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Shin Splints

A focus on Shin Splints

What are Shin Splints?

Medically known as Medial Tibial Stress Syndrome, ‘shin splints’ is a term used to refer to pain along the inside of the tibia or shin bone. The exact pathology that causes the pain of shin splints is unclear and imaging such as ultrasound produces similar results when compared to persons who don’t have shin splints. The pain of shin splints is usually felt over the area where two particular muscles insert into the tibia. These are Tibialis Posterior and Flexor Digitorum Longus, these muscles act to extend the foot and toes respectively.

Despite having an unclear pathology, this can be a debilitating condition that can impact activity levels significantly. The pain can be quite limiting and may even be an early warning sign of a stress fracture and this will need to be ruled out by a medical professional.

What are the symptoms?

Shin splints are typified by persistent leg pain, usually the inside of the shin, halfway down the lower leg. The pain might be felt during exercise or directly after. Some people experience a dull ache over their shin that lasts for quite a while after exercise stops, while for others the pain may be sharp and fades quickly.

The pain is often progressive, becoming worse with shorter distances. Eventually, shin splints can severely impact activity levels as the pain becomes too severe to continue exercise.

What are the causes?

Shin splints are predominantly seen in runners who increase their distances quickly, often while training for an event. Activities that require repetitive weight bearing of any kind, such as marching or high impact sports have also been shown to cause shin splints. Although the pathology of shin splints is unclear, studies have been able to identify certain risk factors that may predispose someone to shin splints. These include:

  • An abrupt increase in activity level
  • Improper footwear and support
  • Higher BMI
  • Training on hard or uneven surfaces
  • Tight calf muscles
  • Flat feet
  • Females are more likely to develop shin splints than males
  • Increased external rotation range of the hips
  • Prior history of shin splints
  • Wearing or having worn orthotics

How can physiotherapy help?

The first step for your physiotherapist will be to address any contributing factors and help to adapt your training program to a level that is optimum for you. A period of relative rest may be recommended along with a targeted strengthening and stretching program for any tight or weak muscles.

Switching to low-impact activities such as swimming, cycling and yoga may also help to maintain fitness during recovery. Your running technique will be analyzed and any training errors may be corrected. When getting back into your training routine, it is usually recommended that distances are not increased by more than 10% per week as this allows the tissues of the body to react to the increased demands and adapt accordingly.

The information in this article is not a replacement for proper medical advice. Please speak to one of our physiotherapists for advice on your individual injury.

Caboolture Physical Therapy Centre - serving people in need from the following areas: Caboolture, Morayfield, Elimbah, Wamuran, Beerburrum, Beerwah, Glasshouse Mountains, Toorbul, Donnybrook, Ningi, Woodford, Kilcoy, Bribie Island, Goodwin Beach, Sandstone Point, Banksia Beach, Bongaree, Bellar, Woorim, Burpengary & Beachmere.
Spondylolysis and Spondylolisthesis

What Are Spondylolysis and Spondylolisthesis?

One of the primary roles of the spine is to protect the spinal cord. This means that the spine needs to be strong while maintaining the flexibility required for a movable trunk. While the spine is very sturdy, spinal injuries do occur. Health professionals often use terms to describe and classify injuries of the body, two of these terms that you may have heard are Spondylolysis and Spondylolisthesis.

What are they?

Spondylolysis refers to a stress fracture of the pars interarticularis of the vertebra. This is the part of the vertebra that connects the body of the vertebra with the rest of the vertebra that surrounds the spinal cord. A separation of this fracture where the body of the vertebra is displaced forwards or backwards is called a spondylolisthesis.

Spondylolisthesis is a progression of spondylolysis and is given grades to classify its severity. Both spondylolysis and spondylolisthesis commonly affect the fourth and fifth lumbar vertebrae, found at the base of the lower back.

What are the causes?

Spondylolysis and spondylolisthesis can be a result of trauma with the spine being moved forcefully into extension, particularly in younger people. Certain sports such as gymnastics, football and weightlifting require repetitive backward movements of the spine and this can eventually lead to a stress fracture of the pars interarticularis. Growth spurts in teens have also been known to be responsible for the development of these conditions.

In older adults, common causes of spondylolysis or spondylolisthesis are degenerative changes in the spine due to aging, osteoporosis, infection or even a tumour. Some people have a genetic vulnerability in this area of their spine making them more susceptible to developing spondylolysis and then spondylolisthesis.

What are the symptoms?

Many people with spondylolysis and spondylolisthesis may be asymptomatic, which means they perform their normal activities without experiencing any symptoms. However, when symptoms do occur, common complaints are pain and tightness, much like a muscle strain, spreading across the lower back. This pain may be eased by bending forwards and aggravated by walking, running or leaning backwards.

In more progressive cases of spondylolisthesis, the shift of the vertebral body can cause narrowing of the spinal canal that can lead to nerve compression. This may cause hamstring tightness and even numbness and weakness of the lower limbs, affecting gait and daily activities.

How can physiotherapy help?

Your physiotherapist will work closely with you and any relevant medical professionals to determine exactly what is needed for your particular condition. Severe instability in the spine may require stabilization surgery, however this is rare and in most cases, symptoms of spondylolisthesis can be improved with regular physiotherapy management.

Physiotherapy that focuses on strengthening and improving the flexibility of both the lower back and the abdominal muscles has been shown to have positive effects on both pain and function for those with symptomatic spondylolysis and spondylolisthesis.

Speak to one of our physiotherapists for more information regarding your individual condition. The information in this article is not a replacement for medical advice.

Caboolture Physical Therapy Centre - serving people in need from the following areas: Caboolture, Morayfield, Elimbah, Wamuran, Beerburrum, Beerwah, Glasshouse Mountains, Toorbul, Donnybrook, Ningi, Woodford, Kilcoy, Bribie Island, Goodwin Beach, Sandstone Point, Banksia Beach, Bongaree, Bellar, Woorim, Burpengary & Beachmere.

Tibialis Posterior Tendinopathy

The tibialis posterior muscle sits just inside the shin, halfway up the lower leg. The muscle travels downwards and runs along the inside of the heel, with the tendon attaching at the base of the arch of the foot.

The role of the tibialis posterior muscle is to move the foot and ankle downwards and towards the midline of the body. The tibialis posterior also helps to support and maintain the arch of the foot. Tendinopathy is a broad term that refers to painful pathologies of the tissues in and around a tendon, usually related to overuse.

What are the symptoms?

Signs and symptoms of tibialis posterior tendinopathy can include pain and/or stiffness over the tendon, clicking or ‘crepitus’ sounds with movement and swelling. Pain can be felt both when you touch the tendon or with movements that involve contraction of the tibialis posterior muscle, such as when going up on to your toes, hopping or running.

As the condition progresses, the tendon might become weaker and elongated, providing less support to the arch of the foot. This might become more noticeable over time as the lack of support in the foot further aggravates the damaged tendon.

Pain may become so severe that eventually running and even walking becomes too painful. In some cases, the affected tendon may be weakened but painless. For some, a complete tear of a weakened tendon can be the first sign that anything is wrong.

What are the causes?

Like most tendinopathies, overuse and biomechanical errors are the main cause of tendon pathology. Prolonged or repetitive activities that place excessive strain on the tibialis posterior tendon can cause degeneration and disorganization of collagen fibres within the tendon.

Excessive pronation or rolling in of the foot while walking can place the tendon under extra stress as it acts to support the arch. Unsupportive footwear can exacerbate this process as it allows the foot to roll inwards. Often, a person may not have any issues until they begin to increase their training. If tendons are subjected to too much load too quickly, they can begin to break down, developing into a tendinopathy.

Being overweight, muscle weakness or tightness, poor warm up and insufficient recovery periods can all contribute to the development of tendinopathy. As you might expect, runners are most affected by this condition, along with other athletes of sports that require lots of running. Non-athletes can also be affected by day-to-day activities causing tendinopathy.

How can physiotherapy help?

Your physiotherapist can help by making an accurate diagnosis, which can be confirmed by MRI or ultrasound. Your physiotherapist can also identify which factors may be involved in the development of this condition, helping to address them and reduce pain as quickly as possible.

For most tendinopathies, a period of relative rest is required and a graded training program to help strengthen the tendon has been shown to have the best evidence for recovery. Other interventions such as ultrasound, ice or heat treatment, soft tissue massage, stretching and joint mobilization may be used. Arch support taping, biomechanical correction, bracing and footwear advice may also be added.

 

The information in this article is not a replacement for proper medical advice. Always see a medical professional for advice on your individual injury.

Caboolture Physical Therapy Centre - serving people in need from the following areas: Caboolture, Morayfield, Elimbah, Wamuran, Beerburrum, Beerwah, Glasshouse Mountains, Toorbul, Donnybrook, Ningi, Woodford, Kilcoy, Bribie Island, Goodwin Beach, Sandstone Point, Banksia Beach, Bongaree, Bellar, Woorim, Burpengary & Beachmere.

When will my injury heal?

When injury strikes, the first thing that most of us want to know is ‘how long will this take to heal?’

Unfortunately, the answer to this can be complicated and requires at least a little understanding of how the different tissues of the body heal. Each of the tissues of the body, including muscles, tendons, ligaments and bone, heal at different speeds and each individual will have some variation on those times as a result of their individual health history and circumstances.

Understanding the type of tissue injured and their different healing times is an important part of how your physiotherapist approaches treatment and setting goals for rehabilitation. On an individual level, a patient’s age, the location and severity of the injury and the way the injury was managed in the first 48 hours all affect the healing times of an injury. Unfortunately, as we age, injuries do tend to heal more slowly than when we are young. Any medical condition that reduces blood flow to an area, such as peripheral vascular disease, can also reduce the body’s ability to heal at its usual rate.

There are some guidelines that can be followed when predicting how long an injury will take to heal based on the tissue type affected. Muscles are full of small capillaries, giving them a rich blood supply, and as such, they have a comparatively fast healing time with 2-4 weeks for minor tears. This time will be extended for larger tears and more complicated presentations.

Ligaments and tendons have less access to blood supply and tears to these tissues generally take longer to heal. Larger or complete tears of all soft tissues, may not be able to heal themselves and in rare cases, surgery may be required for complete healing to occur. Similarly, cartilage, the flexible connective tissue that lines the surface of joints is avascular, which means it has little or no blood supply. To heal, nutrients are supplied to the cartilage from the joint fluid that surrounds and lubricates the joint.

While the different tissues of the body all have different healing times, they do follow a similar process of healing with three main stages, the acute inflammatory phase, the proliferative stage and finally the remodelling stage.

The inflammatory stage occurs immediately after an injury and is the body’s primary defence against injury. This stage is identifiable by heat, redness, swelling and pain around the injured area. During this phase, the body sends white blood cells to remove damaged tissue and reduce any further damage. This stage usually lasts for 3-5 days.

The proliferation stage is the phase where the body starts to produce new cells. Swelling and pain subside and scar tissue is formed that eventually becomes new tissue. This stage usually occurs around days 7-14 following an injury.

The final stage, known as the remodelling stage is when the body completes healing with the reorganization of scar tissue and the laying down of mature tissue. This stage usually occurs roughly two weeks after the initial injury is sustained.

At each stage of the healing process, a different treatment approach is required and your physiotherapist can help to guide you through your recovery. Ask one of our physios at Caboolture Physical Therapy Centre to explain how your injury can be managed best and what to expect in your recovery process.

Caboolture Physical Therapy Centre - serving people in need from the following areas: Caboolture, Morayfield, Elimbah, Wamuran, Beerburrum, Beerwah, Glasshouse Mountains, Toorbul, Donnybrook, Ningi, Woodford, Kilcoy, Bribie Island, Goodwin Beach, Sandstone Point, Banksia Beach, Bongaree, Bellar, Woorim, Burpengary & Beachmere.

Rotator Cuff Tears

What is a Rotator Cuff Tear?

A rotator cuff is a group of four small muscles that surround the shoulder joint. Their tendons attach to the humerus, close to the joint line and act as a cuff that provides support and control to the shoulder. They also play a primary role in creating rotational movements of the shoulder.

Rotator cuff tears are common injuries and can occur in any of the four muscles, usually at their weakest point, which is the junction between the muscle and tendinous tissue. These tears are common in racket and throwing sports and are one of the leading causes of shoulder pain. The prevalence of rotator cuff tears increases as we age due to age related degenerative changes in the tissues.

What are the symptoms?

Many people have rotator cuff tears with no symptoms at all, and are unaware of the injury. However, for others, these tears can be very painful and lead to difficulty moving the shoulder, particularly with overhead activities. They may find their range of movement is restricted and the arm feels weak. They often experience pain that radiates down to the arm and pain at night, which can cause sleep disturbances.

It is interesting to note that the size of a tear is not necessarily related to the amount of pain and dysfunction experienced, with small tears sometimes creating large problems and large tears going unnoticed.

What are the causes?

Movements that create a rapid twisting motion or over-stretching of the shoulder often cause rotator cuff tears. The most common mechanism of injury is a fall onto an outstretched hand. These tears can be acute or chronic, developing over a period of time or related to degenerative changes, where tendon tissue is damaged by everyday activities due to reduced strength and elasticity.

Other causes of rotator cuff tears include overuse, lifting or carrying heavy objects and repetitive overhead activities. Poor biomechanics can cause weakening of the shoulder’s tendons with insufficient blood supply to the rotator cuff over a long period of time. This can leave the tendon more susceptible to injury as is a significant contributing factor to the development of tears and the outcomes of recovery.

How can physiotherapy help?

The primary objectives of physiotherapy treatment are to reduce pain, increase the range of motion and strength and improve shoulder function. Your physiotherapist will work with you to help set goals assist to reach them with a targeted rehabilitation program, manual therapy and education on how to achieve the most from your recovery.

While severe tears are often repaired surgically, research is increasingly showing that even in severe tears, a comprehensive rehabilitation program under a physiotherapist leads to similar outcomes to surgery. For this reason, a conservative approach guided by a physiotherapist is often recommended to patients as the first option for treatment. The exact time frame of treatment and recovery will vary from person to person and is affected by a variety of factors including if surgical repair was chosen, the severity of the injury and function prior to injury.

This information is not a replacement for proper medical advice. Please get in touch with Caboolture Physical Therapy Centre for advice on your individual injury.

Caboolture Physical Therapy Centre - serving people in need from the following areas: Caboolture, Morayfield, Elimbah, Wamuran, Beerburrum, Beerwah, Glasshouse Mountains, Toorbul, Donnybrook, Ningi, Woodford, Kilcoy, Bribie Island, Goodwin Beach, Sandstone Point, Banksia Beach, Bongaree, Bellar, Woorim, Burpengary & Beachmere.