Sasquatch... Yeti... Nessy... Champ... Overuse Injury...

"Have you ever seen a baby pigeon? Well, neither have I. I got a hunch they exist."

This quote is from one of my favorite movies growing up, Harry and the Hendersons. Harry is a Sasquatch, and like Harry, his cousin the Yeti, their aquatic cryptozoological breathern the Lock Ness Monster and Champ of Lake Champliagn fame, the overuse injury seems to be something often seen yet never captured and the evidence is always somewhat dubious. Though I may not have captured one of these mythical creatures, I have some evidence to offer up as to their actual existence. However, like all good evidence, mine too deserves scrutiny.

Patient Information:

14yo female first year cross country runner. Sport background as a downhill ski racer with a muscular athletic build. Finding success in her new sport in a low mileage/low intensity program.

Chief complaint of bilateral shin pain, right greater than left.

Presentation: Insidious onset bilateral shin pain that has worsened over the course of the season that increases with impact and weight bearing activity. Bilateral passive and active range of motion is within normal limits. Negative navicular drop bilaterally. Turning fork produced pain point specific on the right media tibia mid-shaft. Tender points along the medial tibial border bilaterally with right greater than left.

FMS Score - 19 with a 3/2 Asymmetry in Rotatory Trunk Stability

SFMA Remarkable Findings: Cervical Flexion joint mobility dysfunction/tissue extensibility dysfunction.

Potential stress reaction / fracture of the right tibia secondary to bilateral medial tibial stress syndrome.

Given this information it appears difficult to find a regionally interdependent cause for her pain or a biomechanical mechanism of injury. Calling this an overuse injury still seems like a misnomer. I have thought about the term under-use injury, as this young lady has a history of down hill ski racing, a sport where the foot and ankle are asked to do little more than provide a connection to the skis. She has only recently begun distance running training placing a great deal of unaccustomed stress on her feet, ankles, and lower legs. Perhaps we might call this a transitional use athletic injury?