Armstrong Podiatry & Sports Health's Blog

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My perspective on “Shin Splints”

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Frustrating and painful

 

Recently, I have been seeing lots of blog articles about shin splints, which I believe have been rather generic in nature.  I would like to submit my thoughts about the subject, which are a little more unique in nature.

“Shin splints” is a common problem, affecting athletes of all ages.  The pain in the shins can be gradual in intensity and debilitating in nature.  It can be an injury that gets worse and could lead to a stress fracture.

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There’s the spot!

“Shin splints” is really a “catch-all” terms that refers to pain on the inside of the shin bone (tibia).  It really seems to be caused by tension of three muscles on the fascia of the bone.  This friction between the muscles and the fascia causes an inflammatory state (fasciitis), which can occur during walking or running.  If this inflammation continues, the bone could get involved, and you can get periositis (inflammation of the covering of the bone) and then potentially a stress reaction/fracture of the bone itself.

Like any overuse injury, the adage, “Doing too much, too soon”, certainly applies to “shin splints”.  The body that is unaccustomed to increased stress will breakdown. It is usually seen in overweight individuals who are beginning to run as exercise, especially on hard surfaces, i.e., sidewalks.  The pain appears when starting out for a run and gradually disappears, only to reappear after the run is complete.  The pain can usually be replicated by hopping on the affected side.

Individuals prone to this injury may have either a “flat foot” or “high arch foot”.  A “flat foot” already has  increased tension of two of the muscles involved in “shin splints”, in addition to increased internal (turning in) rotation of the legs. Running or walking places increased force on the feet, exacerbating the “flat foot” position, i.e., increasing the muscular tension and internal leg rotation.  A “high arch foot” places tension on the other muscle involved in “shin splints”, in addition to the commonly restricted ankle joint motion.  This type of foot is rigid and running/walking activity creates more forces, leading to more pressure on the foot and more muscular tension.

Treatment and prevention of this injury involves a multifaceted approach. The key is that the inflammation must be reduced and controlled. One way to do this is the usual ice, rest, compression and elevation; the other way is by reducing the tension of the affected muscles causing the inflammation. I usually do both of these and tailor the treatment plan according to the individual. To reduce the muscular tension, an insole or even an orthotic can be used to allow the affected muscles to “rest” for up to six to eight weeks. Activity modification is also emphasized, i.e., limited exercise-related weightbearing activity.

Ice is good!

Ice is good!

Individuals with “flat feet” can benefit from hip strengthening exercises, specifically hip abductor strengthening    (http://runninginjuryclinic.com/resources/exercise-videos/), short foot protocol (http://vimeo.com/43187129) and intrinsic foot exercises (http://www.youtube.com/watch?v=2OOJ9AQ1AEg).  Individuals with “high arch feet” benefit from hip strengthening exercises, specifically hip adductor strengthening and calf muscle stretching.  These exercises work to reduce tension on the affected muscles, by mobilizing and utilizing other ones.  Once inflammation control is achieved, a slow gradual return to activity from low stress, i.e., short job to high stress, i.e., hopping, jumping.

Of course, prevention is the key for “shin splints”.  It is important for beginner runners to follow a structured workout plan, conceived by a knowledgeable running coach.  Running on softer surfaces is also recommended, in addition to flatter surfaces.

As always, if you have any questions, please contact me.

Health and happiness!

March 10, 2014 Posted by | Fascia, Foot and ankle injuries, Overuse injuries, Running, Sportsmedicine | , , , , , | 1 Comment

NFL and Achilles tendon injuries

As an outsider looking in, I have noticed an inordinate number of Achilles tendon injuries at NFL camps (nine the last time I looked) this year.  As many try to explain them away as not related to the lockout, I would contend it is precisely due to the lockout that these injuries are occurring.

The Achilles tendon is the longest and thickest tendon in your body.  It is made up of two muscles, the gastrocnemius (which is more easily seen and referred to some as the “calf muscle” with its two heads) and the soleus muscle (which is deeper in the body and makes up most of the tendon).  They join together to form the Achilles tendon and occupies the bottom quarter of the leg. It inserts at the back of the heel bone (calcaneus).  This anatomy makes the tendon a powerful force during accelerations, sudden stops and sprinting activity.

Jumping to Achilles tendon readiness

Massaging the tendon after intense activity

 
 

Even though the Achilles tendon is not a muscle, studies have shown that it has contractile properties, so it should be treated as such.  Sensible, progressive training principles should be done to help strengthen the Achilles tendon and give it adequate viscoelasticity.  Typical training methods, such as resistance exercises, plyometric training and sprint training all provide strength to the tendon, and recovery activities, such as stretching and massage therapy, provide pliability to the tendon (so it will be useful for the next training session).  These methods such be put into place for months before full game day activity is attempted.

Struggling to get into game shape with limited training time is certainly a dilemma.  If someone asked me (and no one will!) how I would solve this, I would tell them to do less volume daily, but increase the restorative activities.  This will do two things, allow the athletes to do more intense work on a more regular basis, because they are recovered fully and also give the athletes a fitness base with the restorative activities such as circuit training or stationary biking.  Then, like any fitness program, slowly increase the volume of intense work as the weeks progress.  As a podiatrist, I would add two measures in regards to the Achilles tendon:  add in some eccentric heel drops, made famous by Alfredson;  and of course, to wear some shoes with no heel lift, i.e., Altra,  during the day (not during exercise) to provide increased Achilles tendon activity.

Always back to shoegear!

Hopefully all the players get into game shape and are able to play the beloved sport of football! Please contact me if you have any questions.

Health and happiness!

August 10, 2011 Posted by | Foot and ankle injuries, Resistance training | , , , , , | Leave a comment

Common foot and ankle injuries

I am planning to do several talks to local shoe stores to inform the staff about certain common foot and ankle injuries and how to approach them. Here is a handout of what I talk about:

PLANTAR FASCIOSIS
• Arguably the most common foot complaint
• When first seeing a podiatrist, it has progressed from fasciitis to fasciosis
• Fasciitis is an inflammatory condition of the fascia on the bottom of the foot
• Fasciosis is collagen degeneration with no inflammatory cells present
• Seen in all types of people, but common thread is usually a sudden increase in activity; pain after a period of rest that goes away after 5-10minutes and at the end of the day
• Treatment involves: rest, supportive shoegear in conjunction with therapy that causes an inflammatory response, i.e., aggressive stretching, self-massage, injection (cortisone/anesthesia mixture or just anesthesia)
• Orthotic therapy maintains the healed/healing plantar fascia, along with prevention of any biomechanical abnormalities that caused the condition

ACHILLES TENDONOSIS
• Has become common, especially for individuals who have worn high-heeled shoegear for a long period of time and want to start wearing flatter shoes
• When first seeing a podiatrist, it has progressed from tendonitis to tendonosis
• Tendonitis is an inflammatory condition of the tendon about ¾ inch from the back of the heel bone
• Tendonosis is collagen degeneration with no inflammatory cells present
• Pain is present after a period of rest that goes away after 5-10 minutes and with increased activity
• Treatment involves: rest, supportive shoegear in conjunction with therapy that causes an inflammatory response, i.e., Alfredsson stretching protocol, aggressive cross friction massage
• Orthotic therapy maintains the healed/healing Achilles tendon and may incorporate a heel lift to decrease stress upon it

CAPSULITIS
• A condition mostly due to biomechanical abnormalities
• It is an inflammatory condition of the capsule (sheath surrounding the joint with nerve and artery supply)
• Pain usually in the ball of the foot, is mild in the morning, but increases as the day continues and is usually sharp in nature with no radiation.
• Mostly like to compensatory overload of the second metatarsalphalangeal joint, due to inadequate functioning of the first ray (i.e., too short, too long, too stiff, etc.)
• Treatment, involves rest, supportive shoegear and use of adequate orthotic therapy that restore normalcy to the first ray joint.

Happiness and good health!

March 28, 2009 Posted by | Foot and ankle injuries | , , , , | Leave a comment