Shin Splints

The term ‘shin splints’ is a catch-all phrase for lower leg pain that occurs below the knee, usually on the inner edge of the tibia (‘shin’ bone).  Medial tibial stress syndrome is the most common cause of shin pain.  This pain originates from an inflammation of the outer layer of the tibia and/or the connective tissues that attach your muscles to the bone.  Whether you are an experienced runner looking for a new challenge or a beginner looking to establish a healthy habit, you need to avoid the ‘too much, too soon’ philosophy that activates this inflammatory process.   Common mistakes include increasing your mileage too quickly, switching from running on flat surfaces to hills or abruptly changing your workout regimen. 

If you have shin splints, you will notice pain on the inner edge of the tibia and this area will be tender to touch.  Mild swelling is possible but less likely.  In the early stages, the pain begins immediately but often goes away when you are warmed up.  As the condition progresses, the pain lasts throughout your run and usually into the next day during normal activities. What can you do to treat shin splints?

  • Select the correct running shoe! – The folks at the Pulse can help you find the right shoe for your foot type. If excess pronation is a problem for you, shoe inserts or foot orthotics may be necessary to support your arch and maintain proper alignment of the foot/ankle. Running shoes should be replaced after 300-400 miles to ensure the ability to absorb the shock/stress created when the foot hits the ground.
  • ICE! Apply ice for up to 20 minutes on a regular basis (2-4x/day) to decrease pain and inflammation. Use a compression bandage with the ice to reduce any swelling and provide support for the soft tissues of the lower leg.
  • ‘Relative rest’ – Rest until there is no pain with normal daily activities. Increase days of rest between running days, maintaining cardiovascular fitness with stationary bike or pool running which have less impact on the legs. Stop hill training. Reduce speed and mileage to 50% of preinjury level, increasing gradually over 3-6 weeks.
  • Anti-inflammatory medications – Talk with your physician regarding the short-term use of over-the-counter meds like Motrin, Advil or Aleve to control pain and inflammation.
  • Stretching of calf (gastrocnemius & soleus) and anterior tibialis muscles
  • Strengthening of the anterior tibialis muscle
  • Run on a softer surface, such as grass, dirt or outdoor tracks
  • Strengthening of the gluteus medius, hip abductors and core muscles

Try these self-treatment techniques for 2-4 weeks.  If your symptoms continue, consult a physical therapist to determine if faulty skeletal alignment or muscle imbalances contribute to your condition.   Your therapist will recommend a re-evaluation by your physician if they suspect the pain is related to other pathologies, such as a stress fracture or compartment syndrome.

Dean Myers, PT


Lymphedema: Treatment

The treatment for Lymphedema is called Complex Decongestive Therapy (CDT). This is a gentle, non-invasive therapy that has been used in Europe for over 70 years.  It is a cost-effective treatment to reduce swelling of the limbs, decrease risk of infections (Cellulitis), and halt the progression of the condition. Complex Decongestive Therapy includes:

  • Manual Lymph Drainage (MLD) – a light massage technique, which stimulates the superficial lymphatic system and enhances lymph drainage.
  • Compression bandaging – short stretch bandages are applied after MLD as added resistance to the limb so the lymph fluid does not refill. In addition, bandages help break down fibrotic areas and soften the tissues.
  • Exercises – which utilize the muscle pump to move lymph fluid through the limb against resistance of the bandages or compression garments.
  • Skin care – to prevent infection, cellulites, and dermatological changes.
  • Education/Self-Management training – to manage this lifelong condition.

The length and intensity of treatment depends on the cause and severity of involvement. Lymphedema goes through three stages:  Grade I is mild edema which will decrease to nearly normal with elevation overnight- therapy is short and very effective, Grade II is when fibrotic buildup begins to occur and the limb continues to enlarge, elevation no longer reduces the swelling – therapy needs to be a little longer and is still very effective. Grade III, the limb is large, fibrotic, and the skin changes texture- therapy is still effective, but takes considerably longer.  Complex Decongestive Therapy should be started as soon as swelling in the limb is noted.

Sonja M. Maul PT, CLT-LANA
National Board Certified Lymphedema Therapist

Tendinitis & The Ankle

Tendinitis is an inflammation of the tendon. Tendinitis of the ankle can involve the Achilles tendon, the posterior tibial tendon, or the peroneal tendon. This condition usually results from trauma but can result from underlying inflammatory diseases or illnesses such as reactive arthritis (formerly called Reiter’s syndrome), rheumatoid arthritis, and ankylosing spondylitis. All forms of tendinitis cause pain, swelling, and tenderness in the tendon area involved. The onset may be rapid, such as with an athletic injury.  Immediate treatment involves immobilizing the area, elevation, and limiting weight-bearing, applying ice, and using nonsteroidal anti-inflammatory drugs (NSAIDs) to decrease inflammation.  NSAIDs such as naproxen (Naprosyn) or ketoprofen (Orudis) are commonly used for this purpose.  More severe inflammation can require orthopedic casting. Athletic participation should be limited when the tendon is still inflamed, as there is a significant risk of rupturing or tearing the tendon, especially in the Achilles area, with continued athletic activity. A rupture of the Achilles tendon more frequently occurs in patients who have had previous Achilles inflammation. When the Achilles tendon ruptures, it usually requires orthopedic surgical repair.

Alan Crothers, PT, SCS
Board Certified Sports Clinical Specialist
Downtown Site Manager

Lymphedema: Possible Signs & Symptoms

Mostly a person’s History, Observations, Measurements, Signs and Symptoms diagnose Lymphedema. These include:

  • Swelling of a limb or body part.
  • Swelling that is pitting in nature (pressure leaves an indentation (pit) that slowly fills in again).
  • Swelling worsens over time.
  • Sensation of heaviness and fatigue in the swollen limb.
  • A dull aching in the limb.
  • Repeated episodes of infection (Cellulitis).
  • Clothing or Shoes do not fit.

There are a couple of studies that have been used to evaluate the lymphatic system, though not commonly used.

  • Lymphoscintigraphy – a water-based contrast medium, which does not damage lymphatic tissues, makes it possible for a gamma camera to trace the flow of lymph. A computer generates images based on the data gathered by the gamma camera.
  • Lymphangiography – A radiographic study of lymphatic structures following the injection of an oil-based contrast medium. (The purpose of the contrast medium is to make the lymph vessels and nodes visible on the x-rays.) This oil-based substance damages lymphatic vessels and this procedure is no longer used in the diagnosis of lymphedema.

A thorough history and evaluation is best at deciphering Lymphedema, and if further studies are indicated your therapist will consult with your physician to get them done.

Sonja M. Maul PT, CLT-LANA
National Board Certified Lymphedema Therapist
Downtown Site

Lymphedema: Many Possible Causes

Lymphedema is when an area of the body swells due to the collection of lymph fluid. This can be any part of the body: arm, foot, leg, breast, abdomen, head, face, chest wall, genitals…The lymph fluid builds up when the lymph system has in some way become impaired.  Causes of an impaired Lymph System include:

  • Treatment of lymph node removal and radiation for cancer:  this reduces the amount of fluid the lymph system is able to transport per unit of time, and can lead to Lymphedema right away, or years down the road.
  • Scar tissue from trauma or surgery:  Trauma from injury or surgery if it blocks or affects the lymph flow.
  • Congenital malformation:  some people are born with a lymphatic system that was not developed fully.  This can show up at birth, within the first year of life, in the teen years, or as an adult fallowing a somewhat minor injury.
  • Venus insufficiency:  if the veins are not returning the blood as efficiently as they should, then the blood system is not taking bake its 90% of the clear high protein fluid it releases to nourish the skin and surface tissues as the blood pools, and that means more than 10% is remaining for the lymph system to transport.  The lymph system can step up to the plate for a while, even years, but over time it gets tired and gradually is unable to keep up.  Veins can become stressed to insufficiency due to obesity, pregnancy, blood clots, or simple genetics.

The cause of the lymphedema, and other medical conditions the person may have, need to be taken into consideration during treatment, but the basic treatment is the same for all. 

Sonja M. Maul PT, CLT-LANA
National Board Certified Lymphedema Therapist
Downtown Site

Lymphedema: What is the Lymph System?

Many have never heard of the Lymphatic System, let alone Lymphedema.  So before talking of Lymphedema we need to take a look at what the Lymph System is and how it works.

When we take a look at the body from the outside in, we have our skin, just below that is our layer of fat, and then under that is our Lymph System (comprised of lymph collectors/capillaries, vessels that lead to the deeper lymphatic vessels along which pathway are the lymph nodes), and this over lays our muscles.  The blood capillary system comes into the area between the fat layer and the lymph capillaries and releases the nutrients to the skin and surface tissues of the body.  It is a clear fluid including a lot of proteins. As the blood leaves, it takes back 90% of what it dropped off- most of the clear fluid and the smallest particles.  The other 10% of clear fluid (with the larger particles of proteins/cell debris/medications we’ve taken/etc.) makes up the lymph fluid.  The human body produces approximately 2 liters of lymph fluid every day.

The Lymph Nodes are the “garbage disposals” of the system that filter and breaks down all those particles, balancing the solid to liquid consistency.  Also, they manufacture white blood cells for our immune system.  The last tube of the lymph system goes up through the chest and dumps the lymph fluid into the blood system just above the heart.  There the lymph fluid joins the blood, being further filtered through the liver and kidneys, and then passing out of the body through urine.

In brief, the Lymphatic System is a network of vessels, tissues, and organs in vertebrate animals that helps the body regulate fluid balance and fight infection.

Sonja M. Maul PT, CLT-LANA
National Board Certified Lymphedema Therapist

If The Shoe Fits…

Foot pain affects over 80% of seniors.  Pain with our feet can be the first sign of more serious medical conditions such as arthritis, diabetes, and nerve and circulatory disorders.  These more serious conditions need to be properly evaluated by a physician and treated medically.  But, a study in 2005 found that a lot of older adults suffered from pressure caused by shoes that don’t fit properly.  Poorly fitting shoes can put pressure on bony prominences, corns and calluses that can cause foot pain and reduce activity levels.  This study showed that most people wear shoes that are too narrow for their feet.  Women also tend to wear shoes that are too short.  Did you know that people over the age of 40 can gain half a shoe size every 10 years?  Over time tissues weaken, muscle mass declines, ligaments become less resilient and our bodies lose that natural spring and bounce.  The result- our feet widen, the arch lowers and the foot becomes a little longer.  So the next time you buy shoes make sure you get properly measured.  You may find out you are wearing the wrong size and have to start looking for wider widths.  A good pair of shoes may relieve some of your foot pain and allow you to increase your level of fitness.

These are a few helpful hints when buying shoes:

  • Try shoes on later in the day, feet may swell as the day wears on
  • Some of us have one foot longer than the other, so fit the longest foot
  • Make sure you have enough depth in the front of the shoe to wiggle your toes
  • You need at least 1/2 inch at the end of your longest toe in the length of the shoe when standing up
  • Make sure the ball of your foot fits comfortably in the widest part of the shoe
  • Consider a lace up shoe, they conform better to the size of your foot
  • For better support look for a shoe with arch support, a firm heel counter and stiff midsole
Carrie Whitted, MPT
Foot and Ankle Specialist