The study of relationship between Shin splints and Anemia
Abstract
Purpose: Some researchers have reported that there is a relationship between
ischemia and shin splints and also anemia is one of the causes of ischemia.
Therefore maybe there is a relationship between anemia and shin splints too. The
purpose of the current study was to determine the relationship between shin splints
and anemia among people who suffers from shin splints.
Method: 18 girls with shin splints (who had pain in the middle or distal part of their
lower leg during or after activity) as experimental group and 23 girls without pain
(comparable as to age and BMI), as control group, were chosen. Both groups were
non-athletic girls, who took part in physical fitness program within 4 months. The
blood tests of experimental group were compared with control group. Red blood cell
count (normal range: 4.2-5.9 million/ cmm), hematocrit (normal range: 34.7- 44.7%),
and hemoglobin (normal range: 12.1- 15.1 g/dl) that are relevant to the diagnosis of
anemia, were measured in two groups.
Results: Of the 18 subjects with shin splints, 6 (33%) met anemia while 12(66%)
didn’t have any problems. 25% of control group had anemia too (P<0.05). No
significant differences in the red blood cell count (P<0.05), hematocrit (P<0.05) and
the hemoglobin (P<0.05) were found between shin splints group and without shin
splints group.
Conclusion: These results indicated that there is no relationship between anemia
and shin splints.
Submitted by: Khoshraftar Nahid, Ph.D student of Sport medicine - Bielefeld
University
Prof .Dr. Med. Elke Zimmermann
nkhoshraftar_yazdi@uni-bielefeld.de
Uni. Bielefeld Sportmedizin
Nahid Khoshraftar
1
Universitätsstr.25
33615 Bielefeld
----------------------------------------------------------------------------------------------------------------Introduction
Shin splints are the most common cause of disabling leg pain in young
competitive athletes.1 Shin splints, anterior tibial pain syndrome, medial tibial
syndrome, and chronic compartment syndrome have all been used to describe the
symptoms of exertional lower leg pain. 2’3’4
Although runners are most commonly afflicted, with one study reporting a 13%
incidence, individuals involved in jumping activities may also develop this disorder.
These athletes complain the exercise induced pain along the posteriormedial border
of the tibia.³
Women had high rates of injury than men. 5
The American Medial association defined shin splints syndrome is pain and
discomfort in the leg from repetitive activity on hard surfaces, or due to forceful,
excessive use of foot flexors.¹
The cause of shin splints has also been a source of disagreement among
clinicians. some of causes include: abnormal biomechanics of the lower limb6, Jenu
valgum7, errors in running form, leading too far forward or backward, running to high
on the toes or hitting too hard on the heels, over striding swaying from side to side,
running too tense, inadequate rest time between applied forces8’9’10. Over pronation
11,
periostitits, ischemia within a closed facial compartment12 and ischemia caused
bone remodeling.13
When a bone is loaded to normal physiologic levels, the small blood vessels that
supply the cortex are squeezed.14 In most cases, this pressure is necessary for
proper movement of the blood.15 When the load is higher, the blood flow may be
temporarily cut off. The result is a brief period of ischemia in the cells that would
normally be perfused by the compressed medullar vessels. Repeated loads over a
prolonged period of an activity, such as a long run, cut off the oxygen during that
period as well.
16’¹⁵This
ischemia, in turn, facilitates bone remodeling and subsequent
bone weakness and stress fracture.
14
In fact, Kelly and Bronk17 found that restricting
venous flow without any mechanical loading was enough to stimulate bone
2
remodeling. In the above scenario, blood flow and oxygen perfusion are both
restricted. The result is a weakened bone that is less able to withstand subsequent
loads.
In regard to the relationship between shin splints and ischemia ²’⁴’³’¹¹’¹³’18,.and also
positive relation between anemia either ischemia or bone strength and mass, 19’20’21 it
maybe speculated that anemia causes shin splints too. Purpose of this paper is,
studying of relationship between shin splint and anemia.
Method
Participants were included if they exhibited signs and symptoms of shin splints with
no evidence of any other specific injury condition. The diagnosis of shin splints was
made on the basis of the clinical presentation. The inclusion criteria were (1) anterior
and medial lower leg pain during running and jumping/ hopping activities, (2)
insidious onset of symptoms unrelated to a traumatic incident and it related to
training, (3) pain appears at the beginning of the activity and diminishes or
disappears with taking rest.
18 girls suffering shin splints, assigned as an experimental group, were selected
among non-athletic girl students with age 18-30 years who took part in physical
fitness regularly program within 4 months. This program was done 2 times per week
and 1 hour per session. Also, 23 girls without shin splints comparable as age and
BMI (18.5-25) were considered as control group.
All subjects were given informed consent letter to participate in this study. Venous
blood samples were collected from a forearm vein with the subjects in their sitting
position. Individual blood test was done to consider Anemia. A
Coulter counter was used for determination of red blood cell count (RBC), hematocrit
(HCT) and hemoglobin concentration (HGB). A positive diagnosis of Anemia in
female required: RBC less than 4.2-5.9 million/ cmm, HCT less than 34.7-44.7% and
the HGB less than 12.1- 15.1 g/dl.
Statistical analysis: All values are reported as means ± SD. The paired student’s t
test was used to evaluate the differences of variables. All tests of significance were
two-tailed and significance was defined at P<0.05.
3
Results
After laboratory examination on the blood samples and their analysis, information
was obtained about blood factors which were relevant to the diagnosis of anemia.
Red Blood cell (RBC)
Red blood cell count was less than 4.2 million/ cmm in 2 (11%) patients with shin
splints and 2 (8%) subjects without shin splint
(P<0.05). Red blood cell count was found as normal in 16(89%) of experimental
group and 21(92%) of control group. (As shown in fig.1)
Fig.1- The relationship between shin splints and RBC
count
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
no
t
pli n
wit
s
hin
hs
no
les
s
t
plin
s
n
shi
rm
a
l ra
ng
th a
e
n4
.2 m
illi o
n
/cm
m
w ith shin splint
no shin splint
less than 4.2 million/cmm
11%
8%
normal range
89%
92%
Hematocrit (HCT)
Hematocrit of 3(17%) patients with shin splints and 3(12%) subjects without shin
splints was less than 34.7% (P<0.05). However, HCT of 15(83%) patients and
4
20(88%) subjects was normal range. (As shown in fig.2)
Fig.2-The relationship between shin splints and HCT
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
wit
h in
hs
int
s pl
No
p
ns
s hi
les
lin t
s th
nor
ma
l ra
nge
an
34.
7%
w ith shin splint
No shin splint
less than 34.7%
17%
12%
normal range
83%
88%
Hemoglobin (HGB)
HGB was less than 12.1 g/dl in 2(11%) of test group and 2(8%) of control group
(P<0.05). 16(89%) patients and 21(92%) subjects had normal range of HGB. (as
shown in fig.3)
Fig.3- The relationship between shin splints and HGB
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
h
wit
no
les
s
t
pli n
ns
i
h
s
n
hin
os
int
spl
w ith shin splint
less than 12.1g/dl
11%
normal range
89%
rm
a
l ra
th a
n1
ng
e
2 .1
g /d
l
no shin splint
5
8%
92%
Regarding to these results, 6(33%) subjects with shin splints and 6(25%) subjects
without shin splinst had anemia. However, 12(67%) patients and 18(75%) health
people didn’t meet anemia. (P<0.05)
As shown in fig.4
Fig.4-The relationship between shin splints and anemia
80%
70%
60%
50%
40%
30%
20%
10%
0%
wi
No
a
s
h in
th s
wit
h
t
plin
No
p lin
ns
i
h
s
t
nem
ia
ane
mia
w ith shin splint
No shin splint
w ith anemia
33%
25%
No anemia
67%
75%
Discussion
Recent studies ²’³’⁴’¹³’¹⁸ have shown that ischemia plays a significant role in the
pathophysiology of shin splints.
Romani ¹³ reported ischemia facilitates bone
remodeling and subsequent bone weakness and stress fracture. Johnell
22
believes
morphologic bone changes are the basis for shin splints and attribute the pain to
stress microfractures. Several authors ¹⁹’²⁰’²¹ have indicated that anemia is one of
causes of ischemia.
The current study has been investigated the hematological differences between
patients (with shin splints) and control subjects (without shin splints). In attend to role
of blood flow and importance of oxygen transport to tissue within activity; we have
6
examined the blood samples and measured RBC count, percent of HCT and HGB
content as screening tools of anemia 23’24 in both above mentioned groups.
No significant difference, as to RBC count and HGB concentration and HCT was
found between two groups.
The results of this study indicated that the cause of ischemia in shin splints group is
not anemia and it is considered that maybe other factors affect on ischemia.
In addition, any relationship between shin splint and anemia
has not been found . Although Schon reported one of different conditions that may
affect on leg pain, is anemia which is caused by hemoglobinopathies. 25’26
Conclusion
In regard to either relationship between shin splints and ischemia or anemia and
ischemia, number of red blood cell, the hemoglobin level and hematocrit value were
measured in shin splints group and control group. These measurements were done
for diagnosis of anemia. There was no relationship between shin splints and anemia.
Therefore ischemic pain of shin splints group can be caused by other factors.
7
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