-----Original Message-----
From: Scott Epsley <[log in to unmask]>
To: [log in to unmask] <[log in to unmask]>
Date: 08 October 2001 12:18
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]
>
>
Dear Scott
Just what I wanted to say myself but was too chicken - way to go!
Emilie McGrath
|