By Kim O’Leary

Do you ever wonder what the term ‘shin splints’ means?

Shin splints has been widely used as a catch-all term referring to a collection of different conditions that cause lower leg pain.

The term Medial Tibial Stress Syndrome (MTSS) better defines this injury, and separates it from injuries such as stress fractures or compartment syndrome.

Major causes of MTSS are:

  • Flat feet
  • Calf tightness
  • Old shoes or shoes that offer poor support
  • A rapid increase in training workload; either in speed or distance

MTSS is the most common presentation of lower leg pain, with pain localized to the inner portion of the tibia in the middle/lower thirds of the lower leg and the surrounding soft tissue.

Despite being the most common lower leg complaint, MTSS is often a common misdiagnosis for similar conditions such as stress fractures or compartment syndrome.

It is important to remember that stress fractures can also give you leg pain. It often follows as a result of shin-splints that have not been managed correctly, or when a patient tries to “run-through” the problem. This is why it is important to manage MTSS correctly.

Common signs of MTSS:

  • Aching along the front of the shin with physical activity: the pain may begin as a dull aching sensation after running. The aching may become more intense, even during walking, if ignored
  • Pain along the inside (medial) part of the lower leg
  • Pain that develops gradually over weeks/months
  • Swelling in the lower leg
  • Small bumps along either side of the shin bone

How to manage shin splits:

Initially you can manage it with rest, ice and anti-inflammatories (ie nurofen, voltaren). Physiotherapy at this stage will involve ultrasound, light massage, and education with guidelines into exercise intensity and frequency. This aims to settle and relieve the inflammatory process, and thereby relieve symptoms.

After this initial period, more intense physiotherapy can be commenced. This usually involves deep tissue massage, Myofascial releases, muscle frictions, structure rehab programs to increase flexibility, strength and endurance, as well as gradual recommencement of normal activities.

Throughout rehabilitation, your physiotherapist will advise you on continuing aerobic fitness activity, however it will likely be modified to reduce lower limb impact (ie. activities such as swimming, orbital training, beach walking/running).

In conclusion:

MTSS can be painful but it is usually easily resolved. If you experience pain in your shin:

  • Thoroughly stretch before exercising, reduce your activity level, and check your footwear
  • If you run on a hard surface, find some softer ground to train on
  • Avoid training errors (ie. ‘start low and go slow’)
  • Introduce gradual changes in intensity, activity, and terrain
  • Maintain adequate calf and anterior tibial flexibility, strength, and endurance.

Happy Running!

By Sophie Marshall

Still working from the dining room table, or are you heading back into the office? How’s your posture after an hour or two?

Bad ergonomics are a pain in the neck/back/bum, so there’s no better time to optimise your workstation ergonomics!

Ergonomics help facilitate better posture. Good ergonomics reduce the kinds of postural stress and fatigue that can often cause neck and back pain, neurogenic (nerve) symptoms, and headaches.

Setup tips for your workstation include:

  • Using an adjustable chair with lumbar support or a lumbar roll
  • Ensuring that your feet are either flat on floor or you are using a foot rest
  • Ensuring that your hips, knees and elbows are at 90 degrees (or in a slight downward slope)
  • Ensuring that your keyboard and mouse are directly in front of you and within easy reach when your arms are resting by your side
  • Ensuring that your keyboard is flat or provides wrist support
  • Ensuring that the computer screen is no further than an arms reach away
  • Ensuring that the top of the computer screen is approximately at eye level
  • Ensuring that documents are directly in front of you and between keyboard and screen, or are in an appropriate holder
  • Ensuring that you do not hold your phone between your head and shoulder

Australian guidelines state that we should minimise the amount of time spent in prolonged sitting positions, and therefore break up long periods of sitting as often as possible. Sedentary behaviour is associated with poorer health outcomes, including an increased risk of type 2 diabetes.

A suggested work pattern is 20 minutes of sitting in a neutral posture, 8 minutes of standing in a neutral posture, and 2 minutes of moving and/or stretching.

Tips to help get you moving:

  • Have reminders/cues to move every 20 minutes
  • Take phone calls while standing
  • Drink plenty of water (toilet breaks and refills!)
  • Eat lunch and morning tea away from your workstation
  • Walk to a colleague’s workstation rather than using email
  • Move the bin and printer away from workstation
  • Make meetings standing or walking ones
  • Consider walking or cycling to work, or parking further away

Having an ergonomic workspace is only half the story; we need sufficient endurance of postural muscles, and extensibility of pectoral muscles to be able to maintain upright posture and scapular retraction.

Your PhysioPro can prescribe stretches and strengthening exercises appropriate for you at your next appointment!

For more information, please contact your local PhysioPro.

By Jack Gangemi

Falls place a large amount of pressure on the healthcare system and cause great personal angst in the community. Unfortunately for people over 65, falls are the leading cause of injury-related hospitalisations and the second most common cause of community injury hospitalisation.

Globally, approximately 28 to 35 per cent of people aged 65 and over fall each year. Thankfully, there is a large amount evidence showing that a targeted Physiotherapy balance exercise regime can greatly reduce the risk of falling.

The main risk factors for falls include:

  • Decreased lower limb strength
  • Poor ankle, hip and step reactions
  • Issues with glasses/eyesight
  • Urinary incontinence
  • Footwear
  • Home hazards
  • Medications
  • Dizziness/nausea

Strategies for reducing your falls risk include:

  • Physiotherapy balance and strength training
  • A medical review from a GP or Pharmacist
  • An optical check up
  • A footwear review with a Podiatrist
  • Reducing tripping hazards ie. rails in bathroom and shower

At PhysioPro, we can use standardized measures to assess balance reactions and a patient’s falls risk. From there, we can implement a tailored balance and lower limb strengthening program.

Physiotherapy for falls are aimed at 4 key areas:

  1. Gait retraining and advisement on appropriate walking aids – It is important that the patient is as independent as they can safely be. However, it is also vital that a fear of falling does not limit exercise!
  2. Balance – Targeted exercises for ankle, hip, and step reactions. We can challenge our patient’s balance reactions by manipulating their base of support (ie. standing with feet together, tandem stance, eyes closed, heel/toe walking, using Bosu balls, exercise balls, external perturbation practice etc.)
  3. Strength – Specific exercises to strengthen calf, quad, and gluteal muscles (ie. sit-to-stands, squats, bridges, lunges, calf raises etc.)
  4. Co-ordination – Putting it all together in functional movement

Contact your local PhysioPro to organise your own fall prevention program!