the involvement of the anterior tibial muscle
whose angular structure often imposes stress during contraction.
If this stress is severe enough, the anterior tibial muscle may tear
along its attachment to the tibia and may even cause a partial tearing
of the interosseous membrane from the tibia and fibula. On the other
hand, Craig reported that the symptoms may be due to involvement of
the tibialis posterior. In this instance, it is suspected that an
irritation of the osseous attachment occurs during plantar flexion.
This muscle also undergoes a great amount of stretch during dorsi-
flexion in the landing phase of running and jumping. Craig concluded
that partial separation of these muscles from their bony attachments
is commonly manifested in shin splints.

Dolan (16) named the interosseous membrane between the tibia
and fibula as the probable site of injury in cases of shin splints.
His discussion of this membrane's structure and function lends some
credibility to the theory. The interosseous membrane serves as a
buffer or "elastic bone" to stabilize the structure of the lower
leg. It also serves as an added source of attachment for the
gastrocnemius, soleus and at least six of the anterior tibial
muscles. The latter are pressed tightly between the skin and bone
and tend to warm up slowly and cool off rapidly. Since the inter—
osseous membrane receives only a limited blood supply, its nourish-
ment and the removal of waste products are insufficient in view of
the great amount of irritation created by strenuous use of these

muscles. Dolan listed five possible causes of irritation to this area:

19

1. Isolated fibers of the tibialis anterior muscle that are
abnormally attached to the shin bone may tear loose causing pain.

2. There may be separation of the tibiofibular ligament that
lies between the tibia and fibula about an inch above the ankle
joint.

3. A tough, non-yielding covering (sarcolemma) of the
tibialis anterior muscle.

4. There may be a general displacement of the tissue that
lies between the fibula and tibia.

5. Adhesions may form causing the calf muscles (gastrocnemius
and soleus) to bind one another.

A similar theory was described by Morehouse (32), who suggested
that constant muscle pull tears the origins away from the inter-
osseous membrane or the periosteum away from the bone. He termed
this an "irritative myositis." In his text on the treatment of
athletic injuries, O'Donaghue (34) noted the tearing of the attach-
ment of the posterior tibialis muscle along the tibia and irritation
of the interosseous membrane among several conditions which are

manifested in shin splints.

Inflammation

 

The symptoms commonly associated with shin splints also have

been attributed to inflammation at various tissue sites.

Myositis. Inflammation of voluntary muscle, or myositis, is
found only rarely in athletes, according to Paul and Soderberg (37),
and is most common when traumatic injuries are involved. It is char-

acterized by local pain and muscle spasm, followed by a period of

20
muscle atrophy and finally muscle repair. According to Brown and
Moritz (6), a true inflammatory process is not present. Steindler
(42) observed that the pain resulting from a myositic condition is

of a more constant nature than that resulting from mechanical stress.

Fibrositis. Dorland (17) defined fibrositis as an "inflamma-

 

tory hyperplasia of the white fibrous tissue of the body, especially
of the muscle sheaths andfascial.layers of the locomotor system; it
is marked by pain and stiffness." In evaluating this condition as

a possible explanation for the pain of shin splints, Paul and
Soderberg (37) pointed out that while in shin splints the pain is
brought on by activity and relieved by rest, the opposite is true

in the case of fibrositis.

Enthesitis. The term enthesitis was first used by La Cava (24)

 

in 1959 to describe a traumatic disease of muscular insertions. He
suggested that the "continually recurring concentration of muscle
stress at points of insertion of muscles provokes a reaction of
inflammation with a strong tendency to the formation of fibrosis

and calcification." He further noted that the condition is found in
numerous occupations and frequently in sports. According to La Cava,
the conditions commonly known as "glass arm", "tennis elbow", "shin
splints" as well as periostitis of sprinters and achilles tendinitis
in tennis players and skiers are some of the more frequent examples.
He described the symptoms as a slight pain in the area of insertion .
which appears at first only toward the end of competition or in
exaggerated movements, but which finally becomes constant to tne

point where all movement of the muscle is painful. While there is

21
tenderness in the area of insertion, it often is impossible to
localize the pain exactly. Pain is not elicited by movement of the

joint except when the affected muscle is used.

Periostitis. According to Dorland (l7), "inflammation of the

 

periosteum" or periostitis generally is chronic and is marked by
tenderness and swelling of the bone and an aching pain. In their
review of the shin splint syndrome, Paul and Soderberg (37) observed
that very little could be found in the medical literature to support
the periostitis theory.

O‘Donoghue (34) listed several conditions which are commonly
called "shin splints." Among them are two forms of periostitis:

(a) irritation of the attachment of the posterior tibial muscle
along the posterior face of the tibia with resulting periostitis,
and (b) an ordinary periostitis along the posteromedial angle of
the tibia.

In his discussion of sports injuries, Colson (9) denies the
possibility that shin splints involve muscle attachments. His con-
clusion is based on the observation that there are no sites of
muscle attachment on the lower third of the tibia where the pain
is greatest. He suggests that the condition does bear strong
resemblance to a traumatic periostitis, but he points out that
frictional massage would be expected to aggravate a periostitic
condition while in shin splint cases it often helps.

Liljedahl (26) briefly discussed shin splints and its symptoms
in his article on physical training injuries and attributed them to

"so-called periostitis", adding that it is "not yet established

22
whether this periostitis is a very early symptom of an insufficiency
(stress) fracture." Corrigan (10) referred to shin soreness in a
discussion of the "overuse syndrome." He suggested that while the
pain may be due to minute muscle tears, it is more likely a periosti-
tis caused by the constant overuse of the musculotendinous origin.
James and Brubaker (22) classified "runners injuries" into

four groups: fatigue (stress) fractures, muscle strains, ligament
sprains and tendinitis. Shin splints were mentioned exclusive of
these categories which apparently indicated their belief that this

condition is of a completely different nature.

Tenosynovitis. Inflammation of a tendon sheath, or teno-

 

synovitis, is manifested by pain over the involved tendons which
becomes severe on movement. There is localized swelling. A special
form called crepitans is accompanied by a crackling sound in the
soft tissue on movement.

Jagerink (35) reported the first case of tenosynovitis of the
tibialis anterior tendon in 1929. He suggested that this condition
could be expected to develop as a result of continued and prolonged
irritation in any tendon sheath in which the tendon bends or moves
in an angular direction.

Several studies (21,27) have shown that the tibialis anterior,
tibialis posterior, and extensor hallicus longus tendons are all
susceptible to tenosynovitis. According to Howard (21), it is a
condition which results from fatigue of a definite muscle group and
is not of infectious, rheumatoid or toxic origin.

While many theories have been offered in regard to its cause,

Paul and Soderberg (37) observed that strain, rather than rapidity

23
of movement seems to favor the development of this condition. In \
attempting to verify their theory that shin splints are primarily
tenosynovitis with occasional periostitis, muscle tears, and/or
microscopic hemorrhage, Paul and Soderberg cited several pieces of
symptomatic evidence. The most important symptom of shin splints
is the pain which occurs over the tendon. Pain is intensified by
movement and relieved by rest. Crepitus can at times be felt or
heard. Atrophy or foot drop, which would result if a nerve were
damaged, is seldom seen. No systemic symptoms are present and
there occasionally is a slight increase in skin temperature over
the involved area. Treatment of shin splints with rest and anti-
inflammatory drugs relieves the pain and swelling rather promptly.

This is the treatment used for patients with rheumatoid arthritis

in whom tenosynovitis of varying degrees is a common occurrence.

Current Status

 

In 1966, the American Medical Association (A.M.A.) brought a
measure of order to the longstanding confusion surrounding the
shin splint syndrome when, based on extensive canvassing of pro-
fessionals in athletic medicine and related fields, it published
the first restrictive definition of this condition. In its first
publication of the Standard Nomenclature of Athletic Injuries (43)
the A.M.A. defined shin splints as

"pain and discomfort in the leg from repetitive run-

ning on hard surfaces or forcible, excessive use of

foot flexors; diagnosis should be limited to musculo-

tendinous inflammations, excluding fracture or ischemic
disorder."

24

Slocum (39) pointed out that this authoritative step by the
A.M.A. eliminated the use of the term "shin splints" as a "catchall"
phrase and restricted its application "to a specific syndrome with
a distinct anatomic location and typical clinical course." Based
on the restricted A.M.A. definition, Slocum presented a detailed
clarification of the shin splint syndrome. The lesion must lie
within the plantar flexors of the foot (tibialis posticus, flexor
hallicus longus, flexor digitorum longus) or within the extensors
of the foot (tibialis anticus, extensor hallicus longus and extensor
digitorum longus). It must lie at the origin, belly or musculo-
tendinous junction of these muscles, for the diagnosis is restricted
to conditions lying within the shin (tibial) area. Distal tendinous
involvement is excluded on the basis of anatomical location since
most of the tendons and tendon sheaths of these muscles lie at or
below the ankle joint. There must be a history of aching pain of
varying intensity which comes on following repeated rhythmic and
repetitive exercises incurred while walking or running. Classic
signs of mild inflammation are usually present at the site of the
lesion: tenderness, mild swelling, slight rise in local skin
temperature, and pain on movement. Conditions resulting from direct
trauma or recognized disease entities are excluded.

The essential problem in the diagnosis of shin splints lies in
differentiating this condition from other non-traumatic condi.ions
causing pain in the lower leg due to overuse and overexertion (39).
In the early stages, the onset and symptoms of other conditions may
simulate those found in shin splints so closely that they are dis-

tinguished as separate entities only with great difficulty. Slocum

25
(39) included in this group stress fractures, acute anterior tibial
syndrome, primary arterial occlusion, acute peroneal compartment
syndrome, fascial hernias, tenosynovitis, acute sprains of the

distal tibiofibular ligament, and strains of the interosseous membrane.

Symptoms

While the basic symptoms of shin splints are generally recog-
nized, some variation has been observed in the location, intensity
and onset of pain as described by different authors.

O'Donoghue (34) suggested that tenderness along the postero-
medial angle of the tibia and pain on function of the posterior
tibial muscle was a specific indication of irritation of the attach-
ment of the posterior tibial muscle. In the case of involvement
of the interosseous membrane, he observed that the symptoms were
more posterior and seemed to be deeper in the muscles of the calf.
Slocum (39) reported similar symptoms elicited by injury to the
tibialis posterior and added that involvement of the tibialis
anterior is manifested in tenderness at its attachments to the
lateral border and crest of the tibia.

In cases of muscle tears or ruptures, Steindler (42) stated
that "the pain will be most intense when rupture occurs at the tendon
of origin or insertion, less if at the musculotendinous junction,
and least if in the muscle belly. A minor degree of hemorrhage or
edema may occur which may increase the intensity of the pain." An
unusual symptom was reported by Brown (5), who described rough
sand-like protrusions under the skin when running the fingers

down the shin bone.

26

Responding to a questionnaire by Drake (18), one trainer noted
that pain was not always noticeable when actually running hard, but
there was pain immediately on stopping. Another respondent reported
that pain was most noticeable on plantar or dorsiflexion of the foot.
In most cases, with proper and immediate treatment, the athlete with
shin splints is able to participate, although with some discomfort.
Slocum (39) observed, however, that if the symptoms are not
relieved, the intensity of pain increases to a point where running
capacity for distance and speed are so greatly diminished that the
sport must be discontinued.

Colson (9) noted that some athletes seem particularly susceptible
and predisposed to shin splints, suffering frequent recurrences
despite careful and progressive training. Dolan (16) also made
such a distinction in classifying two types of shin splints:

(a) preseason - a transient condition that usually occurs in the
first two weeks of the season, and (b) chronic - a condition that
never responds to treatment and from which the athlete never fully
recovers. In response to Paul's (37) questionnaire, one respondent
explained this variation in symptoms by suggesting that "the simple
shin splint is at one end of the spectrum and complete necrosis of
the anterior tibial muscle at the opposite end--representing dif-

ferent degrees of the same entity."

Precipitating or Contributing Factors
A wide diversity of opinion was found to exist with respect to
the cause of shin splints. Many authorities cite several possible

factors or a combination of factors. Most theories fall into one

27
of three categories: conditioning of the athlete, external factors,
and body structure and mechanics.

Slocum (39) stated that the type of strain which leads to shin
splints is

"most likely to occur in muscle which is underdeveloped,

untrained, weakened by fatigue, or when the tension

within the muscle rises rapidly to an abnormally high

peak as it does under the jarring strain encountered

when running on hard ground or pavement."

He noted further, that shin splints are more likely to appear if
there is improper warm-up, cold weather, uneven terrain, defective
running technique, skeletal malalignment, or activity involving
sudden direction changes or stop-and-go running. A change in foot-
wear or a sudden change to a hard playing surface also were suggested
by Slocum as possible precipitating factors.

Paul and Soderberg (37) observed that while shin splints com-
monly occur in track athletes, cross country and distance runners,
tennis players, and basketball players, it is rarely seen in football
players. They attributed this to the difference in footwear, noting
that most athletes commonly affected by shin splints wear flat shoes
with little or no heel while football players have cleats under both
the heel and sole. Paul and Soderberg reported a consensus of
opinion that shin splints would appear in football players as well
if they wore tennis shoes. They ruled out the differences in play-
ing surface as a factor noting that many practice football fields,
especially in high school, have clay surfaces.

Various explanations were offered by authors of training texts.

Litton (28) stated that shin splints occur "most frequently before

28
the athlete has become fully conditioned and usually are associated
with running on hard surfaces."

Colson (9) and O'Donoghue (34) also attributed shin splints to
continual pounding on a hard surface. Colson observed that cross
country runners were much less likely to contract shin splints than
sprinters because they run on grass.

According to Dolan (16), "most trainers look for a sprained or
weak longitudinal arch" in cases of shin splints. He also mentioned
tenseness in the lower back and structural defects such as uneven
length of the legs as possible contributing factors. Cerney (8)
stated categorically, "...in all cases of shin splints, a foot
problem is present concurrently."

Brown (5) listed three major causes: dropped arches, running
on the toes before being in condition, and running on hard surfaces.
In their discussion of running mechanics, James and Brubaker (22)
also blamed several factors for placing abnormal stresses on the
foot: limiting anatomical features (such as foot deformity), gait
which is not mechanically sound, certain types of shoes, and strenuous
or prolonged effort by poorly conditioned athletes.

Klafs (23) noted that shin splints usually result from strenuous
work on a hard surface or jumping activities. His theories included:
falling arches, faulty posture alignment, muscle fatigue, and over-
use stress. He also mentioned two theories not found elsewhere in
the literature: body chemical imbalance and lack of proper reciprocal
muscle coordination.

In his diagnosis of the syndrome, Craig (11) stated, "strain

and prolonged irritation rather than rapidity of movement result in

29
shin splints." He listed hard and unyielding surfaces, weakness and
lack of flexibility of the tibialis anterior and posterior, and
awkward running mechanics as contributing factors.
The survey by Paul and Soderberg (37) showed that most athletic
trainers were decidedly in support of underconditioned athletes and

running on hard surfaces as the two major factors.

Treatment

Despite the diversity of opinion with respect to the diagnosis
and cause of shin splints, the literature revealed consistent sup-
port for a program of rest and heat in treating the condition.
Strapping also is a common recomendation, although the techniques
suggested are as varied as the proposed causal factors.

O'Donoghue (34) noted that the syndrome involves many etiological
factors and, therefore, requires various types of treatment in
response. He recommended rest and local heat in all cases and
added that the length of initial rest is directly related to the
degree of recovery. When the athlete returns to work, careful
supervision should be provided to see that function is kept below
the level of pain.

Dolan (16) suggested the use of a hot whirlpool or analgesic
pack to stimulate circulation in the legs and lower back. Craig
(11) advised rest "to reduce strain and prevent swelling of
inflamed muscles." Brown (5) called for a program of rest, constant
heat, taping under the arches and strengthening. He also recom-
mended the application of heat 30 minutes before play. Liljedahl

(26) proposed that most overuse injuries are inflammatory conditions

30
and can be cured by heat and rest. Although pessimistic toward the
value of all types of treatment, Colson (9) observed that relief
often may be gained by the use of frictional massage which probably
relieves congestion.

Drake's (18) survey indicated that most trainers use moist heat
(such as packs and whirlpool) and recommend rest whenever possible.
Although an adequate rest period undoubtedly is the most effective
treatment, Drake observed that this method also results in a loss
to the athlete's level of conditioning. Most authors advise the use
of heat and strapping as a means of treatment while continuing the
athlete's training at a normal or modified level when rest is not
possible. Corrigan (10) observed that, in cases of minor injury,
the athlete may be able to continue in this manner ignoring the pain
for some time. However, in most cases the pain will eventually
become so great that the athlete cannot continue.

Drake (18) reported that many trainers find the pain of shin
splints to persist until a rest period is provided while others
feel the symptoms may disappear with continued exercise. It would
appear, as Drake observed, that the severity of the condition is of
major importance in determining the course of treatment.

Assorted strapping methods and padding were suggested by many
authors as a means of reducing strain on those muscles suspected as
the source of pain. Litton (28) stated "it has been demonstrated
that shin splints are relieved when the function of the gastrocnemius
and soleus is restricted by strapping at the lower end of the calf
muscle mass." Strapping reduces the effectiveness of muscle con-

traction and thus reduces the force required to oppose it.

31
Therefore, strapping of the lower calf results in less strain on the
tibialis anterior.

Slocum (39) viewed adequate rest and supportive strapping as the
most important factors in treatment and recommended physical therapy
measures to aid circulation and reduce swelling. According to Dolan
(16), the use of "high ankle strapping" is effective in supporting
a weak longitudinal arch which may be the cause of shin splint
symptoms. Morehouse (32) advised padding both heels and shins.

From his survey of athletic trainers, Drake (18) reported that eight
used arch taping, ten taped at the point of pain, and seven taped
the tibialis anterior against the tibia. Cerney (8) expressed
disapproval of the theory that strapping the shins will "squeeze"
together the tibia and fibula, thus easing the strain on the inter-
osseous membrane. He recommended strapping the feet with padding
under the arch and stressed keeping the legs wrapped during warm-up.
O'Donoghue (34), however, advised that padding under taping has
little effect on a condition that is due basically to overuse of
muscles. It is worthy of note that Devas (13) recommended a similar
program of rest and/or strapping in cases of stress fracture.

Slocum (39) discussed running mechanics and their relationship
to shin splints. He listed four factors to be considered in a
treatment program: gravity, ground reaction, kinetic force effected
by the forward moving body, and active muscle contraction. Following
heel strike, the anterior tibial group absorbs the initial shock and
is responsible for the smooth descent of the foot to the ground.

It is during this time that these muscles are placed under the

greatest tension and are likely to be strained. He observed that a

32
rubber heel pad would cushion the initial shock of weight bearing
and also would reduce the range of plantar flexion through which
the feet would pass.
Dolan (l6) cautioned that "under absolutely no conditions can
shin splints be 'run out'." This can result in development of scar
tissue and a form of bone growth. The calcified material is never

absorbed.

Prevention

 

Logically, the preventive techniques recommended for dealing
with shin splints vary according to the individual's concept of the
causes of the condition. Again, most theories fall into the cate-
gories of conditioning of the athlete, external factors, and body
structure and mechanics. The strapping techniques described for
treatment programs were recommended frequently as a preventive measure
to be used in early season with athletes who appear to be shin-
splint prone. These will not be repeated here.

Slocum (39) described a preventive program based on three
goals: attaining normal flexibility of the calf muscles and plantar
flexors through stretching exercises, correcting mechanical defects
in the gait, and use of proper coaching techniques. He also observed
that the "dynamic contractile overload which sometimes occurs as the
result of forceful plantar flexion is best prevented by muscle
strengthening exercises prior to participation." With respect to
external factors, he recommended providing cushioned running surfaces
when possible or a shock-absorbing shoe to eliminate the repeated
sharp impact on the anterior and posterior muscle groups caused by

hard surfaces.

33

Brown (S) urged that the athlete be given proper conditioning
before running on hard surfaces, especially strengthening of the
lower leg muscles. He also stressed the importance of immediate
treatment of any soreness in the shin area. Cerney (8) and Craig
(11) both recommended avoiding hard or unyielding surfaces. Craig's
suggestions also included the use of exercises to develop both
strength and flexibility of the anterior and posterior tibialis.
He considered awkward running mechanics to be a source of tension
which may be manifested in shin splints and advised that such
defects be corrected as a preventive measure.

Liljedahl (26) stressed an adequate warm-up in preventing the
development of inflammatory conditions. Static stretching was

specifically recommended by Klafs (23) as an effective preventative.

Running Mechanics

 

A review of the mechanics of the normal running gait was help-
ful in understanding the stress sustained by the musculature of the
lower leg and its possible effect on the development of shin splints.

There is general agreement that it is during the support phase
rather than the recovery phase of the running stride that the stress
occurs. James and Brubaker (22) divided this phase into three
periods. First is the "foot strike" which may occur in one of three
styles: (a) ball and toes (sprinter's style), (b) flat (heel and
toe together), or (a) heel then toe. The second period or "mid—
support" lasts until the heel begins to rise. The final period is
the "take-off" which includes the time between the rising of the

heel and the instant when the toes leave the ground.

34

Paul and Soderberg (37) clearly described the function of the
muscles involved. The tibialis anterior serves to lift the fore-
part of the foot, straighten out the inner side of the main arch
and turn the sole inward at the midtarsal joint. The tibialis
posterior causes inversion of the foot and assists in plantar
flexion. In the heel-then-toe running style, the tibialis anterior
serves as an antagonistic restraint to the plantar flexors and acts
to decelerate the dropping of the toes to the ground immediately
after the heel strike. Craig (11) observed that this action creates
a tremendous strain on the tibialis anterior muscle especially when
running on a hard surface or when the muscles are not in condition.
This period is followed by one of dorsi flexion during which
the calf muscles increase their tension in preparation for takeeoff.
At the point of take-off, the gastrocnemius-soleus group delivers
a powerful contraction which lifts the heel from the ground. The
common toe flexors and several accessory muscles assist in plantar
flexion.

Corrigan (10) cited the initial foot strike as the point of
abuse from which most overuse syndromes arise due to the sudden
check of forward momentum by the counter pressure of the ground.

He also noted that an unusual degree of pliometric dorsi flexion
of the ankle occurs just prior to takeoff placing great strain on
the inner arch of the foot.

Slocum (39) also indicated that during dorsi flexion the
plantar flexors may be stretched beyond their normal working range
of motion. This might be due to an unaccustomed degree of dorsi

flexion, a shortened achilles tendon, or a flat-footed or out-toeing

35
gait. When overstretched, the elastic and tendinous elements of
muscle are most likely to be involved (39). Thus, the musculo-
tendinous junction, the fascial envelopes within the muscle belly,
and the periosteal attachments of muscle to bone are all vulnerable.
He further noted the particular susceptibility of periosteal attach-

ments in the growing teenager and young adult.

CHAPTER III

RESEARCH METHODS

The purpose of this study was to determine the effects of a
selected preconditioning program and a padded running surface on

the development of shin splints in female side-horse vaulters.

Subjects

The subjects used in the study were female students at Everett
High School, Lansing, Michigan. They ranged in age from 15 to 18
years. All subjects were untrained with respect to the specific
factors involved in the study: physical conditioning of the lower
leg and vaulting techniques.

Four regularly scheduled physical education classes were used
for the study. Class sizes ranged from 19 to 32 students at the
beginning of the program and were considered adequate for the
successful completion of the investigation. Variations in current
levels of fitness and physical skill were assumed to be randomly
distributed throughout the comparison groups. It was recognized
that the imbalance in class size between the four groups was less
than ideal and that loss of subjects during the course of the study

could not be controlled.

36

37

Independent Variables

 

Selection of a specific preventive program was based on the
recommendations of coaches, trainers and physicians. A review of
literature yielded two highly regarded preventive measures: pre-
conditioning of the musculature of the lower leg and use of a

shock-absorbing running surface.

Preconditioning Treatment

 

The preconditioning treatment was designed to meet four
criteria: (a) to increase the flexibility of the foot plantar
flexors, (b) to increase the strength of the foot plantar flexors,
(c) to increase the functional endurance of the foot plantar flexors,
and (d) to be compatible with the classroom setting in terms of
time and equipment required. Three suitable exercises were
selected: (a) the wall lean for flexibility, (b) heel raisers for
strength and flexibility, and (c) speed runs for strength and

endurance (see Appendix).

Surface Treatment

 

A 60' x 6' x 2" continuous tumbling mat was chosen as a suitable
shock-absorbing running surface for the approach to the vaulting

board. The classroom floor was tile over concrete.

Assignment of Treatments

 

The four physical education classes were assigned randomly to
the four experimental treatments: (a) Group A - the control group
had no preconditioning and ran on the regular classroom floor;

(b) Group B - an experimental group had no preconditioning but ran

38
on the tumbling mat: (c) Group C - an experimental group received the
preconditioning treatment but ran on the regular classroom floor,
and (d) Group D - an experimental group received the preconditioning

treatment and ran on the tumbling mat.

Administration

 

The study was conducted during a regularly scheduled five-week
gymnastics unit with each class meeting for a standard 40-minute
physical education period five days per week. No indication was
given that an experimental study was in progress. All aspects of
the research program were personally administered by the investi—
gator in her normal capacity as the classroom instructor. Attention
was given to maintaining uniformity between groups in instruction
and in conducting the daily preconditioning exercises and vaulting
activities. All groups used a carpeted reuther board and a 10"
landing pad during the vaulting activities. The subjects partici-
pated in bare feet or stocking feet at all times.

All subjects were given basic group instruction in vaulting
techniques. The instructions covered the correct use of the reuther
board and methods of executing the basic squat vault in the bent
hip, horizontal, and layout positions. Individual instruction was
given as needed to correct errors in vaulting technique. No effort
was made to alter natural running techniques, although all subjects
were encouraged to increase the speed of their approach. Each sub-

ject vaulted five times daily.

39

Schedule of Treatments

 

The preconditioning treatment was administered to the appro-
priate groups during the first two weeks and was continued throughout
the study. Daily vaulting instruction was given during the last
three weeks with appropriate surface conditions maintained for each

group (see Table 1).

Table 1. Schedule of Treatments

 

 

lst week 2nd week 3rd week 4th week 5th week
Group VAULT VAULT VAULT
A Hard Surf. Hard Surf. Hard Surf.
Group VAULT VAULT VAULT
B Soft Surf. Soft Surf. Soft Surf.
Group Precond. Precond. Precond. Precond. Precond.
C VAULT VAULT VAULT

Hard Surf. Hard Surf. Hard Surf.

Group Precond. Precond. Precond. Precond. Precond.
D VAULT VAULT VAULT
Soft Surf. Soft Surf. Soft Surf.

 

Although each group met separately during the day, a uniform
time schedule was maintained in all cases. The first five minutes
of the period were devoted to a general warm-up. No exercises involv-
ing lower leg musculature were included. The warm-up period for
Groups C and D was extended an additional five minutes to accommodate
their special daily preconditioning exercises. All groups then were

given approximately 15 minutes of vaulting instruction (five

40
repetitions). A shock-absorbing running surface was used for
Groups B and D only. The remainder of the period was used for

additional classroom activities involving other types of apparatus-

Daily Records

 

Accurate attendance records were maintained on all subjects.
Absences from the preconditioning drills, the vaulting activity, or
both were noted. Subjects who voluntarily complained of shin sore-
ness prior to the conclusion of the study also were noted; however,
no special attention was given and they continued on their assigned

program.

Collection of Data

 

Identification of Positive Cases

At the conclusion of the five-week period, the subjects were
asked if they had experienced shin soreness at any time during the
unit. Each of these subjects then was interviewed privately. A
history and description of the symptoms was obtained and determina-
tion was made as to whether the pain was of a traumatic or non-
traumatic origin. All non-traumatic conditions were diagnosed as

shin splints.

Adjustments

 

Prior to the analysis of data, two categories of subjects were
eliminated from consideration:

1. One category included six varsity gymnasts who were in
training several months prior to the study and, therefore, already

were preconditioned or already had developed shin splints.

41

2. The second category included 13 subjects who were absent
more than 50% of the time during either the preconditioning or
vaulting portions of the study. It was felt that valid data could
not be obtained on these subjects.

The elimination of 19 subjects affected the final composition
of all four comparison groups since they had been randomly assigned
to treatments at the beginning of the study. The final sample con-
sisted of 90 girls with 23 in Group A, 28 in Group B, 13 in Group C,

and 26 in Group D.

Data Analysis

 

A 2 x 2 Chi-square contingency analysis was used to determine if
the incidence of shin splints was dependent upon the experimental

factors of preconditioning and running surface.

CHAPTER IV

RESEARCH RESULTS

The purpose of this study was to determine the effects of two
types of preventive measures on the development of shin soreness in
female high school side-horse vaulters. The experimental factors
were: (a) a selected program of preconditioning exercises, and
(b) a shock-absorbing running surface. The data were gathered during
a five-week high school gymnastics unit using an available sample of
109 female physical education students. The 2 x 2 Chi-square con-

tingency analysis was used to test for independence of variables.

Findings of the Study
The Chi-square analysis yielded values of x2 = 0.07 (N.S.) for
the effect of the preconditioning factor and x2 = 0.00 (N.S.) for

the surface effect (see Tables 2 and 3).

Table 2. Effect of Preconditioning Treatment on the Development of
Shin Splints

 

 

Not Precond. Preconditioned
(A s B) (C & D) Totals
Shin YES 9 6 15
Splints NO 42 33 75
Totals 51 39 90

 

42

43

Table 3. Effect of Surface Treatment on the Development of Shin

 

 

Splints
Concrete Mat
(A & C) (B & D) Totals
Shin YES 6 9 15
Splints NO 30 45 75
Totals 36 54 90

 

The results indicated that neither the preconditioning program
nor the use of a cushioned running surface had a significant effect

on the development of shin soreness in the subjects studied.

Discussion

 

Although the results of the study failed to support the two
theories most widely accepted by trainers, coaches, physical educators,
and physicians, it was felt that certain limitations of the study must
be carefully examined.

A major limitation involved the length of the study. The time
available for preconditioning of the subjects was limited to 10
sessions. It is possible that this period may have been insufficient
for effective preparation of the lower leg musculature. In addition,
the absences of a number of the retained subjects further reduced
the preconditioning effect. The records showed that of the subjects
in the preconditioned groups who developed shin splints, those whose
symptoms appeared during the first week of vaulting were absent at
least twice during the preconditioning period, while those whose

symptoms appeared during the final three days of the study had

44
participated in all preconditioning sessions. This would suggest
a possible delaying or preventive effect which might have been
shown to be more pronounced if the preconditioning period had been
extended.

Personal interviews with the subjects provided another inter—
esting observation. The exercises selected for the preconditioning
treatment (see Appendix) were focused on the posterior muscle groups.
However, the results showed that, in 50% of the preconditioned
subjects who developed shin splints, the symptoms indicated involve-
ment of the anterior tibialis. It would appear that a precondi-
tioning treatment designed for both muscle groups might have had a
greater preventive effect.

During the vaulting portion of the study, a variety of running
styles were noted among the subjects. Several authors have sup-
ported the belief that individuals with certain types of running
styles may be more prone to the development of shin splints than
others (10,11,22,39). Although no records were kept on this
aspect of the activity, it is quite possible that the factor of
running mechanics, which was not controlled in this study, may have

had an appreciable effect on the results.

CHAPTER V

SUMMARY AND CONCLUSIONS

The purpose of the study was to determine the effects of
selected preventive measures on the development of shin soreness
(shin splints) in female side-horse vaulters of high school age.

Two widely accepted preventive measures were chosen for the study:
(a) preconditioning of the lower leg musculature, and (b) use of

a shock—absorbing running surface. Three research hypotheses were
tested: (a) preconditioning exercises can be used to reduce the
incidence of shin soreness in inexperienced female side-horse
vaulters at the high school level; (b) a shock-absorbing surface
will reduce the incidence of shin soreness in ineXperienced female
side-horse vaulters at the high school level; and (c) the beneficial
effects of preconditioning exercises and a shock-absorbing surface
will be synergistic.

The study was conducted during a five-week high school gymnas-
tics unit using an available sample of 109 female physical education
students. Four regularly scheduled classes were randomly assigned
to four treatments: (a) Group A - the control group had no precon-
ditioning and ran on a concrete floor; (b) Group B - an experimental
group had no preconditioning but ran on a 60' tumbling mat; (c)
Group C - an experimental group received the preconditioning
treatment but ran on the concrete floor; and (d) Group D - an

45

46
experimental group received the preconditioning treatment and ran
on the tumbling mat.

Selected preconditioning exercises were administered to Groups
C and D during the first two weeks of the study while Groups A and
B received no preconditioning treatment. The vaulting activity was
administered daily to all four groups during the final three weeks
of the study. Groups B and D used the mat for their approach and
Groups A and C ran on the concrete floor.

Two groups of subjects were deleted from the study prior to
analysis of data: (a) six varsity gymnasts who were previously in
training and already had attained a significant level of condition-
ing, and (b) 13 subjects who were absent for more than 50% of the
preconditioning or vaulting sessions.

At the conclusion of the five-week period, those subjects who
had developed shin soreness were identified and interviewed. A
history and description of the symptoms were obtained from each.

A 2 x 2 Chi-square contingency analysis was used to test for
independence of variables. The results yielded nonsignificant
values for both experimental factors and failed to support the

research hypotheses.

Conclusions

 

l. The results of the study failed to support the hypothesis
that preconditioning exercises can be used to reduce the incidence
of shin soreness in inexperienced female side-horse vaulters at the

high school level.

47
2. The results of the study failed to support the hypothesis
that use of a shock-absorbing running surface will reduce the
incidence of shin soreness in inexperienced female side-horse

vaulters at the high school level.

Recommendations

 

1. More meaningful results might be obtained by extending the
length of the preconditioning period.

2. A longer study with an extended vaulting period might
reduce the effect of subject absence and allow for the appearance
of delayed cases of positive symptoms.

3. Numerous other preconditioning exercises could be explored
for their effectiveness as a preventive measure. Inclusion of
exercises focused on the anterior tibialis is suggested by this
study.

4. The observation of various running styles during this
study suggests a possible avenue for further investigation.

5. The similarity of many other extra-curricular activities
to vaulting suggests that some effort should be made to identify

subjects who are engaged in such activities at the time of the study.

APPENDIX

DESCRIPTION OF PRECONDITIONING EXERCISES

V

Wall Lean
Standing on tip-toe 3 to 5 feet from the wall, lean forward
placing both hands against the wall and lower heels slowly until a
stretching or pulling sensation is felt in the calf of the leg.

Hold this position for a count of 10. Repeat 3 times.

Heel Raisers

Folded accordion type mats were placed under the high balance
beam. Subjects stood with balls of the feet on the edge of the mat
and held on to the beam.for balance. Posterior portion of the foot
protruded beyond the edge of the mat and could be raised and lowered
without hindrance.

Begin on full tip-toe with straight legs. Gradually lower
heels to maximum ankle flexion taking 6 slow counts. Raise heels
gradually to full tip-toe position in 6 slow counts. Hold tip-toe

position for 6 slow counts. Repeat 3 times.

Speed Runs
This exercise was done on a 2” mat to minimize the possibility
of any causative effect on the development of shin soreness in the
subjects.
Run rapidly in place with a high knee lift, keeping on the
balls of the feet at all times. Run 15 seconds, rest 15 seconds,

run 15 seconds, rest 15 seconds, run 15 seconds.

48

49
Subjects were instructed to count the number of strides during

each repetition and were encouraged to improve their score each day.

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