Stress #

Sorry about my over-sized last post, trying to keep it short this time:)

I have a patient who presented an graduate onset of shin pain (1-2 cm superior to medial malliolus). He had supinated foot (lack of pronation). He started rugby training (5k running twice a week and games on the weekend) beginning of this year before when he hadnt done any sports for a year. 2 month later, he developed this shin splint, aggrovating factors are walking in the morning, hopping and lots of pain when he wakes up in the morning, soleus stretch (passive DF with knee bent) also aggrevates his pain. Isometric tests around the ankle were all negative. He has very short calf (AROM DF=5 degree). My previous 2 treatment with him hasnt been sucessful (US, STM on Calf and later glide on STJ to increase pronation) since his pain score in functional test stays the same (4-5/10 on hopping). He heel strike when hopping on the symptomatic side. I am thinking about stress # however, looking up in the Sports Med book, the spot (above med malliolus) isnt a popular site for stress #(and this is the reason that my supervisor doesnt think it should be a strees #). Tuning fork or US can provoke symptom if applied on the site of stress #. I remember I applied contiuous US at 1.0Wat/cm on his painful site, he felt fine...so now I dont think it is a stress #. But what do you guys think? how can I treat this guy? any thought will be appreciated!

Simon