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Medial Tibial Stress Syndromes -Shin Splints

Medial Tibial Stress Syndromes – Shin Splints “Shin splints” is a general term that is used to describe pain often accompanied by tenderness along the front of the lower leg. The tibia is the larger of the lower leg bones and runs from the knee to the ankle. It can be felt running along the front of your shin. Many muscles attach to the tibia and the bone is covered by periosteum which has a good blood and nerve supply. Medial tibial stress syndromes are commonly caused by prolonged running or walking or repetitive jumping. Shin pain is most commonly diagnosed as a stress fracture of the tibia or an overuse syndrome of the muscles and their attachment to the periosteum. The difficulty in diagnosing between these two conditions is that stress fractures are often missed on X-ray because the hairline fracture is typically not seen until after about 3 weeks when the new bone growth becomes visible. A bone scan or MRI would better detect a stress fracture but are not typically ordered early after pain onset due to the cost. We rely on clinical signs and symptoms to guide the diagnosis if radiographic tests are not conclusive or have not been taken. Typically, stress fractures have more localized area of pain and tenderness to palpation and muscular inflammatory problems tend to have a larger area of pain and tenderness. Stress fractures tend to be painful during the running, walking or jumping and the pain resolves shortly after the activity is finished. Muscular inflammatory injuries tend to hurt early in the morning, and progress in intensity with the...

Physical Therapy for Pediatrics and Adolescents: The Science and Art of Treating Developing Framework

Physical Therapy for Pediatrics and Adolescents: The Science and Art of treating developing body framework Children and adolescents are not “little adults”. Their bodies are still in development as their musculoskeletal and neurological systems are in the process of maturing. The injury patterns that occur in this age group are different than adults in both physical and physiological ways. Most notable is the fact that children and adolescents have open growth plates and their ligaments (tissues that hold bone to bone) are stronger than the bony attachment sites where they serve as connectors. Growth can occur quickly at the growth plate resulting in a rapid change in skeletal length producing longer bones but soft tissues (muscles, tendons, ligaments) that do not grow as fast. With each new body configuration that results from rapid growth, the child/adolescent may experience postural change and a period of incoordination (because the full musculoskeletal system such as muscles and tendons are “catching up” to the new longer bones and the body’s neurological system is relearning to “make internal sense” of the new body for movement and sports participation). This age group also experiences a vulnerability to musculoskeletal injury at these times of development due to the physical activities that they may participate in which stresses the young body system. Physical Therapy treatment of these conditions require specialized consideration and intervention philosophies keeping the growing skeletal system in mind while returning the youth to physical activity and sport. The growth plate portion of bones in this population is vulnerable to injury and growth plate fractures may be more common than a ligament sprain at these...

Backpacks and Growing Spines

Backpacks and Growing Spines “As the sapling is bent, so grows the tree” From Kindergarten through college, the backpack is a fixture in most children’s lives. Children often choose a backpack based on décor or theme when they are young. Older students also want the backpack to look good. It is important though to evaluate the ergonomic function of a backpack. Good preparation for school besides a good night’s sleep and a healthy breakfast may also be the correct backpack. The average daily load in a sixth grader’s pack is 20.5-27.5 lbs! By the time a student graduates from high school, he/she has carried the equivalent of six full-size cars or 11 tons!!! When worn correctly and not overloaded, a backpack is supported by some of the strongest muscles in our body. Unfortunately, according to the Consumer Product Safety Commission, there are approximately 6,500 ER visits per year because of backpack injuries. Here are four helpful hints to help select the proper backpack and help your child avoid strain or injury. 1. Choose right. The best design options allow for even weight distribution and less strain on the spine. Wide, padded shoulder straps are the best. Narrow straps can “dig” into shoulders causing pain and reduced circulation. Use two shoulder straps at all times. One strap or messenger bags that are slung over one side of the body cannot distribute weight evenly and cause children to compensate with bad postural positions. If vanity rules and your child insists on this design, encourage them to at least alternate sides of their body to carry the bag on an every other...

Life Restructuring: Energy Conservation and Work Simplification

Life Restructuring/Energy Conservation and Work Simplification Have you or someone you care about recently experienced a major health change? Perhaps it was a serious injury with a long recovery time ahead or maybe a diagnosis of a chronic disease that requires some readjustments to the way you are used to living, or maybe it was a surgical procedure that requires some down time. All of these circumstances find us in a place that can leave us tired, overwhelmed and frustrated. We cannot do things the way we used to be able to do. We wonder if we will ever be able to manage things again. Who needs energy conservation? Persons with a chronic condition which may cause fatigue or episodes of fatigue. Persons in temporary situations such as recovery from major surgery or acute illness whose body systems are healing but need time to return to normal function. Persons undergoing treatments that may cause fatigue as a side effect. Persons who are experiencing body changes due to normal aging. Anyone who wants to do things more efficiently. We all have a certain amount of energy to spend on any given day whether we are in perfect health or have a condition or situation which affects our health and therefore, our energy systems and reserves. Every person, regardless of ability or disability has their own mobility and energy expenditure range. Athletes train to use their resources as effortlessly as possible to compete as they perfect their performance. Someone who has a chronic condition such as multiple sclerosis, lupus, myasthenia gravis, COPD (to name just a few), may experience episodes of...

Relaxation Exercises to Help Combat Stress

Relaxation Exercises to Help Combat Stress In my twenty-six years of physical therapy practice, I have often had patients come to me with this question, “My doctor told me that I need to reduce the stress in my life. Do you know of any exercises I can do to relax more?” I certainly have some professional advice to share. I also have enough personal experience with stress to understand as well. You see, we are all human and life is stressful. Yes, even physical therapists struggle with stress. I have seen and treated many places on the human body where stress can physically manifest itself from headaches, jaw (TMJ) problems, neck pain and muscular trigger points to even some kinds of low back pain. Ask a roomful of people in what way they experience stress and some will say “tension headache”. Still others are “gut reactors” and they have stomach aches or GI distress. Still others describe feeling “tired and aching all over.” Stress is unavoidable. Our ancient ancestors had to worry about finding food to eat and whether what they were hunting was going to turn around and start to hunt them! They did not stress over rush hour traffic, the kids overscheduled lives or the looming work deadline but they did have stress. The problem is that although our civilization has greatly evolved since those days, our human physiology is still the same. We are wired for the “fight or flight” response to stress. Our adaptive response to stress remains primitive. This system was highly effective for the ancient “life or death” scenarios and is still our...