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PHYSIO  October 2001

PHYSIO October 2001

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Subject:

Re: SV: Chronic Shin Splints

From:

Nechama Karman <[log in to unmask]>

Reply-To:

- for physiotherapists in education and practice <[log in to unmask]>

Date:

Thu, 11 Oct 2001 13:28:03 -0400

Content-Type:

text/plain

Parts/Attachments:

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text/plain (162 lines)

Dealyed Onset Muscle Soreness.

NK

At 07:59 AM 10/10/01 +0200, you wrote:
>Stupid question: what is DOMS?
>
>Isaac
>
>-----Opprinnelig melding-----
>Fra: Jason Steffe [mailto:[log in to unmask]]
>Sendt: 10. oktober 2001 01:05
>Til: [log in to unmask]
>Emne: Re: Chronic Shin Splints
>
>
>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  <mailto:[log in to unmask]> Epsley
>To: [log in to unmask] <mailto:[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] <mailto:[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]>  [mailto:[log in to unmask]]
> >Sent: Friday, 5 October 2001 02:18
> >To: [log in to unmask] <mailto:[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.
>http://clubs.lycos.com/live/events/september11.asp
><http://clubs.lycos.com/live/events/september11.asp>

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