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Art S
October 3rd 04, 06:17 AM
The basic question is what are some of the more likely causes of
shin splints?

My mother has had them for 1 1/2 years and her doctors haven't
been able to determine a cause. Or, more to the point, an
effective treatment.

She is in her late 60's. She doesn't run and, to the best of my
knowledge, never has. She used to walk for an hour but isn't
able to any more - her shins start bothering her if she walks
"more than normal". Her shoes are made by SAS and she
wears orthotics. In the past 1 1/2 years she has gotten new
orthotics and new shoes - apparently they haven't helped.

The exercises that she has been given are more along the lines
of stretching than weight lifting (i.e. point and flex the foot,
write the alphabet, etc. without any exercises designed to increase
muscle strength.)

I'm hoping for areas to follow up on - either exercises with a
good rationale behind them (so she is likely to do them) or tests
revealing some kind of deficiency that can be worked on.

Thanks,

Art

elzinator
October 3rd 04, 06:47 AM
On Sun, 03 Oct 2004 05:17:44 GMT, Art S wrote:
>The basic question is what are some of the more likely causes of
>shin splints?

Mostly caused by repetitive microtrauma of the tibialis anterior
muscle, the one that runs down along the tibia, the shin. Small tears
in the thin connective tissue that covers that muscle causes
inflammation and edema, and consequently the pain that is known as
'shin splints.'

>My mother has had them for 1 1/2 years and her doctors haven't
>been able to determine a cause. Or, more to the point, an
>effective treatment.

I can be caused by overexertion of the muscles in the anterior
compartment (the tibialis anterior and other small muscles) by folks
who are typically sedentary and undertake a new exercise program such
as long walks or runs. They can also occur if the warm up is
inadequate. The muscles in the compartment swell up from sudden
overuse and edema and muscle-tendon inflammation reduces the blood
flow to that area.

It is another form of anterior compartment syndrome, which can also
occur in athletes if their fascia (connective tissue) does not
accommodate the swelling muscle tissue. Sometimes they have to have it
surgically remedied where the fascia is cut to allow for the
underlying muscle to swell. A friend in OR had to have this done to
her calves (she was a competitive soccer and volleyball player).

Another case is when the swelling impinges on the deep fibular nerve,
causing pain. The swelling and edema compresses the nerve and causes
pain in the anterior compartment, resulting in shin splints, but it
also radiates down to the foot. This can also result from tight shoes.

>She is in her late 60's. She doesn't run and, to the best of my
>knowledge, never has. She used to walk for an hour but isn't
>able to any more - her shins start bothering her if she walks
>"more than normal". Her shoes are made by SAS and she
>wears orthotics. In the past 1 1/2 years she has gotten new
>orthotics and new shoes - apparently they haven't helped.
>
>The exercises that she has been given are more along the lines
>of stretching than weight lifting (i.e. point and flex the foot,
>write the alphabet, etc. without any exercises designed to increase
>muscle strength.)

Adding more resistance may help strengthen the muscles there, and this
may also gradually stretch that connective tissue. It worked for a
firefighter that I had as a client (he had terrible shin splints).

There are two approaches that I can think of now: one is increasing
resistance with bands (anchor the bands with a dumbbell or tie to a
stationary object). Attach the other end to one or both feet and flex,
extend, repeat.

The other may be too difficult: place a dumbbell between both feet, so
that one end of the dumbbell is held in between the feet while sitting
on the end of a bench. Lifting up the legs and feet, raise the feet
(flex) and slowly return to the starting position. Gradually increase
reps and sets. This requires coordination and ab strength to support
the weight of the legs, grasp the DB with the feet and the DBs up off
the floor. It can be challenging. It worked for the firefighter, but
your mom may want to use the bands instead.

>I'm hoping for areas to follow up on - either exercises with a
>good rationale behind them (so she is likely to do them) or tests
>revealing some kind of deficiency that can be worked on.

She can try the strengthening exercises first, but the issue may be
the fascia in the compartment.


Beelzibub

"Modern man must rediscover a deeper source of his own spiritual life. To do this,he is obligated
to struggle with evil, to confront his own shadow, to integrate the devil."
- Carl Jung

Art S
October 3rd 04, 06:55 AM
"elzinator" > wrote in message
...
> On Sun, 03 Oct 2004 05:17:44 GMT, Art S wrote:
> >The basic question is what are some of the more likely causes of
> >shin splints?
>
> Mostly caused by repetitive microtrauma of the tibialis anterior
> muscle, the one that runs down along the tibia, the shin. Small tears
> in the thin connective tissue that covers that muscle causes
> inflammation and edema, and consequently the pain that is known as
> 'shin splints.'
>
> >My mother has had them for 1 1/2 years and her doctors haven't
> >been able to determine a cause. Or, more to the point, an
> >effective treatment.
>
> I can be caused by overexertion of the muscles in the anterior
> compartment (the tibialis anterior and other small muscles) by folks
> who are typically sedentary and undertake a new exercise program such
> as long walks or runs. They can also occur if the warm up is
> inadequate. The muscles in the compartment swell up from sudden
> overuse and edema and muscle-tendon inflammation reduces the blood
> flow to that area.
>
> It is another form of anterior compartment syndrome, which can also
> occur in athletes if their fascia (connective tissue) does not
> accommodate the swelling muscle tissue. Sometimes they have to have it
> surgically remedied where the fascia is cut to allow for the
> underlying muscle to swell. A friend in OR had to have this done to
> her calves (she was a competitive soccer and volleyball player).
>
> Another case is when the swelling impinges on the deep fibular nerve,
> causing pain. The swelling and edema compresses the nerve and causes
> pain in the anterior compartment, resulting in shin splints, but it
> also radiates down to the foot. This can also result from tight shoes.
>
> >She is in her late 60's. She doesn't run and, to the best of my
> >knowledge, never has. She used to walk for an hour but isn't
> >able to any more - her shins start bothering her if she walks
> >"more than normal". Her shoes are made by SAS and she
> >wears orthotics. In the past 1 1/2 years she has gotten new
> >orthotics and new shoes - apparently they haven't helped.
> >
> >The exercises that she has been given are more along the lines
> >of stretching than weight lifting (i.e. point and flex the foot,
> >write the alphabet, etc. without any exercises designed to increase
> >muscle strength.)
>
> Adding more resistance may help strengthen the muscles there, and this
> may also gradually stretch that connective tissue. It worked for a
> firefighter that I had as a client (he had terrible shin splints).
>
> There are two approaches that I can think of now: one is increasing
> resistance with bands (anchor the bands with a dumbbell or tie to a
> stationary object). Attach the other end to one or both feet and flex,
> extend, repeat.
>
> The other may be too difficult: place a dumbbell between both feet, so
> that one end of the dumbbell is held in between the feet while sitting
> on the end of a bench. Lifting up the legs and feet, raise the feet
> (flex) and slowly return to the starting position. Gradually increase
> reps and sets. This requires coordination and ab strength to support
> the weight of the legs, grasp the DB with the feet and the DBs up off
> the floor. It can be challenging. It worked for the firefighter, but
> your mom may want to use the bands instead.
>
> >I'm hoping for areas to follow up on - either exercises with a
> >good rationale behind them (so she is likely to do them) or tests
> >revealing some kind of deficiency that can be worked on.
>
> She can try the strengthening exercises first, but the issue may be
> the fascia in the compartment.
>

Any tests for issues with the fascia?

Art

elzinator
October 3rd 04, 07:10 AM
On Sun, 03 Oct 2004 05:55:14 GMT, Art S wrote:

>> She can try the strengthening exercises first, but the issue may be
>> the fascia in the compartment.
>>
>
>Any tests for issues with the fascia?

I'll have to check the sports/ortho book for that answer. Dorsiflexing
the foot against resistance is one way to check the tendon there. but
not sure about the fascia covering the anterior compartment.

I'll have to get back to you on that one.

(flagging post)


Beelzibub

"Modern man must rediscover a deeper source of his own spiritual life. To do this,he is obligated
to struggle with evil, to confront his own shadow, to integrate the devil."
- Carl Jung

Art S
October 3rd 04, 07:11 AM
"elzinator" > wrote in message
...
> On Sun, 03 Oct 2004 05:55:14 GMT, Art S wrote:
>
> >> She can try the strengthening exercises first, but the issue may be
> >> the fascia in the compartment.
> >>
> >
> >Any tests for issues with the fascia?
>
> I'll have to check the sports/ortho book for that answer. Dorsiflexing
> the foot against resistance is one way to check the tendon there. but
> not sure about the fascia covering the anterior compartment.
>
> I'll have to get back to you on that one.
>
> (flagging post)
>

Thanks - I'll be waiting.

When you get back on that one, I have two more questions:
1) What is "dorsiflexing"? (flexing I've heard of. Dorsiflexing? Never.)
2) What kind of specialist would be most likely to test that properly?

Art

elzinator
October 3rd 04, 03:11 PM
On Sun, 03 Oct 2004 06:11:51 GMT, Art S wrote:
>
>"elzinator" > wrote in message
...
>> On Sun, 03 Oct 2004 05:55:14 GMT, Art S wrote:
>>
>> >> She can try the strengthening exercises first, but the issue may be
>> >> the fascia in the compartment.
>> >>
>> >
>> >Any tests for issues with the fascia?
>>
>> I'll have to check the sports/ortho book for that answer. Dorsiflexing
>> the foot against resistance is one way to check the tendon there. but
>> not sure about the fascia covering the anterior compartment.
>>
>> I'll have to get back to you on that one.
>>
>> (flagging post)
>>
>
>Thanks - I'll be waiting.

Art, I found some excellent info in my sport injuries tome. The
authors call it 'medial stress syndrome'. That's news to me, but makes
sense. There are 3 pages with very good info.on compartment syndromes.
No way that I can adequately sum it up in a post here.

I'll scan the pages and convert it to email to you next week.

>When you get back on that one, I have two more questions:
>1) What is "dorsiflexing"? (flexing I've heard of. Dorsiflexing? Never.)

Dorsi- [dorsum] is back. So dorsiflex is flexing backwards.
From your seated position, lift one foot, then lift your toes up and
then down, this moves the heel down, then 'back' and up.

One point I neglected to touch on last night is addressing the
antagonist muscles: soleus and gastrocs. Tight calves can contribute
to shin splints. The combination of stretching calves and dorsiflexion
exercises helped Rob's shin splints.

See this page for example of dorsiflexion (first image with bands)
http://www.bodyresults.com/E2Shinsplints.asp

While searching the net for an image example, I came across this:
(attention Lee!! This could be made or adapted easily, no?)
http://www.dorsiflex-machines.co.uk/

Some of these exercises may be valuable, too.
http://www.sportsinjurybulletin.com/archive/ankle-injuries-1.html

>2) What kind of specialist would be most likely to test that properly?

Sports orthopod.


Beelzibub

"Modern man must rediscover a deeper source of his own spiritual life. To do this,he is obligated
to struggle with evil, to confront his own shadow, to integrate the devil."
- Carl Jung

Art S
October 3rd 04, 03:49 PM
"elzinator" > wrote in message
...
> On Sun, 03 Oct 2004 06:11:51 GMT, Art S wrote:
> >
> >"elzinator" > wrote in message
> ...
> >> On Sun, 03 Oct 2004 05:55:14 GMT, Art S wrote:
> >>
> >> >> She can try the strengthening exercises first, but the issue may be
> >> >> the fascia in the compartment.
> >> >>
> >> >
> >> >Any tests for issues with the fascia?
> >>
> >> I'll have to check the sports/ortho book for that answer. Dorsiflexing
> >> the foot against resistance is one way to check the tendon there. but
> >> not sure about the fascia covering the anterior compartment.
> >>
> >> I'll have to get back to you on that one.
> >>
> >> (flagging post)
> >>
> >
> >Thanks - I'll be waiting.
>
> Art, I found some excellent info in my sport injuries tome. The
> authors call it 'medial stress syndrome'. That's news to me, but makes
> sense. There are 3 pages with very good info.on compartment syndromes.
> No way that I can adequately sum it up in a post here.
>
> I'll scan the pages and convert it to email to you next week.
>

Thanks.

> >When you get back on that one, I have two more questions:
> >1) What is "dorsiflexing"? (flexing I've heard of. Dorsiflexing? Never.)
>
> Dorsi- [dorsum] is back. So dorsiflex is flexing backwards.
> From your seated position, lift one foot, then lift your toes up and
> then down, this moves the heel down, then 'back' and up.
>
> One point I neglected to touch on last night is addressing the
> antagonist muscles: soleus and gastrocs. Tight calves can contribute
> to shin splints. The combination of stretching calves and dorsiflexion
> exercises helped Rob's shin splints.
>
> See this page for example of dorsiflexion (first image with bands)
> http://www.bodyresults.com/E2Shinsplints.asp
>
> While searching the net for an image example, I came across this:
> (attention Lee!! This could be made or adapted easily, no?)
> http://www.dorsiflex-machines.co.uk/
>
> Some of these exercises may be valuable, too.
> http://www.sportsinjurybulletin.com/archive/ankle-injuries-1.html
>
> >2) What kind of specialist would be most likely to test that properly?
>
> Sports orthopod.
>

Thanks again.

Art

MJL
October 3rd 04, 04:11 PM
On Sun, 03 Oct 2004 05:17:44 GMT, "Art S" >
wrote:

>The basic question is what are some of the more likely causes of
>shin splints?
>
>My mother has had them for 1 1/2 years and her doctors haven't
>been able to determine a cause. Or, more to the point, an
>effective treatment.
>
>She is in her late 60's. She doesn't run and, to the best of my
>knowledge, never has. She used to walk for an hour but isn't
>able to any more - her shins start bothering her if she walks
>"more than normal". Her shoes are made by SAS and she
>wears orthotics. In the past 1 1/2 years she has gotten new
>orthotics and new shoes - apparently they haven't helped.
>
>The exercises that she has been given are more along the lines
>of stretching than weight lifting (i.e. point and flex the foot,
>write the alphabet, etc. without any exercises designed to increase
>muscle strength.)
>
>I'm hoping for areas to follow up on - either exercises with a
>good rationale behind them (so she is likely to do them) or tests
>revealing some kind of deficiency that can be worked on.
>
>Thanks,
>
>Art
>

Make sure to czech into claudication.

A quick google will turn up the relevant info. It would be somewhat
odd if her doctors have not considered this but you did not mention
it.


--
http://www.texansfortruth.org/

Kevin J. Coolidge
October 3rd 04, 04:42 PM
"Art S" > wrote in message
...
> The basic question is what are some of the more likely causes of
> shin splints?
>
> My mother has had them for 1 1/2 years and her doctors haven't
> been able to determine a cause. Or, more to the point, an
> effective treatment.
>
> She is in her late 60's. She doesn't run and, to the best of my
> knowledge, never has. She used to walk for an hour but isn't
> able to any more - her shins start bothering her if she walks
> "more than normal". Her shoes are made by SAS and she
> wears orthotics. In the past 1 1/2 years she has gotten new
> orthotics and new shoes - apparently they haven't helped.
>
> The exercises that she has been given are more along the lines
> of stretching than weight lifting (i.e. point and flex the foot,
> write the alphabet, etc. without any exercises designed to increase
> muscle strength.)
>
> I'm hoping for areas to follow up on - either exercises with a
> good rationale behind them (so she is likely to do them) or tests
> revealing some kind of deficiency that can be worked on.
>
> Thanks,
>
> Art
>
>one probable cause of your mothers shin splints is bad posture. Older
>people have a tendency to develop a leaning over posture which can put
>excess stress on the anterior calf, also high heels.

Art S
October 3rd 04, 07:15 PM
"MJL" > wrote in message ...

> Make sure to czech into claudication.
>
> A quick google will turn up the relevant info. It would be somewhat
> odd if her doctors have not considered this but you did not mention
> it.

Interesting.

I'll forward the information on to her.

Thanks.

Art