Sports Medicine Corner

Dr. Don Kirkendall

Summer is a double-edged sword. On one hand, the weather offers lots of opportunity to play. On the other hand, the weather (at least here in the southeast) is so blasted hot that even thinking about exercise causes some to break out in a sweat. I may be odd, but I worry about summer.

I worry because some players are trying to play in as many summer tournaments as possible. And they do this at the expense of training. They may think it’s too hot to train, but not to hard to compete.

Or they rationalize summer sloth as downtime from a long season that for some can stretch back to last August. For these players, it’s not only too hot to compete, but it’s also too hot to train. And that philosophy creates problems for the upcoming August.

Competition without training is a set up for injury. Doing no training, or little training, is also a set up for injury. And the injuries are a real pain, literally and figuratively.

m One player finishes a third straight weekend of tournaments. Another waits until a week before fall camp and starts running with a vengeance. Both are on the fast track for an overuse injury. And it doesn’t take much to start a nasty cascade of issues that are best cured by the one thing most players don’t want to do: rest.

[show_disconnected][show_to accesslevel=’Subscriber’] There are a lot of potential reasons behind leg pain that intensifies with exercise, diminishes with less intense exercise, and, depending on the degree of damage, might continue after exercise during rest. If one thing gets the overwhelming nod by coaches and parents, it is shin splints or more properly, medial tibial stress syndrome.

Pain can be instructive. Is the pain only at rest or just during exercise or both? Does it go away after starting exercise? Did the pain come on all at once or gradually? Where is the pain specifically? For running sports, the location of pain is one of the most troubling problems in sports; pain in the lower leg.

(Anatomy lesson: your lower extremity isn’t an upper and a lower leg. It’s a thigh and a leg. But you knew that. Ever ask for a chicken’s upper or lower leg? Of course not)

The aching pain in the lower leg can happen to people unaccustomed to exercise, the running surface, new or improper shoes. Pain can also hit the experienced athlete who increases their exercise intensity, changed shoes, or moved to harder surfaces without a period of adjustment.

The pain begins with exercise, especially when running on roads or tracks with tight turns and is can be felt on the medial (middle) aspect of the lower leg. The pain may even linger after exercise.

Shin splints are an occupational hazard for figure skaters and gymnasts. They don’t have the freedom to select training shoes with lots of support and cushioning features the runner craves. Shin splints can be practically epidemic on track teams because they train so much on a very hard surface.

The actual medical term for shin splints can be medial tibial stress syndrome or posterior tibial syndrome. All of the muscles of your leg have some attachment to the tibia or fibula. The perception is that the change in exercise habits tears muscles at or near where the muscle attaches to the tibia. Some involvement of the muscle’s tendon may be present.

The typical treatment for shin splints is:

• Several weeks of relative rest (do something other than running)

• Non-steroidal anti-inflammatory medications (e.g. ibuprofen, naproxsyn)

• Stretching and thorough warm-up before activity

• Post-exercise ice massage (about 15 minutes). Fill a bunch of paper cups with water and keep them in the freezer. Peel back the paper as the ice melts while you massage the painful area. Put a towel under the injured limb to soak up the melted ice.

• Stretching exercises to improve flexibility of the calf and heel cord

• Strengthen the lower leg muscles

• Lay a towel on the floor. Put an object of some weight on the towel. Now use the toes to pull the towel/weight towards you

• Loop a towel around the leg of a chair or table-sit on the floor in front of the chair. Put the foot in the looped towel then point the toes up to the ceiling trying to pull the chair across the floor

• Sit high enough up so that the foot is off the floor-loop a towel over the toes and put something heavy (and unbreakable!) in the towel below the foot then raise and lower the weight.

• Slow, gradual return to running. Begin with water running, then progress to a Stairmaster or elliptical, then to a treadmill and finally to over the ground running.

• Shoes matter. So purchase a shoe that is pretty specific to your plans. Trails require one type of shoe and streets require another. Soccer flats and studded boots are NOT for routine running – they are for soccer. Their cushioning stinks and their support is suspect. If I had my way, studded shoes would come out ONLY when training went competitive. Never wear them off the field. Carry them to and from the field.

• Get access to an athletic trainer because there are some taping techniques that help. Soccer shoes are not noted for their cushioning. May have to train in running shoes for a while after returning to training. Orthotics may be prescribed.

Please don’t self-treat based on something you read here. See a sports medicine physician.

Why? Because there are far more serious problems that also cause lower leg pain and get mistakenly called shin splints; specifically stress fractures and compartment syndromes (which require surgery).

Don’t overdo either extreme. Summer is a time to get away from sport, but not from basic exercise. Ignoring any pain is no more a good idea than calling all leg pain ‘shin splints.’A sports medicine physician should be consulted.

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