Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Shin Splints


Related Terms

  • Anterior Shin Splints
  • Medial Tibial Periostalgia
  • Medial Tibial Stress Syndrome
  • Periostitis
  • Posterior Tibial Shin Splints

Differential Diagnosis

  • Bone tumors (sarcoma or osteosarcoma)
  • Bursitis at the knee (pes anserine bursitis)
  • Compartment syndrome
  • Deep venous thrombosis
  • Hematoma
  • Lumbar radiculopathy
  • Muscle strain
  • Spinal stenosis
  • Tendinitis
  • Tibial contusion
  • Tibial stress fracture

Specialists

  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Physical Therapist
  • Sports Medicine Physician

Comorbid Conditions

  • Bowlegs (genu varum)
  • Club foot or reel foot (pes cavus)
  • External rotation of the hips
  • Flat foot (pes planus)
  • Knock knees (genu valgum)
  • Leg length inequality
  • Obesity

Factors Influencing Duration

Factors that may influence disability include obesity, the individual's age, response to treatment, severity of symptoms, length of time symptoms have been present, and amount of running, walking, or stair climbing required by the individual's occupation.

Medical Codes

ICD-9-CM:
844.9 - Sprains and Strains of Knee and Leg, Unspecified Site; Knee NOS; Leg NOS

Overview

© Reed Group
The term "shin splints" is commonly used for exercise-induced pain in the muscles along the large shin bone (tibia) in the front (anterior) part of the lower leg. Excessive demand on the tibia and the connective tissues (tendons) that attach muscle to the bone leads to inflammation and pain. Medial tibial stress syndrome is a term for a spectrum of stress reactions within the tibia that can include tibial stress fractures. Usually, small but widespread tears from stress training (musculotendinous microtrauma) and inflammation are centered over the inside edge of the tibia (medial tibia) along one site of attachment (origin) of the soleus muscle. The broad fibrous attachment of the soleus muscle to the tibia tendon becomes inflamed from repetitive pulling (microtrauma), most often when there has been a significant increase in activity or sudden stress on the muscle. The posterior tibialis muscle origin may also be affected, resulting in medial tibial pain and inflammation. Less commonly, the term "shin splints" may also refer to inflammation at the lateral tibial musculature (anterior tibialis and peroneal muscles) used to lift the foot (dorsiflexors).

Problems with posture or foot alignment, muscle fatigue, and tight Achilles tendons may lead to development of shin splints. Muscle imbalances, poor conditioning, inadequate warm-up, insufficient shock absorption, running on the toes, and walking or running on the inside edge of the foot (pronation) rather than the whole foot may contribute to shin splints. Individuals with increased foot pronation or with an increased angle (Q or quadriceps angle) at which the upper leg bone (femur) meets the lower leg bone (tibia) at the knee are at higher risk for shin splints.

Incidence and Prevalence: Shin splints represent 6% to 16% of all running injuries and up to 50% of all overuse injuries of the lower leg (Craig).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Shin splints are most common in individuals who participate in high impact activities that involve jumping, walking on hard surfaces, hill walking, and running (e.g., basketball, dancing, racket sports, gymnastics). Wearing worn or improper shoes, abruptly starting and stopping while running, and rapidly increasing running speed can also bring on shin splints. Although shin splints primarily affect athletes, any individual exposed to working conditions that involve extensive walking on hard surfaces is at risk (e.g., military personnel).

Women more likely than men to have an increased Q angle and thus are at higher risk of developing shin splints from this cause.

Source: Medical Disability Advisor



Diagnosis

History: A thorough history includes history of previous injuries (particularly stress fractures), current and past medications, dietary habits, history of eating disorders, menstrual history for women, type of surfaces individual walks or runs on, footwear, and training methods for athletes. Individuals with shin splints complain of pain that starts with activity and then may disappear with exertion, only to reappear at the end of a workout or when at rest. Pain commonly occurs in both legs (bilateral). The pain may be described as aching or soreness initially but can escalate to severe stabbing pain over time. At this point, the pain may continue throughout activity and even force the individual to stop the task. Eventually, the pain may be constant and not dependent on activity.

Physical exam: Manual examination (palpation) of the inside edge of the tibia reveals pain in the middle third and lower third (distal third) of the lower leg. Some swelling may be present. Passive and active ankle motion is not painful, but pushing against the examiner's hand with the foot (resisted motion) may replicate the pain. The feet, knees, and hips should be carefully examined for proper alignment. Exam may reveal flat feet (pes planus), bowlegs (genu varus), external rotation of the hip(s), or leg-length discrepancy. The shoes may show wear patterns consistent with excessive pronation.

Tests: Plain x-ray films of the tibias of individuals with shin splints usually are normal, but x-ray images are useful in ruling out more ominous conditions such as bone tumors. A bone scan may reveal areas of increased bone formation resulting from the overload placed on this particular region and can help differentiate shin splints from stress fractures. MRI may be able to differentiate between shin splints and stress fractures in the early stages of injury. MRI of the lumbar spine may also be used to rule out lumbar stenosis or lumbar radiculopathy.

Source: Medical Disability Advisor



Treatment

The fundamental principle in treatment of stress-induced injuries such as shin splints is to stop the activity that produces symptoms. Rest of the affected muscles should continue until the individual is able to walk without pain. Use of crutches, a cast to immobilize the foot and ankle, or a walking boot may be necessary, especially for individuals with a tibial stress fracture. Ice massage is a simple but highly effective treatment. Other pain control and treatment measures may include nonsteroidal anti-inflammatory medications (NSAIDs), massage, whirlpool baths, ion therapy (iontophoresis), ultrasound, and ultrasound enhanced delivery of topical medications (phonophoresis).

Although taping procedures are useful in alleviating shin pain, they should not be used as a way to continue or resume running or other activities too soon. Other preventive measures include use of proper footwear, running or walking on softer surfaces, and increasing mileage and other training goals gradually.

Orthotic devices prescribed by a podiatrist or other healthcare professional, including arch supports or heel lifts, can reduce the amount of flat foot (pronation) that places stress on the shin region. By supporting the foot in a better position, orthotics can help prevent recurrence.

Surgical intervention may be indicated in rare cases in which the shin splints have recurred at least 2 to 3 times or when symptoms continue more than 6 months after adequate trials of rest and rehabilitation. Although shin splints are not a compartment syndrome, releasing the band (fascia) around the area of attachment of the soleus to the tibia may help to relieve symptoms (fascial release, fasciotomy). An additional technique splits the soleus at its insertion. This redirects the forces at this point, decreasing the tendency for tears (avulsions).

Source: Medical Disability Advisor



Prognosis

Most individuals recover fully from shin splints with early, appropriate treatment and use of measures to prevent recurrence. Prevention should also include modification of factors that led to development of shin splints, such as avoiding hard surfaces or changing footwear. A thorough understanding of causation is important to prevent recurrence. Recurrence is likely if the inciting activity is resumed too early during the course of rehabilitation or if there is no reduction in activity to 50% of pre-injury levels.

Although rare, disability may be permanent in individuals who do not respond to nonsurgical (conservative) treatment and are not candidates for surgical intervention because of bleeding disorders, peripheral vascular disease, or other conditions.

Source: Medical Disability Advisor



Rehabilitation

The primary focus of rehabilitation for shin splints is to control pain and restore function. An attempt should be made to identify and modify the activity that may have led to the current symptoms (Wilder; Yeung). Stretching ankle plantar flexor and dorsiflexor muscles may be useful. Non-weight bearing activities should be substituted until the individual is pain free for 7 to 10 days (Kliegman). Proper shoes and/or orthotics may be beneficial during weight bearing activities (Kliegman), and shock-absorbing insoles may be indicated. A few sessions of physical therapy should be sufficient to manage most shin splints.

Modalities such as heat and cold can be used if needed to control pain, and localized ice massage may be helpful (Stretanski). Temporary use of an assistive device, such as a cane or crutch, may be recommended to normalize gait. Individuals should be instructed in general stretching and strengthening exercises of the affected limb. Eccentric strengthening exercises may also be helpful (Stretanski). Educating the individual in prevention strategies is a critical component of rehabilitation. A home exercise program may be necessary to complement supervised rehabilitation and can be continued independently.

Additional information may provide insight into the rehabilitation needs of these individuals (Pell).

FREQUENCY OF REHABILITATION VISITS
Nonsurgical
SpecialistShin Splints
Physical TherapistUp to 6 visits within 3 weeks
The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice.

Source: Medical Disability Advisor



Complications

Pain from shin splints may force the individual to walk on the outside of the foot, placing additional stress on other muscles and tendons. Abnormal walking patterns (gait) can lead to back strain. Changes in posture or gait can also cause inflammation and arthritic changes in nearby joints (e.g., back, hip, knee, ankle). Untreated shin splints and uncorrected biomechanical malalignments in the legs and feet may result in stress fractures and even true fractures, potentially endangering normal function in affected legs.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Return to previous activity level should be gradual, individualized, and based on the individual’s response to increasing levels of activity. In general, the individual recovering from shin splints should avoid repetitive stair climbing, running, hill walking, and excessive walking on hard or extremely soft surfaces. In severe cases, the amount of time standing may need to be restricted or alternated with periods of sitting. Use of crutches and/or a cast may limit mobility and dexterity. Proper footwear suitable to the work or recreational activity in question will help prevent recurrent injury. Use of shock absorbing insoles and other appropriate orthotics may prove helpful.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Did individual complain of pain in the shin area?
  • Did pain begin as aching or soreness and escalate to severe, stabbing pain?
  • Was pain continuous during activity and at rest?
  • Have imaging scans been done to evaluate for stress fracture?
  • Has diagnosis of shin splints been confirmed?
  • Have x-rays been taken of the hip, knee, lower leg, or ankle?
  • Have contributing factors such as muscle imbalances, poor conditioning, use of improper shoes, or running on hard surfaces been identified?

Regarding treatment:

  • Have conservative treatments such as rest, analgesics, and ice been effective in relieving symptoms?
  • Would individual benefit from massage therapy or whirlpool baths?
  • Would individual benefit from physical therapy (deep heat, ultrasound, electrical stimulation, and a good stretching program)?
  • Would individual benefit from consultation with a podiatrist?
  • Would individual benefit from the use of orthotics?
  • Is individual a candidate for surgical intervention?

Regarding prognosis:

  • Has recovery required more than 2 months?
  • Does individual have underlying conditions such as obesity, fallen arches, flat feet, club feet, bowed legs, knock knees, external rotation of the hips, or leg length inequality that could influence recovery from shin splints?
  • Is individual realistic about the time needed for a full recovery?
  • Has individual made appropriate modifications in activity, footwear, and physical conditions?
  • Has individual tried to resume activities too soon?
  • Is intensity of resumed activity too great?

Source: Medical Disability Advisor



References

Cited

Craig, Debbie I. "Medial Tibial Stress Syndrome: Evidence-based Prevention." Journal of Athletic Training 43 3 (2008): 316-318.

Kliegman, Robert M., et al., eds. "Lower Leg Pain: Shin Splints, Stress Fractures and Chronic Compartament Syndrome." Nelson Textbook of Pediatrics. 18 ed. Saunders, Elsevier, 2007. 686-687.

Pell, R. F. , H. S. Khanuja, and G. R. Cooley. "Leg pain in the running athlete." Journal American Academy Orthopedic Surgery 12 4th (2004): 396-404.

Yeung, E. W., S. S. Yeung, and L. D. Gillespie. "Interventions for Preventing Lower Limb Soft-Tissue Injuries in Runners: Update." Cochrane Database of Systematic Reviews 7 (2011): CD001256.

General

Coutre, Christopher J., and Kristine A. Karlson. "Tibial Stress Injuries." Physician and Sportsmedicine 30 6 (2002):

Mayo Clinic Staff. "Shin Splints." MayoClinic.com. 29 Dec. 2006. Mayo Foundation for Medical Education and Research. 26 Dec. 2008 <http://www.mayoclinic.com/health/shin-splints/DS00271>.

Stretanski, Michael F. "Chapter 69 - Shin Splints." Essentials of Physical Medicine and Rehabilitation. Eds. Walter R. Frontera, Julie K. Silver, and Thomas Rizzo. 2nd ed. Philadelphia: Saunders, Elsevier, 2008.

Source: Medical Disability Advisor






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