Tuesday, June 23, 2015

Wrist Pain

Have you ever suddenly realized that you’ve been taking a body part for granted? You know, you try a new workout and the next day you’re saying to yourself (or anyone who will listen), “Muscles I didn’t even know I had are sore!” Or you stub your little pinky toe and end up walking with such a limp that those around you think surely you’ve broken your leg instead. Well, that’s how I feel about wrists and wrist pain. I was a gymnast growing up and wrist pain has bothered me on and off since then. Every time it flares up though, I’m always shocked by it. I’m surprised at just how many little tasks cause pain and remind me that my wrist hurts. Then, undoubtedly the pain goes away and I forget all about it until the next episode. Smart, I know. Anyway, all day everyday we use our wrists for billions (ok maybe that’s an exaggeration) of movements and tasks, and it’s not until you have pain that you realize just how heavily you rely on them.  Lifting, grasping, typing, writing, working out…even flipping pancakes…all require healthy, mobile, pain free wrists. I mean in all seriousness, if you can’t scoop ice cream or pick up your kids without pain then we’ve got a problem. Let’s talk about one cause of wrist pain and how it can be treated. But first, some anatomy….

Now the wrist itself may look like a pretty small, simple joint, but in reality it’s like the major highway of body parts.  In one very small space you’ve got 8 wrist bones, a bunch of muscle tendons, arteries, nerves, and veins. You’ve also got a band of ligament squeezing most of this into a very tight space, with very little wiggle room. When you take all of this into consideration, you can imagine that there are a ton of structures that can actually cause your wrist pain. Surprisingly enough, the first cause of wrist pain that we’ll talk about today hardly involves the wrist at all.  

You’re probably thinking, “What could possibly go on OUTSIDE the wrist that gives me pain IN my wrist. That’s just silly.” Well maybe you didn’t think that at all but let’s talk about it anyway. One of the most prominent wrist injuries actually comes from the forearm. You’ve basically got two compartments of muscle in the forearm: the flexors and the extensors. If you sit and lay the backs of your hands on your thighs, palms up, and bring your hands/fingers toward your body, you are activating the flexor muscles. Each of the muscles in this group start at the bony point on the inside of your elbow when your palm is up, and travel through the forearm until it attaches down in the hand/wrist. If you turn your hands over, palms down, and lift the fingers/hands back up toward your body, you are engaging the forearm extensors. These muscles all start on the outside of the elbow and travel down the forearm into the wrist/hand. The tricky part of all of this is that when a muscle or a tendon becomes irritated, you usually feel it wherever it attaches to the bone/joint and not necessarily in the muscle belly itself.  This means that you can have a problem with your forearm muscles and have wrist pain. What a sick joke huh? This also means that if you overuse your forearms by say, typing all day long at your desk, or working with your hands, or using all of your electronic devices, you can end up with wrist pain. Not too many people spend a day at their computer right? Or on their phones or ipads? No way!

So how does this all happen? To provide you with one example: you sit at your computer typing all day long, with your forearms working hard to allow you to keep your hands in the proper position. Over 8 hrs a day, 5 days a week, for however many years, your forearm muscles makes sure your wrists can move. Just like any muscle, when they’re overused they can start to build up scar tissue, adhesions, or trigger points (irritated bundles of muscle that can refer pain other places). To these muscles, repetitive typing or overuse is a form of trauma. It’s a very small trauma, but a trauma nonetheless. Eventually, your muscles aren’t moving the way they should because of the scar tissue or the adhesions or the trigger points. The muscles start tugging in weird ways on the tendons down at the wrist and the tendons become irritated. Irritation leads to inflammation (think tendonitis) and inflammation leads to poor wrist range of motion and pain. As if that weren’t enough, some of these muscles attach to the small wrist bones themselves, and may start to tug on those bones. This doesn’t allow the bones of the wrist to move like they should, causing more inflammation and restriction and pain.

Not so coincidentally, strain on these muscles can also cause pain on the inside/outside of the elbow itself through the same mechanism. If you’ve got some elbow pain take a look at Dr. Piretti’s article here.

But back to wrist pain. What can you do to address wrist pain coming from your forearms?

·             Rest: We can’t avoid some of the activities that cause our wrist pain, but there are a few that we can go without. That may mean you take a couple of weeks off from the gym or the sport that is flaring things up. I know that’s not what anyone wants to hear but sometimes you have to quit aggravating the area in order to let it heal. While you’re resting though:
·             Ice: Ice the forearm, ice the wrist, then ice them both again a couple more times. Part of the reason you have pain is because of the inflammation and one of the best ways to squash inflammation is to cycle ice on and off so the blood vessels change size and pump inflammation out. Usually 10min on, 20min off 3-4 times/day is a good place to start.
·             Muscle work: The muscles of the forearm should be evaluated for trigger points, spasm, and fascial adhesions/scar tissue. These sensitive spots in the muscle can be worked out by hand by your massage therapist or chiropractor, or a technique called Graston can be used to break up all the grit in the muscle and restore function. Ask your chiropractor if he or she is familiar with the Graston technique and can evaluate your forearms/wrists. It won’t be the best 5minutes of your day, but it’ll probably be the most productive. It’s a great way to get the muscles of the forearm to calm down and start functioning properly again.
·             Adjustments: Getting the bones of the wrist/elbow moving properly is crucial to decreasing potential inflammation in the surrounding area, and allowing the muscles to heal and do their jobs. Your chiropractor can assess these joints for you and restore motion to them if needed.

·             Ergonomics: If you can’t change the fact that you’re on your computer/ipad/phone all day, or the fact that you work with your hands, and those activities seem to be exacerbating your pain, it might be necessary to evaluate HOW you carry out these activities. Changes to your desk/computer set up can help take pressure off the forearms, elbows, and wrists. The same can be true for how you use your phone or other electronic devices. Sometimes the smallest tweak to your set-up or how you move can make all the difference. Both google and your chiropractor probably have some pretty good suggestions for you in this area.

When my gymnastics-induced wrist pain flares up, I go to all of these things to treat the problem. It may not be the most comfortable avenue but it sure is effective and gets me back on track quicker than anything else I’ve found. As we said before though, that wrist pain of yours can come from plenty of other places. We’ll be sure to explore those options in the coming weeks. Until then, see if it’s “just” some stubborn old forearm muscles and have someone evaluate them for you!

Thursday, April 2, 2015

Jumpers Knee/Tendonitis

So, I spent the weekend before last watching March Madness. By “spent the weekend watching” I mean that it was on at my cousin’s house while I was there doing laundry for 2hrs, but thankfully it was enough to inspire this week’s blog. Duke was playing San Diego State and there was a lot of sprinting, cutting, and jumping happening. Obviously my chiropractic brain started thinking about knee injuries. It actually made me think of one injury in particular given the season we’re entering into. According to the calendar at least, Spring is here and I’m seeing more and more runners logging their miles through the streets of Boston now that the Earth has started to thaw (fingers crossed). The overuse knee injury that plagues runners and jumpers most commonly this time of year is Patellar Tendonitis, or Jumper’s knee. It sneaks up on you, and can be surprisingly painful, so let’s take a second to talk about the injury and some ways to treat it.

A lot of people who show up to the office with knee pain caused by this injury are just confused. They haven’t tripped, they didn’t run into anything, and they can’t really pinpoint when the pain started. All they know is that their knee has been bothering them during their last few runs or pick-up basketball games. The hardest thing for people to wrap their minds around is that the pain associated with this injury is caused by a combination of cranky muscles and tendons, and not some major tear or fracture. Patients suffering from this injury present with stories so similar to one another that sometimes it feels like déjà vu. They sit on my exam table, point to the front of their knee right under the knee cap, and tell me they haven’t “done” anything but it sure does hurt when they exercise. When I ask how it feels to go up and down stairs they look at me like “How did you know?!” While I wish it was because I am brilliant and can also read minds, the truth is that the nature of this injury dictates what activities are painful, and stairs are almost always one of them.

When we’re talking about the knee, there are a couple of muscle groups to consider. Some of the muscles of the thigh/quad attach from the pelvis to the femur/thigh bone, and others attach from the femur/thigh bone to the shin bone. It is these muscles, the ones that cross over the knee on their way to the shin, that create movement at the knee joint. When the muscles of the quad contract, they extend the lower leg out straight. The opposite happens when the muscles of the hamstring contract. This brings your heel towards your buns.  For now, let’s focus on the muscles in the quad.

The main muscles of the quad are the rectus femoris and the vastus lateralis, medialis, and intermedius. They are all responsible for extending the knee and all play an important role in walking, jumping, running, and squatting as a result. The rectus femoris is particularly important because it attaches up into the hip and is important in swinging the leg forward while walking/running. It also travels down to the knee where it surrounds the kneecap before it turns into the patellar tendon and attaches to the shin bone. You can imagine how a muscle that crosses not one but TWO major joints is probably both very important and also under a lot of stress. This is especially true when it comes to the point at which the muscle attaches to the shin bone below the knee. Any overuse of the muscles (think runners with constant knee flexion and extension through their stride, basketball players jumping AND running, etc) can irritate that attachment point and cause tiny tears, inflammation, and weakness in the tendon, resulting in knee pain. Any imbalance of the muscles of the quads (or even the hamstrings/gluts for that matter) that affects how they work can make things even worse. The muscles start contracting in ways they aren’t meant to, and your body reacts with irritation and discomfort in that patellar tendon right below the kneecap. Eventually, the biomechanics of your knee are just “off” enough to cause that cranky, nagging  pain that you’re feeling.

So, how do we diagnose Patellar Tendonitis? Well, we rule out the bigger/badder stuff first. We use orthopedic tests to figure out if anything else can be causing your pain. Sometimes we take X-rays to make sure the bones aren’t involved. The rest of our diagnosis comes from testing the muscles for imbalances, assessing the joints of the knee for motion or lack thereof, and figuring out where the tenderness/pain is coming from.

Now the important part: How do we fix it?

Rest: There isn’t an athlete on the planet that likes to be told to rest, but sometimes it’s necessary to let things heal. Now, 2 weeks of rest won’t fix the cause of the injury, but it will help with the pain and inflammation.

Foam Rolling: I’m sure that you’ve seen someone at your gym rolling around on one of these over-sized pool noodles. They’re great for working through muscles that are so tight that stretching just isn’t going to cut it. If you’re tight enough it might feel like torture, but it works to loosen up both the muscle and the covering of the muscle that tends to develop adhesions and scar tissue over time. This allows the muscle to work more appropriately and takes stress off of that cranky insertion point we’ve been talking about. To use it, put it on the floor and lower yourself onto the roller so that your upper body is supported by your forearms in a plank position, and your lower body is supported by the roller under your quads (perpendicular to your body) with your feet off the ground. This probably WON’T feel good. I’m sorry! The goal is for you to roll up and down your quads 15-20times in this position. If it’s too much pressure, feel free to put one foot on the ground while you roll out the other leg to take some of the pressure away.

Graston: If this isn’t the first blog of mine that you’ve read, you’ve probably heard me talk about Graston. It’s that soft tissue technique that looks like a medieval torture technique but is actually AWESOME for soft tissue injuries. Your chiropractor can use it to break up adhesions in the covering of the quad muscles or around the tendon just under the knee cap. It hurts, but it’s a really effective way to get the muscles contracting the right way, taking pressure off stressed out joints.  

Muscle imbalances: Because there aren’t too many ways to tackle this one yourself, you may want to consult with your chiropractor. You may have thought that your chiro was just there to address your low back and neck pain, but we can do knees and extremities too! We are able to figure out which quad muscles are doing what, and target them accordingly. I’d love to tell you there’s a magic formula for everyone’s Jumper’s knee, but I’d be lying to you. Sometimes we need to put you through different squatting routines, practice proper sit-to-stand technique, or add some strengthening/stretches exercises to your gym routine. Proper function and biomechanics can make all the difference in this kind of injury.

Adjustments: Sometimes the way the joints of the knee are moving , or not, is the cause of the problem. If joints aren’t moving or gliding the way they should be, the muscle attachments in that area can get stressed, begin to work improperly, and create pain where that muscle inserts. In this case, irritated quad muscles due to restricted knee joints can result in inflammation just below the kneecap. The same is actually true for the low back and pelvis as well. If joints aren’t moving properly in these areas, the muscles that connect these areas into the legs get tight and irritated. If these muscles go to the knee, you might have yourself some knee pain. Ask your chiropractor to evaluate your spine and knees for good motion in the joints, and address them with adjustments if necessary .

The moral of the story is that knees are sensitive, and even if you haven’t sustained a major injury there are plenty of soft tissues and joints that can cause more pain than you’d expect. Take time to figure out where your pain is coming from, and get it treated before the real Spring season arrives. Stay healthy and injury free, and good luck with your March Madness brackets!!

Friday, February 27, 2015

Looking forward to Spring!!

Prepping for Spring

I woke up this morning, checked my weather app to see another 16 degree day, and threw a little temper tantrum in my head before even getting out of bed. Once I collected myself and returned to being an adult, I realized we’re all in the same boat. Everyone in Boston has endured an insane winter, and I’d be willing to bet that even the winter-lover’s enthusiasm is waning at this point. The good news is that (hopefully) it’s almost over. On February 2nd Punxsutawney Phil played a sick joke on all of us by seeing his shadow despite overcast skies, predicting another six weeks of winter. The great news is that at this point, there should be just three more weeks to go! That being said, instead of reviewing another injury this week I thought it might be nice to redirect our focus. Let’s set our sights on the nice weather just around the corner and talk about ways to prep for spring by staying healthy through the last bit of cold.

By the time the last month of winter rolls around, there’s a good chance we’ve succumbed to the harsh weather and hunkered down as we wait for the Earth to thaw.
Workout regimens have gone out the window with 6ft of snow barricading our doors and rendering the streets impassable. Healthy eating habits have taken a back seat in exchange for comfort food. The outdoor activities that usually clear our minds and help us to de-stress aren’t available, and curling up on the couch on a snowy day probably happens more often than it should when everyday is a snowy one. My point is, your ‘winter lifestyle” probably looks a lot different than the health-oriented one that you commit to the other three seasons of the year. And how could we blame you!? After all, bears hibernate during these months for a reason. Spring is fast approaching, though, so let’s get back on track. Let’s take inventory of how we’re feeling, thinking, eating, sleeping, and living so that we stay healthy and propel into the beautiful weather as our best selves.

SLEEP: I’m sure I’m not the first, or the fiftieth, person to tell you how important it is to get ample sleep each night. I also know it’s not always easy. It’s tough to find enough time in the day, or to pull yourself off the couch and out from under the three blankets keeping you warm, to get to bed. Sleep lets our bodies and minds recuperate from the day, prepare for the next, and maintain a healthy immune system. Think of it as the body’s quiet time to heal without having to worry about responding to stress, walking, talking, working, exercising, etc. It allows for tissue growth and repair, restoration of energy, and control of hormones. Inadequate sleep can throw off hormones responsible for appetite and feelings of fullness and hunger, confusing your body and causing you to overeat. It can affect levels of stress hormones, which in turn can cause weight gain and insulin resistance. It can also impact levels of growth hormones that allow for growth and development. In reality, it’s not just about feeling tired when you don’t get enough sleep. It’s much bigger than that!
            TO DO: Attempt to re-vamp your schedule to allow for adequate sleep each night. I know it’s difficult, but think of it as an investment to keep you healthy so that you can more effectively tackle your daily schedule. Start to wind down at least 30min before bed. That means electronics are turned off, lights dim, and to-do lists are put aside for the night. Instead of watching TV, try light reading or listening to calming music. Also, take stock of the light sources in your bedroom. Do you have good shades or blinds to keep it dark? Can you unplug some electronics that produce light? The darker you can get the room, the less stimulus you’ve got while trying to fall asleep and stay asleep.

MEDITATION: Some love to practice meditation, and others think it’s for the birds. Personally, I can relate to both. At first, I found the practice of meditation to be extremely frustrating. I started it as a requirement for one of my thesis projects at UMass. I remember thinking, “A person like me can’t sit still and “not think” for 10 minutes! This just isn’t for me.” I also remember realizing that it’s probably those of us who can’t imagine quieting our minds for just 10min a day that probably need it the most. After lots of practice, I have come to think of meditation as a reset button for my day. It doesn’t have to be 10min of beating yourself up for thinking about things when you’re not “supposed” to be thinking about things. It can be two or three minutes at the start, middle, or end of your day when you close your eyes, focus on your breathing, and regroup. Some biofeedback forms of meditation are even known for their physiological affects on the body, meaning your body is physically changing and relaxing in those couple of minutes. Many of the outdoor and exercise-related activities we turn to in order to relieve stress aren’t possible during the winter months. Unfortunately, stress doesn’t just disappear when it realizes our typical outlets aren’t available to us. Instead, try some meditation. After all, at the very least high stress = high cortisol levels = weight gain! More importantly, stress can compromise your immune system. You’ve made it this far without getting sick. Let’s keep it that way!
            TO DO: Because I’m a chiropractor, and not a meditation instructor (surprise!), I won’t try to pretend that I’m the best person to lead you through it. Instead, I’ll lead you to my friend Heidi Spear. She is an instructor at Kripalu in the Berkshires, and has created easy to follow CDs on meditation and relaxation, written books on mindfulness, and led workshops in yoga. You can find her work at http://heidispear.com, and even look her up on iTunes. If she can get my overactive brain to turn off for 5min a day, I’m confident she can help you too! You can also check out https://www.headspace.com for some free meditations to get started.

EXERCISE AND STRETCHING: When winter weather takes over, you can’t get outside for a run without frostbite, and your yoga class keeps declaring snow days, it’s easy to settle into a routine of inactivity. Finding ways keep moving and flexible are difficult, but not impossible. We want you ready to throw on your sneakers that first beautiful spring day, and we want you to stay strong and limber. Fitting in some form of activity each day not only provides all of the benefits that we know exercise to promote, but it also boosts the immune system, keeping you from getting sick this flu season. Staying active also helps prevent injuries from creeping up when you’re able to get back into your normal exercise routine.
            TO DO: Search for free workouts on-demand with your cable service. This way if you can’t get outside you can still sneak in some exercise. I’ve seen programs for yoga, cardio, strength training, and even zumba. And try your best to get outside for a walk when you can. Fresh air and sunlight do amazing things for your brain and your Vitamin D levels. If your gym is closed but you can still get around the city, see if other gyms in the area have a ‘drop in’ rate so you can take another class and try something new.

FOOD: Fresh fruit and veges are hard to come by during the winter months, and sometimes you just want a hearty meal to warm you up. Either way, diets change this time of year. Holidays bring sweets into the house, and no one wants to go grocery shopping when it’s below zero. As a result, we end up relying on a lot of processed and/or sugar-laden foods to fill up on. Remember this though, our bodies run on fuel in the form of food. They run on big macronutrients like carbohydrates, fats, and proteins, and smaller nutrients like vitamins and minerals. All of these things can be found in real food. When I say “real” I mean the things that come from nature, not from a box. Boxed processed foods, with ingredient labels full of unpronounceable chemicals and additives aren’t real. Not only do they fail to provide our bodies with the fuel necessary for us to function and stay healthy, but they also add harmful ingredients to our bodies in the form of chemicals, excess sodium/sugar, and unnatural dyes. Also remember, illness, sickness, and disease breed on things like sugar. When your body is already struggling to avoid whatever flu is going around this season, don’t give it any more ammo! Instead, give it whole foods that promote health, good digestion, and immunity.
            TO DO: Try shopping the perimeter of the grocery store one of these days. That means relegating yourself to the produce, dairy, and meat sections, and avoiding the aisles full of processed food. Obviously the different diets that you adhere to may exclude the diary and/or meat, but my goal is to simply help you fill your cart with more food from nature than from a box. The next time you grab chips for a snack, try grabbing some celery with some natural peanut butter instead. Swapping out a few typical food choices here and there can make a huge difference. By the time spring rolls around, you’ll be dying to stock up on fruits and veges at the farmer’s market on the weekends.

WATER: When you think about it, water is miraculous. Not only is most of the earth composed of water, but so are our bodies. Our skin, hair, and nails need it to stay healthy. Our digestive system doesn’t function without it. Our organs rely on it. The discs of our spine, the shock absorbers between the vertebrae, are made up of 86% water. Our muscles require it. Detoxification depends on it. Anyway, because we don’t get our daily intake of water from taking a shower or jumping in a lake, we must drink it! Drinking half of your body weight in ounces of water each day is the latest recommendation for staying adequately hydrated. And no, hot cocoa, coffee, soda, and fruit juice don’t count! Just water!
            TO DO: If the ‘taste’ of water doesn’t do it for you, there are some tricks you can use. Adding lemons or limes to your water can help, as can freezing berries in your ice cubes and adding them to your water bottle in the morning. That leads me to another point. Carry a water bottle with you, and fill it when it’s empty. Sometimes, people need to set water goals for themselves throughout the day. One bottle before lunch, one at lunch, one after, or whatever you need to get your daily intake. Either way, try actually focusing on this for the next week. In no time, it will become a habit, and your body will start to rely on it. And remember, by the time you realize you’re thirsty, you’re already dehydrated so stay ahead of the game!

ADDRESS INJURIES: One of the biggest bummers is watching everyone else put on their sneakers to get outside and exercise on the first beautiful spring day, and being sidelined by an injury. Winter treadmill running, slip and fall accidents, or starting a new activity too quickly can all lead to injuries that hang around through the spring. Take the time to address injuries now, rest if necessary, and rehab your body.
            TO DO: If you’ve got a spinal, soft tissue, or extremity issue check in with your chiropractor for an exam and evaluation. Depending on the injury, adjustments, strengthening, stretching, muscle work, taping, and/or stability can be used to address it. Catching it sooner rather than later is always better, making recovery easier and quicker.

SET GOALS: This is an easy one. What do you want to accomplish in the coming months? Is it better health? Is it a fitness or exercise goal? Is it a professional or family goal? The spring can be used like the New Year to start fresh and evaluate your life. But don’t wait until it gets here to set goals. Sit down and think about how you’d like to spend the next 6 months. That way, as soon as the weather allows us all to operate like fully-functioning adults again, you’re ready to go!

Hopefully this week’s blog has you looking forward to a spring of warmth, health, and wellness! Remember, the ground hog says just three more weeks…..

-Dr. Lauren Doscher

Friday, February 20, 2015

Shin Splints

Now to put it nicely, the city of Boston is kind of a mess right now. I know I’m not telling you anything you don’t already know, but between the arctic temps and one million feet of snow, we have seen transportation routes, daily activities, work schedules, and exercise options change drastically in the past month. One of the biggest things I’ve noticed is how few runners are out and about in the city. If I know anything about these athletes, I know that the inability to get outside for their daily or weekly routes around Boston is driving them crazy. You want to see someone have a mini crisis? Try telling a runner who is used to jogging along the Charles everyday that he’ll be relegated to a treadmill for a month or two while the city figures out what to do with 10’ tall snow banks. It’s torture! Anyway, the point is that when I was walking around the city yesterday, my thought process started with the snow and went to: “No one is outside running. That’s so unusual. à Oh my goodness, I bet everyone is trying to make due on treadmills. à Ooooooo their bodies aren’t used to thattttt. à Ugh, bring on the shin splints.” So here we are talking about shin splints, all because Mother Nature seems to want the Northeast in a blanket of white until July.

Training for a sport or working to get back in shape is hard enough, right? No matter the activity or goal, it takes conditioning of your lungs, muscles, and mental strength just to get to the point where you don’t feel like you’re going to die every time you head out for some exercise. Given all of that, it seems pretty unfair that some people have do deal with excruciating and debilitating pain in their shins as well. Now unfortunately, shin splints don’t discriminate. Most people associate this particular injury solely with runners, but in reality I’ve seen it sideline cyclists, basketball players, and neighborhood walkers alike. If you’re active, changing up your fitness routine (like going from running outside to on a treadmill), or starting fresh in the New Year, shin pain can creep up on you and stop you in your tracks. If you’ve experienced it before, you know exactly what I’m talking about. If you haven’t, you’re one of the lucky ones! Let’s talk about some of the causes of this nasty pain, and how to treat it.

How in the world do your itty bitty shins cause so much pain and discomfort? Well, there are a few ways, some soft tissue and some bony in nature. First of all, the ‘shin bone’, also known as the tibia, is actually pretty strong and much bigger than you might think. Reach down and find the sharp ridge of your shin running down the middle of your lower leg. Grab hold of it with your fingertips. Now let your thumb slide toward the inside of your leg until you no longer feel bone. You’ve basically got your tibia in a pincher grip that’s probably about an inch wide. This bone travels from the inside of your ankle up to your knee, widening at the top to meet the end of the thigh bone (femur) and form the knee joint. Not only does it make up part of the knee joint, allowing the lower leg to bend and extend, but it bears a lot of weight while standing, walking, running, etc. Lying along the outside of shin is the tibialis anterior muscle. This muscle travels from just below the outside of the knee, down along the shin until it crosses over the shin toward the inner ankle. It actually attaches itself to the bones of the first toe. When it contracts, this muscle works to lift the top of your foot towards your shin. Imagine it as the muscle responsible for allowing you to walk around on your heels. If you sit with a leg out in front of you and draw your toes/foot back toward you, you will probably see the muscle along your shin pop out. There it is! Another important job of the tibialis anterior is to support the arches of your feet. Now which parts have the ability to become injured?

Sometimes, pain in the shin can be caused by tiny stress fractures of the tibia. Usually caused by repeated trauma (lots of running, jumping, etc.) or an initiation of a new activity too quickly, these stress fractures happen over time. Now I don’t want you to sit there and imagine your shin bone broken into a million pieces. Instead, think of little hairline fractures probably not even perceptible on x-ray, but present enough to cause inflammation, pain, and slight weakening of the bone.

Another cause of pain in the shin comes from stress on the tibialis anterior muscle. Repetitive activities like running, walking, stair climbing, and jumping all require the muscle to work overtime. Just like any other muscle in the body, overuse can mean irritation, spasm, and inflammation resulting in pain. Further, if the arches of your feet have fallen and you over pronate, extra stress is placed on this muscle.

Sometimes improper biomechanics of the low back, pelvis, hips, knees, and ankles are to blame. If the joints in any of these areas are not moving properly, the surrounding muscles react. For example, maybe the joints of the pelvis aren’t moving smoothly, affecting the way you walk. A muscle like the Tensor Fasciae Latae that runs from the outside of the pelvis to the knee, tighten. Now both your hips and your knee are affected, putting strain on a muscle like the tibialis anterior and causing you pain. Think of it as this crazy biomechanical chain of events that can happen from the feet up, or spine down to change how you move and feel.

Lastly, some pain the in shin is caused by a more serious condition called compartment syndrome. While this isn’t considered true ‘shin splints’, the two conditions occasionally get confused. During chronic compartment syndrome, the pressure in muscles of lower leg (such as the tibialis anterior) increases, usually due to some sort of injury or overuse. Because the muscle is surrounded by an inflexible covering known as fascia, when injury-induced swelling occurs, there is little room for the muscle to expand. Instead, venous and lymphatic drainage is stunted and waste and extra fluid are not cleaned out of the muscle. Blood supply to the area remains and pressure grows. Eventually oxygen to the muscles is decreased and nearby nerves and muscles have a chance of being damaged. Swelling results and now you’re in the middle of a nasty cycle of injury to the muscles!

So what can we do short of requesting shin transplants to feel better? Just in case that option doesn’t exist let’s explore other treatments:

·      Rest: I know that suggesting rest to active, motivated individuals doesn’t always go over well, but sometimes it’s necessary! If you’re in a lot of pain during/after activity, consider taking a couple of weeks off. If you’re dealing with over-worked muscles, you should be able to see a bit of improvement in that time. Ease back into activity at that point, starting slow, to gauge how you feel and go from there. Stress fractures, however, won’t heal in two weeks.
·      Ice: As a natural anti-inflammatory, ice can help reduce inflammation caused by both stress fractures and irritated muscles. Try filling a Dixie cup ¾ full with water, and freezing it. You can then peel back part of the paper cup to expose the ice, and use it for an ice massage along the shin and muscles. 4-5min of icing, 20min rest, followed by another 4-5min of icing after activity may help. You may really dislike me for those 5minutes of freezing cold, but your shins won’t!
·      Cross-train: Your body likes diversity! If you’re a runner dealing with shin splints, try cross-training with cycling or running in the deep end of the pool. Anytime you subject your body to the same motions or actions repetitively, there’s a chance that it will get cranky. Switching things up can help you develop different muscles, and give overused muscles a break. You can even try training on different terrain. Try trail running if you’re used to pavement!
·      Stretch: Before you begin activity, warm-up! Sit with your legs out in front of you and start by drawing the alphabet with your toes/feet. Then gently point your toes, hold for 3s, and relax, repeating 10 times to stretch the tibialis anterior before use.
·      Orthotics: As we talked about, sometimes the arches of the feet are to blame. If you question the integrity of your arches or notice any foot pain along with your shin splints, question your chiropractor about getting some orthotics to put into your shoes. They work to put your feet back into biomechanically appropriate positions, and make the soft tissues and joints much more cooperative.
·      Graston: Ask your chiropractor about this technique. It uses lotion and a stainless steel tool to work through adhesions and scar tissue that may have developed in the covering of the tibialis anterior muscle. Any time adhesions and/or scar tissue develop there is potential for inflammation, restriction of movement, improper function, and spasm. Any of these things can contribute to your pain. Now, I’ll never try to pretend that this is the most comfortable or pleasant treatment on the planet. That being said, a patient recently told me that the work we did on his shins with Gaston saved his senior year basketball season. He told me that without it, he wouldn’t have been able to make it through the games. I’ve also seen it help treat triathletes, cyclists, and long distance runners. Pretty cool stuff….
·      Adjustments: You can always have your chiropractor assess your low back, pelvis, hips, knees, ankles, and feet for joints that aren’t moving well and need to be adjusted, and for muscle imbalances throwing off your biomechanics and in need of retraining. These things can all help relieve excess stress on the shins.
·      If you’re experiencing extreme pain that doesn’t improve with a couple weeks of rest, or extreme pressure in the lower legs with exercise, consult your doctor about the possibility of stress fractures or compartment syndrome. Again, these fractures probably won’t show up on x-ray, but it can’t hurt to check. Longer periods of rest will be necessary to heal in this case. If compartment syndrome is suspected, further testing can be done to confirm and if necessary surgery may be a treatment option.

Until next time, switch up your exercise routines or take some time to let your body rest. Meanwhile, try to embrace the snow. It may be around for a while….

Dr. Lauren Doscher