Most of us have heard of shin splints, but I’ll bet than many don’t really understand what shin splints are. Typically if a patient describes pain in the front of the lower leg, it will be diagnosed as shin splints. Let’s talk about the causes and treatment of this condition.
This condition is common in people who do a lot of running, as well as with people who have jobs that involve excessive standing or walking. The pain is typically felt in the front of the lower leg bone, the tibia. It is often described as a throbbing pain, or a deep ache, but also can produce sharp pain as well. The interesting thing is that although the pain feels as if it is coming from the bone, it is typically produced by the soft tissues that attach to the bone. This includes the tibialis posterior muscle, which is attached on the posterior (back) side of the tibia bone. This muscle is active whenever we are bearing weight on our leg. It helps to keep the arch of our foot from collapsing during weight bearing. People who have flat feet/arches would be more prone to developing this condition, as the tibialis posterior muscle will work hard to try to support the collapsing arch.
In terms of treatment, there are a couple of things to consider. First, a precautionary X-Ray or bone scan is often a good idea, as repetitive stress on the shin (especially in long distance runners) can lead to a stress fracture. If this is ruled out, then we treat the soft tissue problem. As always, we want to identify the cause of the problem, not just treat the symptoms. Patients can take anti-inflammatory meds, or ice the painful area, but these will only provide temporary relief and will not address the cause of the pain. We first need to look at the lower leg and foot alignment to see if an orthotic is indicated. If a patient has poor foot structure (especially flat arches, but sometimes excessively high arches), a shoe insert to support the arch can relieve stress from the lower leg muscles (tibialis posterior) that have to work excessively to support the arch. We also want to make sure that the patient has full range of motion and flexibility in the lower leg/ankle/foot region, as well as good muscle strength in the lower leg/ankle/foot region. A gait evaluation and possibly a running assessment are also indicated to identify abnormalities which may be contributing to the condition.
If you have been dealing with shin pain, please give us a call so that we can help you! This can be a difficult condition to treat, but it is treatable, especially with the help of an excellent physical therapist.
By: Mason Riegel, PT
Unfortunately, knee pain is common. The good news is, many cases of knee pain can be prevented, treated, and reduced or eliminated with proper treatment and exercise!
Here are a few tips for dealing with you knee pain. Remember, knee pain has many causes, and if you’re dealing with acute pain, severe pain, or knee pain from trauma, you should see your doctor or physical therapist to find the cause of your knee pain.
Air squats Backward lunges
Glute bridges Single leg balance
Calf raises Donkey kicks
Calf stretch 1 Calf stretch 2
Quad stretch Hamstring stretch
When should you see a doctor? If your pain is new, very painful, or persistent, it is a good idea to see a doctor or physical therapist right away and get advice on what treatment you may require or what your next steps should be.
By: Lisa Bartz, Certified Exercise Physiologist (C-EP)
We see many people who are frustrated with the speed in which they are progressing. They feel that they should be ready to return to their usual sports or activities right away without having to go through the healing and rehabilitation process.
It is important to remember that your body is trying to heal itself, but this is a process. Soft tissue healing, such as a moderate to severe sprain or strain, can take up to six weeks to recover. Bone fractures often take weeks to heal and after surgery many people have a combination of bone and soft tissue issues that have been surgically addressed and need to heal.
Here are some tips to help you through this process from verywellfit.com:
1. Learn about your injury. The more you know about the injury and healing process the more comfortable you will be when you experience pain, stiffness, or even frustration about how things are progressing. You may be ahead, behind or right on track of the typical healing process. By knowing what to expect you can reduce your anxiety about what lies ahead.
2. Accept responsibility for your rehabilitation. It is important to accept responsibility for your rehab program, because only you can control how well you will do with your rehab. While the physical therapist is important, without actively participating in your rehab, you are doomed for failure.
3. Maintain a positive attitude. Try to focus on what improvements you are making rather than your deficits or where you aren't progressing as quickly. You need to be realistic about your condition, but you also need to be optimistic about where you’re headed. Then, when you do see improvements, this will reinforce the behaviors you will need to continue.
4. Have good support. Try to surround yourself with friends, family members, physicians and therapists who will support and encourage you in your recovery. Besides the sense of support, these individuals will hold you accountable for your program.
5. Set appropriate goals. Discuss with your therapist a timeline and set goals along that timeline. This helps you objectively measure where you are at in your program. Ask your physician and physical therapist their expectations for your recovery as well.
6. Maintain your fitness level while injured. Work with your therapist to help establish a fitness routine that will not hinder your recovery from your current condition. Often times someone with a leg injury can aggressively work their upper body and core without having a negative impact on the recovery time for their leg. The same holds true for a hand injury in that you can work your legs more aggressively without hindering your recovery time. A higher level of fitness often helps improve your tolerance to perform various exercises as well as functional activities.
By: Steve Bartz, PT
Physical therapists are often asked about our opinion of braces. There are many types of braces, including support braces for the spine, as well as sport/recreational/occupational braces for many areas of the body, including the knee and ankle. My opinion of braces varies on a case-by-case basis. We need to look at a variety of factors to determine whether wearing a brace is appropriate or not.
In general, I am not typically in favor of wearing spinal braces. The exception would be in a post surgical case, where the surgeon has specifically told the patient to wear a brace, normally to prevent movement while the body heals. However, once this healing has taken place, we want the patient to wean out of the brace as soon as possible. The reason for this is that the brace immobilizes the spine, leading to stiffness, loss of flexibility, and loss of strength due to inactivity. The spinal muscles, when operating efficiently, will provide a natural “brace” of support for the spine. If a patient becomes reliant on a brace for their support, their muscles will weaken due to not being used, and their problem actually worsens.
There are certain types of braces that I will recommend for a limited time, as long as they are not used as a long term solution. Examples would be a “tennis elbow” brace, a patellar support brace, an ankle support brace initially after an ankle injury, or a shoulder sling. In all of these cases, we are only using the brace for a limited period of time to allow the body to heal, or recover. We are still trying to rehabilitate the body to work properly in the long term, so that the brace will not be needed long term.
Often the trickiest decision regarding braces comes when discussing the use of preventative braces during sports. Examples would be ankle support braces for volleyball or basketball or knee braces for football linemen. In each of these cases, the rationale for wearing the brace is to prevent potential injury by providing additional support for the joints. Strong cases can be made for wearing the braces, as well as for not wearing the braces. There is not even consensus within the medical field as to which is the better option!
In summary, the decision about whether or not to wear a brace is often complex and not clear cut. The key is to have a thorough discussion of the pros and cons of bracing, so that each individual patient can make their own well informed decision.
By: Mason Riegel, PT
When elbow pain strikes, what do you do? First, let’s take a look at what causes elbow pain. There are many different types of injuries related to the elbow. Today, I want to touch on two of the most common. They are easy to diagnose, easy to treat but can be difficult to totally get rid of the pain.
The two most common diagnoses are “Tennis elbow” and “Golfer’s elbow”. Tennis elbow’s clinical name is Lateral Epicondylitis. It is the inflammation of the common extensor tendon of the forearm and is located on the outside of the elbow.
Golfer’s elbow’s clinical name is Medial Epicondylitis. It is inflammation of the common flexor tendon of the forearm and is located on the inside of the elbow.
For the non athlete, there are many things that can cause or bring on these conditions. The two most common are 1) A strenuous or aggressive activity, like swinging a heavy hammer or lifting something very heavy, or 2) A repetitive or overuse activity, such as factory line work or keyboarding.
The good news is they are easy to treat!
1. REST. Avoid any activity that causes pain.
2. ICE. I feel that an ice massage for 5 minutes is most effective.
3. STRETCH the affected area. This is done by putting arm straight out in front. Pull wrist up to stretch the flexors for Golfer’s elbow or wrist down for Tennis elbow. Hold stretches for 10 sec for about 5 reps.
4. Lastly, you can purchase a STRAP to wear around your forearm about an inch below your elbow to give you some relief.
Now, as I mentioned earlier, although these conditions are easy to treat they can be hard to totally get rid of. Give it a month or so, and if it does not improve with these 4 tips, let your local Physical Therapist give you a hand. One last thing to remember: don’t let this condition go, the longer you wait the tougher these conditions are to treat.
By: Brian Colvin, PT
What do you do when you get a "Charlie Horse" in your leg? How can you prevent them?
Typically, Charlie Horses are muscle spasms of either the hamstring or calf muscles. They occur when the muscle is suddenly contracted after being in a shortened state (like waking up in bed with a sharp cramp) or when over-exerting the muscle such as when sprinting.
To prevent these it is important to gently stretch the muscle regularly to train it to handle the stretch without going into a spasm. Calf and hamstring stretching can help with this. Long slow repetitive stretches can reduce the chances of the spams, especially before bed. Good diet and hydration may help also.
So what do you do in the middle of a Charlie Horse to try to get relief? A very effective but tricky way to reduce a spasm in your calf while in bed would be to immediately role over onto your stomach and let the bed hold your foot in a position that points your toes down (away from you). It is important you do not actively try to point your toes down while getting into this position. By taking the stretch off the muscle, it can relax quicker.
The same is true for the hamstring. Try to pull your knee into a more flexed position using your hand and NOT flex your knee with your leg muscles. Relax and wait for the muscle to relax.
Most people to quickly LENGTHEN the muscle, but this can put the muscle into a sharper spasm. Here, we are trying to shorten the muscle further without contracting it.
By: Steve Bartz, PT
Everyone has their own unique style of movement, with mild variations from person to person. The next time you attend a sporting event, observe the variations in how people run, or jump, or swing a bat or golf club. You will seldom see people that move exactly the same way. Yet there is an optimal way to move in everything that we do. As athletes become more elite, you will notice that they move similarly, and that is because they have learned the best and most efficient ways of moving, so that they can perform at an elite level.
Unfortunately, most of us are nowhere near that type of athlete. However, we can actually train our bodies to move differently; to “move better”. In doing so, we can improve our performance as well as reduce the frequency of injuries by learning how to move in the way our bodies were biomechanically designed to.
Did you know that we can help you to move better? Physical therapists are trained to watch you move, identify movement abnormalities that you may have, and offer tips and exercises to improve your movement.
Taking that a step further, we have developed a performance training program for athletes! Utilizing the Functional Movement Screen (FMS) as a baseline, we develop personalized training programs to improve physical performance and reduce the incidence of non-contact injuries. We do these programs on an individual basis, as well as in small group classes.
If you are interested in “moving better” and “performing better”, Hudsonville PT is the place for you! Contact us and let us know that you are interested in our FMS based training programs.
Mason Riegel, PT, FMS Level 1&2
Hypermobility is a condition characterized by excessive mobility of the joints. It can be a single joint, but is frequently found in multiple joints. Often people will describe hypermobility as being “double jointed”. People with this condition basically have joints that are excessively “loose”, due to having more elasticity in their ligaments. This is not necessarily a problem if the person has very strong muscles to support the joints, but often these people do not.
When a patient with hypermobile joints comes to see us in PT, they frequently complain of pain in the joints, and sometimes will complain of the joint feeling as though it is slipping out of place. Typically these patients will have excessive range of motion in their joints; more than what we normally would see. Also, they often complain of their joints “cracking” or “snapping” all of the time.
The best remedy for hypermobility is strength! People with hypermobility do not need to stretch more, but rather strengthen more! They need stability, not flexibility. A good strengthening/stabilization program can help provide stability to the hypermobile joints, which can reduce symptoms and improve performance.
Mason Riegel, PT
If you injure a muscle don’t panic! Follow these steps to safely recover! The old RICE acronym is now outdated and a newer one has replaced it.
As a reminder RICE stood for Rest, Ice, Compression, Elevation. The new acronym is POLICE (awesome right!?) and is recommended for minor musculoskeletal injuries. POLICE stands for Protection, Optimal Loading, Ice, Compression, Elevation.
Let’s break the acronym down to clarify any confusing words.
Remember, don’t panic over a small muscle strain. The body is amazing at healing itself if you take the right steps.
And if you have questions or concerns about a muscle strain, don’t hesitate to call you doctor or call us here at Hudsonville Physical Therapy!
Brian Colvin, PT
Mike van Der Laan, DPT
Steve Bartz, PT