Tuesday, October 30, 2012

Remedies for Shin Splints

Shin Splints- an Athletic Trainer’s Perspective

Shin splints is a "syndrome" or "collect-all" term
for a variety of aches and injuries in the lower leg region. Some estimates put it as high as 31 conditions. While it is true that shin splint injuries occur mostly to athletes and those who often run or walk long distances, in my career I have seen the injury occur in football lineman and baseball center fielders that do not necessarily run long distances. I have also heard that changing surfaces, i.e. soccer players going into basketball season, may precipitate the muscle inflammation we call shin splints. But I wonder, if that is the case, why then doesn’t every one of my soccer athletes turned basketball athletes get them? Obviously there must be something different about different athletes.
I have found two predominant conditions that often lead to shin splints: foot/gait patterns of over pronation and tight heel cord muscles. With ankle over pronation (rolling inward), the entire structure from ankle to hip/low back operates at a less than peak efficiency. When muscles chronically work at less than their optimum angle, stress (inflammation) occurs. Secondly, heel cord muscles (gastrocnemius or the calf and the soleus muscle) are critical to smooth propulsion in the walking and running cycle. Calf tightness causes premature heel raising which redistributes body weight along the bottom of the foot and alters muscle contraction timing. Any change that alters what the body perceives as its optimum performance range (which is a floating definition based upon age, genetics, level of conditioning, etc.) will result in breakdown or at the least inflammation and pain.

Since shin splints may represent a variety of ailments, there are likewise a variety of ways to treat the injury. Remember the adage "everything in moderation" so ease into any changes in your exercise routine and as always when it doubt, see a professional.

Remedies for Shin Splints

Working though the discomfort must be tempered with common sense. "It hurts when I do this", then "don’t do that!"

Ice has an inflammation reducing capability. Remember that muscles that are angry with you with become inflamed. Inflammation causes pain, which causes inflammation, which causes pain...you get the idea.

Sore muscles supported with elastic wraps, tape or neoprene sleeves often feel better. These products can hold in body heat which has relaxing (increased blood flow) results for sore muscles due to greater oxygen delivery.

The age of the athlete in front of me determines what I say about the use of aspirin or ibuprofen. Typically state laws prohibit medication dispensing in high schools and aspirin is not advised for children. Adolescents must be told "whatever your parents want to give you" while college and professional athletes can make their own decision but should be reminded not to overdo it in an attempt to mask the discomfort.

Foot-shoe Interface
In the case of an overpronator, arch supports may produce some relief, if not, prescription orthotics may be needed. For some it may be as simple as checking the insole in the shoe. Through wear, age and sweat the softness afforded by the insole may become compromised and is resulting in excessive force being transmitted up through the foot-ankle-shin.

Alternative Activities
Use cross training whenever possible to focus on different muscles, different distances and different intensities in order to "rest" the sore shins. Swimming and bicycling are good sore shin alternatives. Take this time to focus on your core strength and overall flexibility.

Warm Up & Cool Down
General warm up involves overall blood flow increase while specific warm up mirrors the demands of the activity. Dynamic warm up is a blending of these two by large muscles movements related to the activity. Warm muscles move better and are less likely to be injured. When you are done, do some simple large muscle movements on your way over to pick up the ice bag for your sore shins.

Stretching with both straight and bent knees for 30 seconds each several times a day alleviates many cases of sore shins. Since the calf muscle does most of our propulsion and is more powerful than the shin, it usually wins the "argument". Once they get short and tight, the shin muscles are forced to function at a slightly altered angle and they do not like it...thus the pain.

More Athletic Trainer Perspectives on Shin Splints:

Here’s what other athletic trainers have to say:
  • Kent Scriber, ATC Ithaca College, Ithaca, NY: Aside from the traditional care (rest, ice, stretching, and gradual return to participation), I have found that providing some sort of arch support is helpful. It seems most of these lower leg problems are triggered by some sort of biomechanical issue. Therefore taping, providing a foam or felt pad, or a more permanent orthotic often alleviates symptoms.
  • Jennifer Wuyscik MS, ATC, LAT and John Geist, ATC, LAT, Knoch HS, UPMC Sports Medicine, Saxonburg, PA:
    • Jennifer: Like Maria Hutsick, I have also had several athletes, predominantly female soccer players, who have had chronic exertional compartment syndrome, which can in its beginning stages mimic shin splints. Since presenting a case study at NATA in 2010 on this topic, I have had 2 additional female soccer players and 1 male soccer player with this condition. Two of the three have had to have surgery before the end of their high school careers to be able to continue playing.
    • John: My basic thought regarding "shin splint" pain is monitoring the pain during activity and the duration of the pain after activity. Does it go away after 3, 6, 9 hrs., etc..? or does the pain linger on into the next day’s workout? Any increase in pain or duration of pain would lead me to limit the athlete’s activity and/or refer them for further evaluation/x-rays. If the athlete’s pain dissipates within a short period of time after their workout or if the athlete can start their day with pain not being any worse than the day before, I am usually comfortable allowing that athlete to continue. I also (encourage) icing, stretching both (calf muscles), checking foot biomechanics, and adding arch supports, if needed. I will take my cleated athletes (primarily screw-ins) out of their cleats for a period of time and have them workout in (athletic flats.
  • Maria Hutsick, ATC, Medfield High School, Medfield, Ma.: Another area to look at especially in female athletes is the issue of compartment syndrome. Many girls end up with chronic pain and numbness and tingling in the lower leg/foot region. Further investigation results in symptoms such as muscle hardness in the lower leg, pain after or during exercise, and the symptoms may progress. This is usually an issue that shows up in 10th or 11th grade. By the time they get to be freshman in college they may need surgery to continue playing.

More Professional Input

Mayo Clinic's Definition of Shin Splints 

Products to Ease the Pain of Shin Splints

 For products to help care for shin splints, go to www.esportshealth.com and look at
Phil Hossler, ATC has been an athletic trainer on the scholastic, collegiate and Olympic levels. He has authored 4 books and numerous articles and served as an officer in state and regional athletic training associations for 20 years. He is a member of four halls of fame including the National Athletic Trainers’ Association’s.

Thursday, October 25, 2012

How Stability and Balance Training Improves Athletic Performance

Proprioception Separates Great Athletes from "Pretty Good" Athletes

Proprioception is the body’s ability to transmit a sense of position, analyze that information and react (consciously or unconsciously) to the stimulation with the proper movement (Houglum 2001). Put simply, it is the ability to know where a body part is without having to look.

Proprioception allows you to scratch your head without looking in the mirror or walk up a flight of stairs without having to peer at each stair. (Tarrant, 2003) Proprioception might be one of the major factors that separate the men from the boys - or more accurately the great from the pretty good athlete.


One Thing All Great Athletes Have in Common - And How Injury Can Quickly Decrease Performance

Think about it: look at the body control, the awareness of where they are and others around them, and the sport specific moves that the great athletes of our time are known for. The ability to turn and see the basket; dive, catch, and come up throwing; the quarterbacks that not only have amazing "field vision" but also the near instantaneous body control to avoid the tackler.

These proprioceptive abilities may be interrupted when there is an injury. Taken as a whole, proprioception includes balance, coordination and agility because the body’s proprioceptors control all these factors. Proprioceptors consist of both sensory and motor nerves that send and receive impulses to and from the central nervous system from stimuli within the skin, muscles, joints and tendons (Houglum 2001). These impulses transmit vital information, such as the amount of tension in a given muscle and the relative position of a body part during a given movement. An example of proprioceptive exercises is the use of a balance board after an ankle sprain. The unpredictable movements of the balance board teach your body to react without having to think about these movements.

For Optimal Performance, Proprioception Cannot be Overlooked or Overdone

More equipment designed to improve proprioception is on the market today than ever before. There are boards on round blocks, air “cushions”, boards on air cushions and foam rubber of varying thickness and shapes. There are balance boards, wobble discs, stability trainers, BOSU® Balance Trainers, and Thera-Band® Stability Trainers just to name a few. The improvement or restoration of proprioception should be a normal part of every athlete’s conditioning and/or reconditioning protocol. For further clarification, go to How to Improve Proprioception by Michelle L. Tarrant, Med. For an excellent selection of proprioceptive supplies go to Sports Health at www.sportshealth.com.

Phil Hossler, ATC has been an athletic trainer on the scholastic, collegiate and Olympic levels. He has authored 4 books and numerous articles and served as an officer in state and regional athletic training associations for 20 years. He is a member of four halls of fame including the National Athletic Trainers’ Association’s.

Tuesday, October 23, 2012

Teen Hydration FAQ's

Get the Facts on Teen Dehydration

Q: Should you drink during a workout, rinse your mouth or pour water on your head?
A: You can do all of them. Replacing fluids lost during exercise is critical to performance, stamina and comfort. Losses as little as 3% body water can have a negative impact on stamina and performance. Spraying your mouth is comfortable but does very little for actual body needs. Since up to 40% of heat lost during exercise is via your head and scalp, proper ventilation and cold water on your head and neck can be both helpful as well as overall health protecting.

Q: What is the best drink?
A: Cold water is good; sports drinks are very useful for those long days or double practice days. Avoid carbonated drinks before and during exercise. Avoid drinking excessive amounts of carbonated drinks which contain sodium and/or caffeine since they may produce dehydration.

Q: How much should you drink each day?

A: Young exercising teens should drink 10-12 glasses of water or sports drinks (before and during) as well as juices (after). You cannot count on your thirst though since it shuts off before the body is fully replenished. Q: How common is dehydration?
A: Fortunately not very common. Dehydration develops over a couple of days. This gradual loss of sufficient fluids can produce muscle cramps, headache, dizziness and fatigue. It can occur in any sport, indoors or outdoors. You should return to 90-95% of your weight by the following day; if not you have not replaced sufficient amounts of fluids. Check the color of your urine. It should be the normal light yellow not dark.

Q: What else can be done to help acclimatization?
A: When given the chance to rest....rest. Seek cool, air conditioned areas in the summer heat after practice. Eat plenty of fruits. Low fat chocolate milk after practice has the added benefit of providing protein to repair sore muscles, fluids to help hydrate and carbohydrates to restore energy.

Shop hydration products from Sports Health >>

Remember: Proper hydration begins at home!
Come to practice well hydrated and go to bed well hydrated!
Phil Hossler, ATC has been an athletic trainer on the scholastic, collegiate and Olympic levels. He has authored 4 books and numerous articles and served as an officer in state and regional athletic training associations for 20 years. He is a member of four halls of fame including the National Athletic Trainers’ Association’s.