Izraz trkačka potkoljenica se odnosi na nespecifičnu bol do koje dolazi u donjem dijelu nogu prilikom trčanja.
Ponavljajuće udarne sile prilikom trčanja ili brzog hodanja (npr. planinarenje) mogu preopteretiti muskulotetivni aparat te uzrokovati bol u potkoljenici. Takva bol ponekad nastaje zbog specifične ozljede (npr. stresni prijelom tibije, vježbom uzrokovan kompartment sindrom, tibijalni periostitis, pretjerane pronacije stopala), ali često se ne može utvrditi točan razlog. U takvim slučajevima koristi se izraz trkačka potkoljenica.
Simptomi i znakovi
Simptomi i znakovi trkačke potkoljenice
Bol uslijed trkačke potkoljenice se može pojaviti s prednje ili stražnje strane potkoljenice, a tipično započinje na početku trčanja, ali tijekom trčanja slabi. Bol koja traje i tijekom odmora ukazuje na drugi uzrok, poput stresnog prijeloma tibije.
Dijagnoza
Dijagnoza trkačke potkoljenice
U mišićima se prednjeg odjeljka prilikom pregleda obično pronalazi nekoliko jako bolnih točaka, ponekad s opipljivim koštanim bolovima.
Rezultati rendgenskog snimanja obično su bez osobitosti, bez obzira na uzrok. Ako se sumnja na stresni prijelom, može biti potrebno skeniranje kostiju.
Vježbom uzrokovan kompartment sindrom se dijagnosticira posebnim manometrom kako bi se dokazalo povećanje tlaka unutar odjeljka za vrijeme vježbanja.
Liječenje
Liječenje trkačke potkoljenice
S trčanjem treba prekinuti sve dok se bol više ne osjeća. Rano je liječenje pomoću leda, NSAID-a i istezanja prednjih i stražnjih mišića potkoljenice. Za vrijeme oporavka, smanjenje kondicije se mora svesti na najmanju moguću mjeru potičući sportaša da se bavi aktivnostima koje ne zahtijevaju ponavljajuće aktivnosti pod opterećenjem, kao što je plivanje.
Kad se simptomi povuku, savjetuje se postupni povratak trčanju. Nošenje potporne obuće s krutim držačem pete i podupiračem svoda stopala pomaže pri podupiranju stopala i skočnog zgloba prilikom trčanja te može pripomoći pri oporavku i spriječiti daljnje simptome. Pomoći također može i izbjegavanje trčanja na tvrdoj podlozi (npr. betonu). Vježbanje prednje strane potkoljenice dorzifleksijom skočnog zgloba uz otpor (npr. gumenu traku ili na spravi za dorzifleksiju) pojačava snagu muskulature noge i može prevenirati bol u potkoljenici.
Vježbe za ublažavanje boli u potkoljeniciHeel Raises
1. Stand with both feet on step with heels off edge of step. Hold on for support.
2. Raise up on ball of feet.
3. Focus on slowly lowering heels to below the height of the step.
4. Return to starting position and repeat.
5. Perform 3 sets of 10 repetitions, 1 time a day.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Toe Walking
1. Stand on balls of feet with heels off the floor.
2. Walk on balls of feet while keeping knees straight.
3. Walk as far as able during given time frame, stop at point of fatigue.
4. Perform 3 sets of 1 minute, 1 time a day.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Heel Walking
1. Stand on heels with balls of feet off the floor.
2. Walk on heels while keeping knees straight.
3. Walk as far as able during given time frame, stop at point of fatigue.
4. Perform 3 sets of 1 minute, 1 time a day.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Standing Soleus Stretch
1. Stand facing or next to wall with hands on the wall for support.
2. Place uninvolved leg forward.
3. Keep heels on the floor and slowly bend both knees to feel stretch along the calf of the rear leg.
4. Hold exercise for 30 sec.
5. Perform 1 set of 4 repetitions, 3 times a day.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Standing Gastrocnemius Stretch
1. Stand facing or next to wall with hands on the wall for support.
2. Place uninvolved leg forward.
3. Keep rear leg straight with knees and toes pointing toward the wall, keep rear heel on the floor.
4. Bend knee on uninvolved leg and lean hips toward the wall to feel a stretch along the calf of the rear leg.
5. Hold exercise for 30 sec.
6. Perform 1 set of 4 repetitions, 3 times a day.
(It is important to maintain a straight back posture with the heel firmly planted [not lifted] during the stretch.)
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Sitting Ankle Plantarflexion Stretch
1. Sit in chair.
2. Bend knee on involved side to place top of involved foot down toward the floor with toes pointing down.
3. Slowly sit forward in the chair and push foot into plantarflexion until a stretch is felt over the top of the foot and ankle.
4. Hold exercise for 30 sec.
5. Perform 1 set of 4 repetitions, 3 times a day.
6. Special Instructions
a. Perform plantarflexion stretching while either sitting or standing, whichever is most comfortable.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.
Standing Ankle Plantarflexion Stretch
1. Stand facing or next to wall with hands on the wall.
2. Bend knee on involved side to place top of involved foot down toward the floor with toes pointing down.
3. Bend knee on uninvolved side and slowly lower body until stretch is felt over the top of the foot and ankle.
4. Hold exercise for 30 sec.
5. Perform 1 set of 4 repetitions, 3 times a day.
6. Special Instructions
a. Perform plantarflexion stretching while either sitting or standing, whichever is most comfortable.
Courtesy of Tomah Memorial Hospital, Department of Physical Therapy, Tomah, WI; Elizabeth C.K. Bender, MSPT, ATC, CSCS; and Whitney Gnewikow, DPT, ATC.