We have been cranking away on the construction and planning of the new Lab and I am happy to say it is looking GREAT and our opening is just around the corner.  However, going into our last month of the original Lab it seems we have some sort of a curse/omen/the old building doesn’t want us to leave…sort of thing going on.  We have broken a window, mirror, and experienced our first fire yesterday.  It was a small electric fire and is currently contained and we have sufficient electricity to operate.  We will be closed on Tuesday from 11-3 for further repairs.  We have had some problems with the key cards working but plan to have those fixed tomorrow or later in the day on Tuesday.  We plan to have the door open or someone at the door in the meantime.  

pumpkin2

On the bright side in case you haven’t seen it yet  here is a tour of our new location (pre-construction):

The NEW Lab 2.0

Jerry and The Shin Splints
By: Virginia Lamonica LaRose, PT, DPT

tomandjerry

Meet Jerry.  Jerry is a lawyer, a kickball enthusiast, and all-around great guy.  Jerry is also a dedicated boot-camper and a few months ago, he decided to join up with the ultra-awesome ‘running rats’ to diversify his workouts.  Adding conditioning and endurance training was a wise choice.  It also allowed him to complete his first half marathon last spring! Just the other day, he bolted his way into a ‘photo finish’ to win a relay race held at boot camp.  Turns out those early morning runs indeed pay off with occasional moments of glory!

Unfortunately following his Chariots of Fire moment, our hero began to experience one of the possible running pitfalls (cue the ‘bad guy’ music) “shin splints.”

You’ve heard of this devilish impairment, yes?  Let’s explore….

Jerry described his symptoms as sharp pain in the front, middle area of his lower legs.  The pain worsened during and after running and was particularly present when running uphill.  He found that pulling his toes into a pointed position during a standing quadriceps stretch caused some relief. 

‘Shin splints’ is just a less-swanky garbage-can term for what’s known as medial tibial stress syndrome.  Generally, the underlying cause, and thus adequate medical terminology to describe medial tibial stress syndrome, is hotly debated.  Allow me one moment to indulge in bit of mind-numbing medical word-vomit: fascial herniation, interosseous membrane tears, tendonitis, muscle strain, stress fractures, periosteal avulsion, compartment syndrome, and periositis.   Each of these pathologies falls under the ‘shin splint’ umbrella and require varying degrees of medical attention*

garbage

“This medial tibial stress syndrome has me in knots!”

Jerry’s symptoms likely arose from being such a badass and causing inflammation to the tendons, muscle bellies, or periostium (membrane that lines outer surface of bones). 

QUICK FACT: ‘-itis’ is a suffix with Greek origins kicked around the medical community to mean ‘inflammation’.  Think “arthritis” = joint inflammation, ‘tendonitis’ = inflammation of the tendon, worditis = inflammation of this article (which I hope to avoid!) 

Treatment. 

Generally, us health care professionals feel comfortable falling back on the RICE method of combating any inflammatory injuries. 

rice

Rice can take care of your pain!

R = rest.  The ACSM (American Collage of Sports Medicine) suggests 7-10 days of rest for shin splints.  Consider substituting high impact activities with those lesser impact counterparts: swimming, cycling, or watching a Real Housewives marathon on Bravo. 

I = ice.  Ice is generally the preferred thermal treatment for acute injuries (within the first day or so).  My favorite ice trick for shin splints is to fill a small paper cup with water and freeze.  Then peel away the top of the cup and apply ice directly to the shin until sufficiently numb (numb trumps pain!). I also recommend using a towel to catch the drippies. 

C = compression.  Ever wonder about those funky tall socks or sleeves worn by some runners?  That’s compression baby.

Above: One of my favorite runners: Peter Sagel. 

Claims to wear these bad boys even when hosting

NPR’s Wait Wait…Don’t tell me!

E: elevation.  Have a seat and prop those tootsies up (somewhere above the heart for best effect).  I find this activity is best paired with reality television…though sadly, I can’t support that with peer-reviewed evidence. 

elevartion 

Proper elevation for RICE technique (shins above heart)

 

NSAIDs (Non-streiodal Anti-inflammatoryIbuprofin—think Motrin or Advil) are another quality inflammation-buster.  Take as advised because there’s nothing worse than a Motrin junkie. 

Once we’ve tackled the basic problem of inflammation (generally creating the pain), it’s time to identify the source of the injury. 

GAIT:

In Jerry’s case, we might consider his running gait.  During ‘heel strike’ – the portion of gait when the foot first strikes the ground – a person must use their anterior tibialis muscle to prevent catching their toes and falling to the ground like a dingbat.  This muscle is located, as described, on the anterior (front) of the tibia (shin bone).  The soles of running shoes are generally tipped forward (think high heels, but not as sexy), to encourage runners to remain on their toes.  If a runner has excessive ‘heel strike’ while running, their anterior tibialis muscle gets stuck working overtime to make up for the forward tipping of the shoes.  Then the poor little guy gets inflamed, angry, and decides to take it out on the unsuspecting runner. The solution?  Try to eliminate excessive heel strike, cue Jerry to stay on his toes! 

FOOTWARE:

We may also consider looking closely at the type of shoe Jerry is choosing.  Arch type should be considered when choosing a running shoe.  Over-pronation or flat feet may cause undue stress on the posterior tibialis muscle when running.  The posterior tibialis is located on the (you guessed it) posterior portion of the tibia, with the tendon running along the inside of the foot and inserting into the arch.  Check out my “happy feet” article for details on choosing a shoe 🙂

TAPING:

I subscribe to this general rule of thumb, “if you cant duct it, f*#@ it.”  I have seen really impressive results from taping a person out of or into a certain movement pattern.  There are certain taping techniques that might be utilized on the lower leg to kick those nasty pains (baby got tape….)**

duck

“f*#@ it”

 PREVENTION:

The main thing to consider is training smartly.  Don’t head out tomorrow and run a marathon, unless you’ve spent the last three months gradually kicking your butt into gear.  Also, find a good pair of shoes and stretch appropriately.  That just about sums it up.  Now time for my thinly veiled promotion:  Join the ‘running rats’!!  We meet Monday, Wednesday, and Friday.  We’re awesome, and promise to help you avoid the evils of shin splints. 

runninrat

Running Rats: Meet Monday, Wednesday, and Friday (for more info call 314-256-1411 or email thelabgym@gmail.com)

*SPECIAL NOTE:

If your shin splints become chronic or don’t respond to the RICE method, it’s important to consult a health care professional.  A therapist can assist you with gait analysis, taping, and choosing appropriate footwear.  If compartment syndrome is causing the symptoms, surgical intervention might be necessary.  Occasionally, shin splint symptoms may indicate a stress fracture, which will require imaging and subsequent medical attention. 

Faciotomy: surgical intervention for compartment syndrome.

If you give me twenty bucks and a scalpel, I’ll save you the

trouble of dealing with the insurance company.

 

**My apologies for the shameless sir mix-a-lot reference.  

 

References:

 

1.  Beck BR and Osternig LR. Medial Tibial Stress Syndrome: location of muscles in the leg related to symptoms.   Journal of Bone and Joint Surgery.  1994. 

 

2.  Carr, Kathleen and Sevetson, E.  How can you help athletes prevent and treat shin splints? Journal of Family Practice.  June 2008 · Vol. 57, No. 6: 406-407

 

 

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