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Laura by Mind Map: Laura

1. Key Info

1.1. 26

1.2. Runner

1.2.1. increased training load (distance)

1.2.1.1. decreased rest

1.2.1.1.1. pain on medial side of both shins

1.2.2. Goal

1.2.2.1. team triathlon

1.3. Intermittent knee and ankle problems in the past

1.3.1. resolved with rest

1.4. Works at law firm

1.5. Biopsychosocial

1.5.1. runner partner

1.5.2. goes out with friends often

1.5.3. lives with 2 friends

2. Further Info

2.1. Weight

2.2. Nature of previous injuries

2.2.1. Treatment & rehab

2.3. Hx

2.3.1. training

2.3.2. family

2.4. Nature of pain

2.5. Special knee questions

2.6. PHYSICAL

2.6.1. functional tests

2.6.2. palpation

2.6.3. biomechanics

2.6.3.1. gait

2.6.4. muscle length & strength

2.6.4.1. tone, bulk

2.6.5. ROM

2.6.6. swelling

3. History

3.1. Pain

3.1.1. Initially for 30 min after running

3.1.1.1. Now aches for ~1 hour after running

3.1.2. Limits running

3.1.3. Present when not running

3.1.4. Left shin worse

3.1.5. Mid to distal medial shin along edge of tibia

3.1.6. 24 hour

3.1.6.1. Morning pain: ~30 min

3.1.6.2. No night pain

3.2. HOPC

3.2.1. Hills + sprints - new to Laura

3.2.2. New shoes

3.2.3. runs 3x a week with group + extra by herself

3.2.4. Intermittent over winter

3.2.5. Runs on road

3.3. Past hx

3.3.1. left patellofemoral pain 2 years ago

3.3.2. short duration left ankle pain last year

3.3.3. Bilateral ankle sprains during adolescence

3.4. Medication

3.4.1. Contraceptive pill

3.4.2. Allergic to penicillin

4. Physical Exam

4.1. Observation

4.1.1. pronated feet

4.1.2. knee hyper E

4.1.3. slight swelling at pain site

4.1.4. medial deviation of knees

4.1.5. no shin or skin deformity

4.2. Palpation

4.2.1. tenderness along mid to distal medial border of tibia

4.2.1.1. left worse

4.2.2. calves stiff, particularly medially

4.2.2.1. left worse

4.3. AROM/PROM

4.3.1. No pain on L NWB ankle & knee movements

4.3.2. Tight tibial musculature on full plantar flexion of ankle

4.3.3. Some pain L medial tibia on repeated inversion (supination) resistance

4.3.4. Lunge to wall limited bilaterally: toe 2 cm from wall, with limit felt in muscle-tendon junction of calf

4.3.5. Full strength on resistance testing ankle

4.3.5.1. L = R

4.4. Joints

4.4.1. LS, ankle, knee NAD

4.5. Functional Assessment

4.5.1. onset of pain; immediately after running

4.5.2. residual pain following running for 30 min

4.5.3. L shin pain on 8 repeated calf raises and immediately with hopping and running

5. Learning Issues

5.1. 1. bone # spectrum

5.1.1. JAYDAN

5.1.2. healing

5.1.3. stress #s

5.2. 2. pathology of shin splints & tendoperiosteum + prognosis

5.2.1. ADAM

5.3. 3. impact of hyperextension, pronation, etc. on gait/running biomechanics and relation to pain

5.3.1. DERRICK

5.4. 4. differential diagnosis of leg pain

5.4.1. JEZ

5.5. 5. Rehab/Mx + running program

5.5.1. DIMMY

5.6. 6. intrinsic & extrinsic factors (e.g. surface, shoes, etc.) on shin pain

5.6.1. BRENDAN

5.7. 7. utility of imaging - types, are they necessary?

5.7.1. TAYLOR

6. Laura Part 2

6.1. Intrinsic/Extrinsic Factors

6.1.1. .

6.2. MTSS

6.3. Physical Exam

6.3.1. pronated feet