Red Alert for Your Legs! Tibial Periostitis in Runners and How to Combat It with Physiotherapy

Tibial periostitis, also known as “tennis elbow” of the leg, is one of the most common injuries affecting runners. It affects the periosteum, the membrane covering the tibia bone, causing localized pain in the inner area of the leg, generally just below the ankle. If you’re experiencing this pain, don’t worry, physiotherapy can be your best ally to recover and return to running without problems. In this article, we’ll explain what it is, how it’s diagnosed, and, most importantly, how to address it from a physiotherapy perspective.

What is Tibial Periostitis and Why Do Runners Suffer From It?

Tibial periostitis is not a bone injury itself, but an inflammation of the periosteum. Runners, especially those who increase the intensity or distance of their training too quickly, are particularly susceptible. The repetitive impact of the feet hitting the ground, combined with an inefficient stride (typically with excessive internal pronation), can exert excessive pressure on the periosteum, causing irritation and subsequent inflammation. Factors such as inadequate footwear, lack of muscle flexibility, and incorrect biomechanics also contribute to the problem.

Physiotherapy Diagnosis: Deciphering the Pain

As a physiotherapist, the first step is a thorough assessment. This includes a detailed medical history to understand your running habits, the onset of pain, and any aggravating factors. We will perform specific tests to evaluate the flexibility of the calf and ankle muscles, the strength of the foot muscles, and your biomechanics of your stride. We’ll use tools like the Ober test and the foot length test to identify potential imbalances. In many cases, a gait analysis with a gait analysis platform can be very helpful in determining if you have a pronated (excessive pronation of the foot) or supinated gait.

Physiotherapy Treatment: A Multidimensional Approach

Physiotherapy treatment focuses on reducing inflammation, relieving pain, and restoring function. Common strategies include:

• Relative Rest: Reduce the activity that aggravates the pain, but without completely stopping running.
• Ice: Apply ice to the affected area for 15-20 minutes several times a day to reduce inflammation.
• Stretching Exercises: Stretch the calf muscles (gastrocnemius and soleus) and ankle muscles to improve flexibility and reduce tension.
• Strengthening: Strengthen the foot muscles (flexors and extensors) and calf muscles to improve stability and impact absorption. Exercises like heel raises and leg cycling are very beneficial.
• Manual Therapy: Techniques of massage and joint mobilization to release muscle tension and improve mobility.
• Gait Correction: If gait is a contributing factor, orthotics can be used to correct pronation or supination.

Prevention: Don’t Wait to Feel the Pain!

Prevention is key to avoiding tibial periostitis. Make sure to gradually increase the intensity and distance of your runs, listen to your body, and rest when necessary. Invest in appropriate running shoes and consider performing strengthening and flexibility exercises regularly. Good running technique is also fundamental.

Conclusion

Tibial periostitis can be a frustrating obstacle for runners, but with an appropriate physiotherapy approach, recovery is possible. The key is to identify the underlying cause, implement an individualized treatment plan, and adopt safe training habits. Don’t hesitate to seek the help of a physiotherapist to guide you on your path to recovery and a return to the track.