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"shin splints"
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"shin splints" - January 16, 2006 4:44:00 PM
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ginger
Posts: 647
Joined: February 26, 2005
From: Melbourne Victoria
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Case #2 Shaun P. 38 yo. textile worker, 88kgs 182 cms ,occasional runner, recently increased running frequency and distance with a personal trainer. Referred by the trainer with a note heading shin splints please fix.
Initial consult 22/12/05. C/o bilateral medial mid to lower shin area pain, R>L. four weeks of slowly increasing difficulty with running, now stopped running due to near constant pain in shins. No injury in last ten year picture.
No previous HX of shin pain , though had C/o calf tightness R>L on previous occasions, limiting running. Some LBP reported though not at present.
OBS, palpably tender into tib post areas of R>L lower limbs. Pronates slightly , R=L. wears orthotics occasionaly when running , but not at other times, recently removed from shoes as felt to be a contributor to shin pain. ( no improvement with no orthotic )
SIJ function nil R, poor L
Hypomobile painfull to mobs R>L L234, with less at L5. Tight sciatic dura, generally poor flexibility.Poor abdominal strength.
Treatment#1 22/12/05
Mobs R=L L2345 5 mins each, to moderate resolution.
SIJ mobs, bodyweight , 2x30 secs full SIJ movements restored.
Sciatic dural stretches, ballistic. 4x8 in long sitting, pushing head to knees, good response with immediate improvements to dural length .
Self stretch strategy commenced.
instructed to wear orthotics for increasing periods till full time over coming three weeks
Treatment#2 6/1/06 reports able to run 3-5 kms twice since last Rx, with minimal discomfort to shins. Stopped when pain increase noted ( as per instructions).
Rx full SIJ mvts noted. Improved sciatic /hams length noted. Mobs L2345 l=R 5 mins each. Dural stretches as per Rx #1. Now wearing orthtics up to 6 hours daily.
Treatment#3 12/1/06
Able to run 5kms three times weekly with no shin pain, full time orthotics use with no complaints of difficulty.Occasional low back pain after each treatment lasting 24 to 48 hours, not severe.
The important issue here was a combination of Poor / nil SIJ function related to poor use of orthotics and his history of general lumbar stiffness.Along with specific hypomobility and related inflammatory events producing referred pain ( increasing with fatigue) to a L34 distribution.
Discharged after L2345 mobs L=R 2 mins each and suggestions for abdominal exs, stretching etc.
Comments invited
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: "shin splints" - January 16, 2006 5:20:00 PM
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TLB
Posts: 346
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From: Arizona
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Ginger,
Can you explain the SIJ mobs with full body weight 2x30 seconds?
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Todd
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Re: "shin splints" - January 18, 2006 11:04:00 AM
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ginger
Posts: 647
Joined: February 26, 2005
From: Melbourne Victoria
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Todd, to restore full rearward rotations of os on sacrum I've found the most successfull and immediate normalisations with my bodyweight( 80kgs) applied direct to the sacrum. Patient prone with pillow to support pelvis, stand barefoot on sacrum with one foot over the other, repeated downward forces with alternate flexion extension of the knee produces a forward movement of the sacrum . 2x 30 second series of foot mobs does the job in most cases. Once pronation control is effected with orthotics , the SIJ function remains normal. ( use the "stork " test )
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: "shin splints" - January 18, 2006 12:18:00 PM
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SJBird55
Posts: 2292
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From: Michigan
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What? So, you're basically standing on one foot? I am lost... can you get a picture of that for me? Who's flexing who's knee? Is the patient flexing and extending or are you? Hmm, I think you are the one squating and unsquating because prone knee flexion of a patient wouldn't change the SIJ. How the heck do you keep your balance? Ginger, you have got to put a picture in this thing, because you know, a picture says a thousand words... And what does a therapist do if a therapist isn't 80 kg?
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Re: "shin splints" - January 18, 2006 2:01:00 PM
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ginger
Posts: 647
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From: Melbourne Victoria
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SJ I see George got a gong at the industry film awards night, you must have had kittens waiting for his interview on the red carpet. Our George is due to cut the lawns today, he's unimpressed.
Not 80 kgs?, I am not sure what the safe limits would be for more than that, or what the lower weights would mean in terms of best effect, trial and error.
Yes it's me doing the flex/ext of the knee, in order to produce mobs at a frequency of around 2 per sec.It's more an unweighting and weighting rather than a squat. No jumping up and down tweety, just careful balanced movements to force the sacrum forward.
I'' do what I can about the picture.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: "shin splints" - January 19, 2006 1:25:00 AM
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SJBird55
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From: Michigan
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ginger, I missed it... darn it. Now I'm going to be sulky all day knowing that I could have seen him. LOL
Yep, you need a picture. It sounds like basically when you squat your weight shifts forward onto your toes. But... how is it that you can keep your balance - we've got some chunkers here and if I tried that the gluteus MAXIMUS would probably toss me off. LOL I need to see a picture. Don't your ankles wobble in an inversion/eversion kind of way to keep your balance too?
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Re: "shin splints" - January 19, 2006 1:39:00 AM
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JLS_PT_OCS
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From: USA
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So, kind of a posterior to anterior mob of the sacrum on the ilium?
J
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Jason Silvernail DPT, OCS, CSCS
"It isn't what you're able to do that requires your courage but rather what you have come to understand and are willing to express." - Barrett Dorko,PT
**I no longer post on RehabEdge**
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Re: "shin splints" - January 19, 2006 11:00:00 AM
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ginger
Posts: 647
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From: Melbourne Victoria
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you got it Jason,
its not difficult to balance on the odd sacrum tweety, I do hold on to the wall however, haven't fallen off ever. Occasionaly I'll have to use a manip of the SIJ on the rare occasion this method fails, which I described to everyones great amusement once before on this forum.
george says hi.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: "shin splints" - January 19, 2006 1:23:00 PM
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SJBird55
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From: Michigan
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Ginger, you have to post a picture. LOL
I can't say I have ever tried to balance on a someone's sacrum on one foot. I know I shouldn't joke, but now seriously, how reliable is your foot at determining that it is on the sacrum? My right hand is pretty darn good at palpating, but honestly, my left hand has a dumb streak in it. I don't believe my feet have any capability to palpate and know squat... maybe I'm wrong though.
Tell George "hi" and that I recommend that he always rake the clippings. LOL You know, I can't believe I missed George. I had a patient asking me what I thought of the interview - and to think I missed it. I forgot all about it.
Ginger, figure out how to do the picture thing - or if you can't, email me one. A close up of where your foot is placed and a distance one of your performance - obviously burst photos.
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Re: "shin splints" - January 19, 2006 9:55:00 PM
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Randy Dixon
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Haven't you guys ever seen a foot massage? That is a massage done by the feet? They're popular in Asia, they just run a rope down the room to hang onto and the guy, or usually pretty girl, walks up and down your body.
I have my daughter do this for me.
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Re: "shin splints" - January 20, 2006 7:54:00 AM
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nari
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From: Australia
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Funny thing about that, Randy - I taught my daughters when they were smaller to do the same. Particularly balancing over the SIJs and shifting weight; it is quite easy to do and feels remarkably good. I think ginger might use more weight...but you feel light and free to move afterwards. All sorts of silly 'pops' occur while the walking or standing is underway; which impressed them no end.
It is actually a well known practice amongst SE Asians.
SJ, it is easy to know where your foot is in relation to the sacrum or anywhere else, even with eyes closed. Feet are surprisingly sensitive and give good feedback......
Nari
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Re: "shin splints" - January 20, 2006 11:12:00 AM
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SJBird55
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From: Michigan
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I can honestly say that I've never physically walked on anyone. That could be a good pick up line... "By any chance, would you mind if I walked on you? In particular, I'd really like to see if I can balance one one foot just above your buttocks. You'll feel so much lighter and free to move afterwards" LOL
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Re: "shin splints" - January 22, 2006 11:56:00 AM
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ginger
Posts: 647
Joined: February 26, 2005
From: Melbourne Victoria
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SJ, what's a burst photo?
I'll have my secretary look into some photo opportunities that come up tomorrow and post something, I'll have to get my funny hat out.
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Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: "shin splints" - January 22, 2006 2:30:00 PM
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SJBird55
Posts: 2292
Joined: May 10, 2004
From: Michigan
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Well, if you have a digital camera - you can have burst photos... say 4 or 5 photos taken really quickly - you push the button once, and the camera just does a series of photos.
Are you bald, ginger? ;)
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Re: "shin splints" - January 22, 2006 2:57:00 PM
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FLAOrthoPT
Posts: 1011
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From: West Palm Beach
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hair follicle challenged is the more PC term...
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Re: "shin splints" - January 22, 2006 2:57:00 PM
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ginger
Posts: 647
Joined: February 26, 2005
From: Melbourne Victoria
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Ok I think my camera does that, a little balding at the crown tweet, I hardly ever have to do the hair flick anymore , I have a number one cut once a month. ( bad for my neck anyhow).
_____________________________
Ubi est mea anaticula cumminosa?
The Grand Pediculator
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Re: "shin splints" - January 23, 2006 7:51:00 AM
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SJBird55
Posts: 2292
Joined: May 10, 2004
From: Michigan
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Ben, Ben, Ben... I'll try to remember that (it is quite a tongue twister though). LOL
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Re: "shin splints" - May 16, 2006 9:10:00 AM
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gomez2
Posts: 51
Joined: May 5, 2005
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what do his hips look like? Alignment of the hips have been key with tx of shin splints at my clinic.
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Re: "shin splints" - November 2, 2006 8:34:00 PM
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joelkphysio
Posts: 27
Joined: September 25, 2006
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I would try to video this guy running and watch it in slow motion to see if the glut med/ER has a role in the "shin splints". If he is only having problems running, watch him run.
Look at how he is able to handle a proper lunge, lunge jump, 1 leg squat...Break apart the running stance phase and look at how the tibia medially rotates (im assuming) and the foot pronates.
DOes a low-dye taping help?
J
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