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I think you guys are debating at cross purposes. What this problem does highlight is the importance of a full detailed assessment prior to prescribing treatment, rehab or whatever!!

cheers

dave riddell

-----Original Message-----
From: Scott Epsley [mailto:[log in to unmask]]
Sent: 10 October 2001 12:48
To: [log in to unmask]
Subject: Re: Chronic Shin Splints

Jason,
I am aware of all of the uses and benefits of eccentric exercise you quote, and am quite impressed by your reference list.  This however does not address the fact that eccentrics will make a compartment syndrome worse.

---
Scott Epsley
BPhty., MAPA, SPG.
PRINCIPAL PHYSIOTHERAPIST
Clifford Chambers Sports Medicine
Suite 4, 120 Russell Street
Toowoomba QLD 4350
Australia

e-mail: [log in to unmask]

On Tue, 9 Oct 2001 19:04:33
 Jason Steffe wrote:
>Scott,
>
>Barring biomechanical influences (which we don't know if there are any), it is my opinion that probable etiology of this patient's condition is not repeated eccentric loading, but rather insufficient eccentric strength given the functional demands (a weak eccentric/concentric muscle ratio which is termed critical deficit %).

>
>Eccentrics can be used therapeutically to strengthen the series elastic component, when speed and loads are controlled and progressed.  Eccentrics are popular modes of exercise for treatment of overuse syndromes and tendinitis.  Eccentric exercise does produce DOMS (theoretically because they selectively recruit Type II fibers and small motor units) but after minimal bouts of exercise one gains DOMS immunity for about 6 weeks.  The rationale for eccentrics is to replicate and concomitantly condition the tissue for the high tensile stresses it must undergo during functional activities.  It can be implemented in the subacute phase, again when controlled for speed and load.

>
>Please refer to:
>
>Jensen K, Di Fabio RP: Evaluation of eccentric exercise in treatment of patellar tendonitis. Phys Ther 69(3): 211-216, 1989

>
>Mannheimer JS: A comparison of strength gain between concentric and eccentric contraction.  Phys Ther 49(11): 1201-1207, 1972

>
>Trudelle-Jackson E, Meske N, Highgenboten C, Jackson A: Eccentric/concentric torque deficits in the quadriceps muscle. JOSPT 11(4):142-145,1989.

>
>Albert MS, ed. Eccentric Muscle Training in Sports and Orthopedics, 2nd ed,. New York: Churchill Livingstone Inc,. 1995.

>
>I didn't make evaluative suggestions to the sender (I forget who asked the original question) because she/he didn't ask for them. The sender was asking for suggestions to give to a friend for home exercises for a chronic condition in a runner, not acute condition.

>
>Regards.
>--------------------------------------------
>Jason Steffe, PT, MS, MTC
>Physiotherapy Associates
>1901 Phoenix Blvd, Suite 205
>College Park, GA. 30349
>Ph: 770-907-1023
>Fax:770-907-5608
>  ----- Original Message -----
>  From: Scott Epsley
>  To: [log in to unmask]
>  Sent: Monday, October 08, 2001 7:18 AM
>  Subject: Re: Chronic Shin Splints
>
>
>  Dear list,
>  I am about to be very critical - please do not take this personally, it is not aimed at individuals, but as a general comment.

>
>  I cannot believe some of the replies about this problem.  I know there are some very highly qulaified and intelligent people on this list - but the over simplification of the responses to this question is dreadful.

>
>  Firstly, there is no such thing as "shin splints" generically.  There must be a diagnosis, and if you must use this blanket term, it must be qualified by anterior or posterior.  If one uses certain treatment suggestions for posterior shin splints on anterior shin splints, one can significantly worsen the situation, to the point of requiring surgery.  And yes, I have seen it, and this poor lady can no longer walk without pain, and has permanent weakness.

>
>  One needs also to establish if there is a component of compartment syndrome developing.  Compartment syndrome is not shin splints, but often ensues.  Usually it occurs in the anterior compatment (Tib Ant, EHL, EDL, Peroneus Tertius), or deep posterior compartment (Tib Post, FHL, FDL).  One suggestion of eccentrically training the dorsiflexors has the potential to seriously worsen an anterior compartment syndrome, because that is the problem in the first place - over use of the dorsiflexors eccentrically.  It has been shown that increased muscular swelling occurs with eccentric exercise.  By the way, I wouldn't be strapping this too tightly, and certainly not circumferentially, even with elasticised bandage.  The compartment needs all the help it can get at this point.

>
>  Most likely there is a periostitis.  This is "shin splints" if you must use this term loosely.  However, one needs to determine that the periostitis is not in fact a stress fracture.  Bone scan may help.  A stress fracture is demonstrated by a very focal "hot spot", as opposed to a more diffuse lesion in periostitis.

>
>  Then one must ascertain the cause, which is almost always biomechanical and occasionally overuse and biomechanical.
>
>  Now and only now is it possible to treat this injury.  There is no general treatment because it is not a general injury.  Rest is effective - it is the easiest treatment suggestion of all - if it hurts don't do it.  That doesn't fit my job description I'm afraid, I help people get back to doing things.  Rest won't fix it either, it will only come back.

>
>  If anyone wishes to know more about suggested treatment for specific conditions I would be happy to help.  But please think a little more closely before applying a general treatment to a blanket term.

>
>  Regards,
>  Scott.
>  ---
>  Scott Epsley
>  BPhty., MAPA, SPG.
>  PRINCIPAL PHYSIOTHERAPIST
>  Clifford Chambers Sports Medicine
>  Suite 4, 120 Russell Street
>  Toowoomba QLD 4350
>  Australia
>
>  e-mail: [log in to unmask]
>
>
>  On Mon, 8 Oct 2001 09:56:50
>   Craig Lawson wrote:
>  >Here's a great, recently published article on Exercise induced leg pain.  I
>  >will cut and paste it if people would like but it is quite long...
>  >
>  >http://www.physsportsmed.com/issues/2001/06_01/amendola.htm
>  >
>  >Craig
>  >
>  >-----Original Message-----
>  >From: [log in to unmask] [mailto:[log in to unmask]]
>  >Sent: Friday, 5 October 2001 02:18
>  >To: [log in to unmask]
>  >Subject: Chronic Shin Splints
>  >
>  >
>  >Hello-
>  >I am trying to help a colleague of mine out with chronic shin splints that
>  >he got in boot camp with the Marine Corps.  Walking 10 minutes in sneakers
>  >bothers him and he has pain everyday.
>  >Running is out of the question at this point.
>  > I was looking for some "home" treatment ideas since this person is not
>  >currently attending P.T. in a clinic.
>  >Any ideas and help would be greatly appreciated.
>  >Thank you-
>  >Jean Momorella, MPT
>  >
>
>
>  Make a difference, help support the relief efforts in the U.S.
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>
>

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