Shin Splints: What every runner should know

Whether you jog daily or are a serious runner, you may have shin splints when you feel throbbing and aching in your shins. While they often heal on their own, severe shin splints can ruin your game.

Shin splints aren't really a single medical condition. Instead, they're just a symptom of an underlying problem. They might be caused by:

• Irritated and swollen muscles, often caused by overuse.
• Stress fractures, which are tiny, hairline breaks in the lower leg bones.
• Overpronation or ''flat feet" -- when the impact of a step causes the arch of your foot to collapse, stretching the muscles and tendons.

Shin splints are very common. They're the cause of 13% of all running injuries. Runners might get them after ramping up their workout intensity, or changing the surface they run on -- like shifting from a dirt path to asphalt. Shin splints are also common in dancers.

What Do Shin Splints Feel Like?

Shin splints cause dull, aching pain in the front of the lower leg. Some people feel it only during exercise; others, when they've stopped exercising. Sometimes, the pain is constant.

Depending on the exact cause, the pain may be located along either side of the shinbone or in the muscles. The area may be painful to the touch. Swollen muscles can sometimes irritate the nerves in the feet, causing them to feel weak or numb.

To diagnose shin splints, your doctor will give you a thorough physical exam. He or she may want to see you run to look for problems. You may also need X-rays or bone scans to look for fractures. Other tests are sometimes necessary.

What's the Treatment for Shin Splints?

Although shin splints may be caused by different problems, treatment is usually the same: Rest your body so the underlying issue heals. Here are some other things to try:

• Icing the shin to reduce pain and swelling. Do it for 20-30 minutes every three to four hours for two to three days, or until the pain is gone.
• Anti-inflammatory painkillers. Nonsteroidal anti-inflammatory drugs (NSAIDs), like ibuprofen, naproxen, or aspirin, will help with pain and swelling. However, these drugs can have side effects, like an increased risk of bleeding and ulcers. They should be used only occasionally unless your doctor specifically says otherwise.
• Physical therapy to strengthen the muscles in your shins. Your physical therapist may also recommend:
  • Arch supports for your shoes. These orthotics -- which can be custom-made or bought off the shelf -- may help with flat feet.
  • Range of motion exercises, done at home or in the office
  • Neoprene sleeve to support and warm the leg.

In rare cases, surgery is needed for severe stress fractures and other problems that can cause shin splints.

How Can I Prevent Shin Splints?

To prevent shin splints, you should:

• Always wear shoes with good support and padding.
• Warm up before working out, making sure to stretch the muscles in your legs.
• Stop working out as soon as you feel pain in your shins.
• Don't run or play on hard surfaces like concrete.

While you heal, you could take up a new non-impact activity that won't aggravate your shin splints. For instance, runners might try swimming.

Your shin splints are fully healed when:

• Your injured leg is as flexible as your other leg.
• Your injured leg feels as strong as your other leg.
• Your can jog, sprint, and jump without pain.

Ankle Sprains

The most common type of ankle injury is a sprain. A sprain results from the stretching and tearing of small ligaments (fibrous bands connecting adjacent bones in a joint). There are many ligaments surrounding the ankle that can become damaged when the ankle is forced into an unnatural position. Although ligament damage frequently occurs during athletics or exercise, ankles are just as often injured stepping off a curb, into a pothole, or onto uneven ground.

The most frequent type of sprain occurs when weight is applied to the foot when it is on an uneven surface, causing the foot to "roll in" or "turn" (inversion). This places the sole of the foot in such a position that it points inward as force is applied, so the ligaments stabilizing the outside part of the ankle become stressed. Many people report hearing a "snap" or "pop" when an injury of this type occurs. Following such an incident, one experiences difficulty walking and, in a short time, the outside aspect of the injured ankle begins to cause pain and swells, sometimes so excessively that people believe it is broken.

Upon physical examination, the ankle will exhibit swelling and discoloration (black and blue) over the outside part of the joint. Touching of the area will result in a variable amount of discomfort. Range of motion (ROM) in the ankle can be limited due to pain and swelling, but strength is not usually affected. X-rays are essential, as the possibility of a fracture must be ruled out.

Degree of Severity of Ankle Sprains:

Grade I

• Mild sprain, mild pain, little swelling, and joint stiffness may be apparent
• Stretch and/or minor tear of the ligament without laxity (loosening)
• Usually affects the anterior talofibular ligament
• Minimum or no loss of function
• Can return to activity within a few days of the injury (with a brace or taping)

Grade II

• Moderate to severe pain, swelling, and joint stiffness are present
• Partial tear of the lateral ligament(s)
• Moderate loss of function with difficulty on toe raises and walking
• Takes up to 2-3 months before regaining close to full strength and stability in the joint

Grade III

• Severe pain may be present initially, followed by little or no pain due to total disruption of the nerve fibers
• Swelling may be profuse and joint becomes stiff some hours after the injury
• Complete rupture of the ligaments of the lateral complex (severe laxity)
• Usually requires some form of immobilization lasting several weeks
• Complete loss of function (functional disability) and necessity for crutches
• Usually managed conservatively with rehabilitation exercises, but a small percentage may require surgery
• Recovery can be as long as 4 months

Treatment and Rehabilitation:

Many problems resulting from sprains are due to blood and edema (swelling) in and around the ankle. Minimizing swelling helps the ankle heal faster. Most sprains heal completely within a few weeks. With increasing injury severity, the rehabilitation process becomes more complex and extensive. Chronic or recurrent lateral ankle sprains usually receive some type of strengthening program and training due to poor balance on the injured leg.

Phase I (Early Phase):

Goal:

Decrease post-injury swelling, bleeding, and pain. Protect the healing ligament(s).

Avoid the first 24 hours:

Hot showers

Heat rubs (e.g. Ben Gay)

Hot packs

Drinking alcohol

Aspirin–it prolongs the clotting time of blood and may cause increased bleeding into the ankle (Tylenol or ibuprofen (Advil) may be taken to help with pain, but will not speed up the healing process)

The PRICE regimen is the most important aspect of the initial management of a sprain:

Protection

Ligaments must be maintained in a stable position so healing can occur

Get off your feet if pain persists

Use an ankle stirrup or brace if necessary

Non-weight bear or partial weight bear with crutches to control other inhibitors of healing

Early walking is essential, since weight bearing inhibits contractures (tightness) of tendons, which may lead to tendonitis

Rest

Allow injured ankle to rest for approximately 24 hours after the injury

Caution should be taken against vigorous exercise

Exercise for the uninjured leg may be performed

Ice

Ice the ankle every 2 hours for 20 minutes to decrease pain, swelling, and spasticity for the first 48-72 hours

Do not place ice on the ankle for over 30 minutes

Compression

Done with ice

Place air or cold water within enclosed bag to provide pressure to decrease swelling

Ace wraps

To add more compression, a horseshoe-shaped felt pad may be inserted under the wrap over the area of maximum swelling

Elevation

Elevate as much as possible with ice and compression

Elevate foot higher than the waist to reduce swelling and pain

Keep the leg elevated while sleeping

Elevation allows gravity to work with lymphatic system rather than against it

Phase II (Rehabilitation Phase):

This phase begins when swelling stops increasing and pain lessens, so that the ligament(s) have reached a point in the healing process at which they are not in danger given minimal activity. Pain is the guide as to how much activity is enough.

Goal:

To increase motion and strength, which will aid in circulation and help eliminate residual inflammatory agents.

Stretching

Do stretches before and after activity

Vigorous heel cord/calf stretches initiated ASAP (hold stretches for 20 seconds each, performed every 2 hours) - moderate pull but no pain

All activities should be done slowly without pain 

Toe curls–place a towel on the floor and curl your toes to pick up the towel

Marble pickups–pick up marbles with your toes

Perform alphabet exercise–rest heel on floor and write the alphabet in the airwith your big toe, making the letters as large as you can

Stationary bike

Strength

Begin with isometric exercises with progression to isotonic exercises (with and without resistance) in a pain free motion

As the ligament heals further and ROM increases, strengthening exercises may begin in all planes of motion

Pain should be used as the basic guideline for deciding when to start Inv and Ev isotonic exercises

Obtain a strip (about 2 feet long) of elastic belting material, surgical tubing (from a medical supply store), or a bike tire inner tube and work your ankle in four directions. Pull the tubing taut, making sure that the tube is placed at the base of your toes, and do the exercises only with your foot and ankle, not the whole leg

Out and up:

sit on floor or chair, loop tubing over foot and around table leg, with heel on floor, work ankle out and up

In and up:

as above, but loop tubing to provide tension against an inward motion, with heel on floor, work ankle in and up

Straight up:

as above, but with heel on floor, work ankle straight up

Straight down:

hold tube loop against bottom of foot, with heel on floor, work ankle down

At the beginning of the rehabilitation process, use ankle weights for light resistance in the four directions described above (2-4 sets of 20)

Heel/toes raises–stand on a step with your heels slightly off the step and slowly rise up on your toes and equally slowly lower heel down; when this exercise becomes simple to perform, do the exercise using only the injured leg in a pain free motion

Single knee flexion exercises–stand on injured leg and bend that knee and straighten it

Phase III (Full Functional Level):

Goal:

Return to prior level; return to activity

• Must have full ROM
• Must have 80-90% strength in injured ankle compared to the uninjured ankle
• Strengthen the uninjured leg
• Run in a pool, using a floating device; swimming
• Tape the ankle if necessary
• High-topped footwear to stabilize the ankle
• Cleats should be outset along periphery of the shoe to provide stability
• Gradual progression of functional activities that slowly increase stress on ligaments
• Full weight bearing when you can walk without a limp
• Lunges forward, on a 45° angle, and sideways with injured and uninjured leg
• Pain-free hopping on affected side (start with hopping with both legs and progress to hopping with only injured leg)–four-square hopping drills
• Step up and over, forward and sideways, on high step in pain free motion
• Stand on your toes of the injured ankle for 20 seconds, and hop on your toes 10 times
• Begin stairmaster, treadmill, biking
• Running can be started as soon as you can walk in a fast pace without pain; initially, start jogging in a straight line, and progress to running from smooth, flat surface to uneven surfaces
• Cutting exercises: run in figure eights, cross-over walking
• Jump rope

Prevention:

• Wear the correct shoes for the event. Good walking shoes provide more comfort and better balance
• Wear hiking shoes or boots in rough terrain
• Different sports activities call for specific footwear to protect feet and ankles. Use the correct shoe for each sport. Don't wear any sports shoe beyond its useful life.
• Use steel toed shoes for occupations that threaten foot safety. Be certain they are fitted properly.
• Do not walk barefoot on paved streets or sidewalks.
• Watch out for slippery floors at home and at work
• Be aware of uneven terrain, potholes, and high curbs.
• If you get up during the night, turn on a light.
• Wear a brace or have ankle taped when doing activities that have a high incidence of ankle injuries (such as basketball, volleyball, soccer, tennis, and other sports requiring a lot of stopping, starting, and twisting motions)

When to Seek Medical Attention:

If the ankle is obviously fractured/dislocated or the injury is causing severe pain/disability, then medical attention should be sought immediately.

Put the Spring Back Into Your Step

This morning, you promised yourself that you'd head straight to the gym right after work. But by the end of the day, you were so beat that all you could think about is collapsing on the couch with takeout and the remote.

Why are you so tired all the time? Are you just not getting enough sleep or could something be medically wrong. If you're constantly plagued by exhaustion, there are a host of medical issues that could be wrong or you may also wonder if you're doing too much. But the most likely answer is just the opposite: You're not doing enough.

Fatigue Rx: Exercise! The biggest cause of tiredness these days, is the modern American lifestyle. Being overweight, eating too much fast food, and not exercising enough.

There are three key lifestyle changes that can make a big difference in your energy level, doctors say:

1. What you eat. Don't try for a quick-fix spurt of energy from caffeine and sugar; it will only leave you more fatigued as your blood sugar levels fluctuate wildly. Instead, go for a balanced, healthy diet replete with fruits, vegetables, and lean protein. 

2. How much you sleep. About 60% of women, according to the 2007 Sleep in America poll, say they only get a few good nights' sleep a week or less. To get more Zs, avoid caffeine and alcohol in the hours just before bedtime, and keep your sleep space quiet and restful.

3. How much you exercise. This is. the best prescription for ordinary, garden-variety tiredness, regular, vigorous exercise. The reality is that exercise breeds energy. Almost all the studies that have looked at this question have found the same thing: Sedentary people who start exercising feel much less fatigue than people who continue to slouch on the couch -- and exercise often boosts energy even more than medication.

So what's the prescription? How much exercise do you need, how often, and for how long, before you start noticing an end to your exhaustion? The recommended dosage is 40 minutes, at least four days a week, to get you going.

How soon should you see results?  Within a month, you should feel at least some improvement. Keep with it for three to six months more, and you should start feeling much better.

What Else Could Be Wrong? Chronic tiredness is associated with many different medical conditions. How can you figure out which one might be the culprit? The short answer is, you can't tell You'll need a doctor for that.

4. Anemia. This is a very common cause of fatigue and very easy to check with a simple blood test.  You can remedy anemia with an iron-rich diet, heavy in meats and dark, leafy greens, or supplements if you have a chronic iron deficiency.

5. Deficiencies in key nutrients, such as potassium. Again, this is easily checked with blood testing.

6. Thyroid problems . Over- and under-active thyroids both can cause fatigue. A blood test for your level of thyroid-stimulating hormone can help evaluate your thyroid function.

7. Diabetes. If you feel draggy and you're also having blurred vision or lots of urination, you should get that checked with a blood test.

8. Depression. If your feelings of exhaustion are accompanied by sadness and loss of appetite, and you just can't take any pleasure in things you once enjoyed, you may be experiencing depression.

9. Obstructive sleep apnea. If you never feel rested, ask the person you sleep with if you're bothering them with your snoring. If they say yes, look into testing at a sleep lab. Some other symptoms of obstructive sleep apnea include waking up each morning feeling unrefreshed and having morning headaches.

10. Undiagnosed heart disease. Tiredness can be a sign of heart trouble, particularly in women. If you have trouble with exercise you used to do easily, or if you start feeling worse when you exercise, this could be a red flag for heart trouble. If you have any doubts, see your doctor.

Healthy Relationships=Better Life

What better month is there than February to take time and evaluate the relationships in your life? Healthy relationships bring happiness and health to our lives. Studies show that people with healthy relationships really do have more happiness and less stress. There are basic ways to make relationships healthy, even though each one is different…spouses, children, co-workers, aging parents, difficult family members. Here are Ten Tips for Healthy Relationships.

1. Keep expectations realistic. No one can be everything we might want him or her to be. Sometimes people disappoint us. It’s not all-or-nothing, though. Healthy relationships mean accepting people as they are and not trying to change them!
2. Talk with each other. It can’t be said enough: communication is essential in healthy relationships! It means— Take the time. Really be there. Genuinely listen. Don’t plan what to say next while you’re trying to listen. Don’t interrupt. Listen with your ears and your heart. Sometimes people have emotional messages to share and weave it into their words. Ask questions. Ask if you think you may have missed the point. Ask friendly (and appropriate!) questions. Ask for opinions. Show your interest. Open the communication door. Share information. Studies show that sharing information especially helps relationships begin. Be generous in sharing yourself, but don’t overwhelm others with too much too soon.
3. Be flexible. Most of us try to keep people and situations just the way we like them to be. It’s natural to feel apprehensive, even sad or angry, when people or things change and we’re not ready for it. Healthy relationships mean change and growth are allowed!
4. Take care of you. You probably hope those around you like you so you may try to please them. Don’t forget to please yourself. Healthy relationships are mutual!
5. Be dependable. If you make plans with someone, follow through. If you have an assignment deadline, meet it. If you take on a responsibility, complete it. Healthy relationships are trustworthy!
6. Fight fair. Most relationships have some conflict. It only means you disagree about something, it doesn’t have to mean you don’t like each other! When you have a problem:
• Negotiate a time to talk about it. Don’t have difficult conversations when you are very angry or tired. Ask, "When is a good time to talk about something that is bothering me?" Healthy relationships are based on respect and have room for both.
• Don’t criticize. Attack the problem, not the other person.  Open sensitive conversations with "I" statements; talk about how you struggle with the problem. Don’t open with "you" statements; avoid blaming the other person for your thoughts and feelings. Healthy relationships don’t blame.
• Don’t assign feelings or motives. Let others speak for themselves.  Healthy relationships recognize each person’s right to explain themselves.
• Stay with the topic. Don’t use a current concern as a reason to jump into everything that bothers you. Healthy relationships don’t use ammunition from the past to fuel the present. Say, "I’m sorry" when you’re wrong. It goes a long way in making things right again.  Healthy relationships can admit mistakes.
• Don’t assume things. When we feel close to someone it’s easy to think we know how he or she thinks and feels. We can be very wrong! Healthy relationships check things out.
• Ask for help if you need it. Talk with someone who can help you find resolution—like a family therapist or ecclesiastical leader. Healthy relationships aren’t afraid to ask for help. There may not be a resolved ending. Be prepared to compromise or to disagree about some things. Healthy relationships don’t demand conformity or perfect agreement.
• Don’t hold grudges. You don’t have to accept anything and everything, but don’t hold grudges—they just drain your energy. Studies show that the more we see the best in others, the better healthy relationships get. Healthy relationships don’t hold on to past hurts and misunderstandings.
• The goal is for everyone to be a winner. Relationships with winners and losers don’t last. Healthy relationships are between winners who seek answers to problems together.
• You can leave a relationship. You can choose to move out of a relationship. Studies tell us that loyalty is very important in good relationships, but healthy relationships are NOW, not some hoped-for future development.
7. Show your warmth. Studies tell us warmth is highly valued by most people in their relationships. Healthy relationships show emotional warmth!
8. Keep your life balanced. Other people help make our lives satisfying but they can’t create that satisfaction for us. Only you can fill your life. Don’t overload on activities, but do try new things—clubs, volunteering, new hobbies or activities, projects. You’ll have more opportunities to meet people and more to share with them. Healthy relationships aren’t dependent!
9. It’s a process. Sometimes it looks like everyone else is confident and connected. Actually, most people feel just like you feel, wondering how to fit in and have good relationships. It takes time to meet people and get to know them…so, make "small talk"…respond to others…smile…keep trying. Healthy relationships can be learned and practiced and keep getting better!
10. Be yourself! It’s much easier and much more fun to be you than to pretend to be something or someone else. Sooner or later, it catches up anyway. Healthy relationships are made of real people, not images!

New Year, Healthier, Happier You!

This year instead of worrying about making a grand scale New Year's Resolution, think about making some small lifestyle changes that can greatly impact your health and happiness. Studies have shown that people who live in certain areas are healthier. Blue zones—areas in Italy, Japan, Greece, California, and Costa Rica where the people have traditionally stayed active to age 100 or older—are some of the healthiest in the world. In these areas people eat 20% less food then in other areas, but even if you don't live in these areas you can apply their habits to achieve a healthier you.

1. One trick for slashing portions: Instead of putting big platters of food at the center of the table, fill each plate at the counter.

2. Eat more plants. Not only are plant-based diets rich in antioxidants and other good-for-you nutrients, they’re also better for your waistline. A plate of food in Okinawa, Japan has one-fifth the calorie density of a typical American meal because they eat a diet high in vegetables.

3. Love the foods that love you back. A diet of berries and elk or tofu and sea vegetables might seem utterly foreign—but taste buds can be retrained. "Americans love fat, salt, and sugar because that’s what we’re used to," says David L. Katz, MD, founding director of the Yale Prevention Research Center. "But studies show that if you eat more wholesome foods, you can learn to prefer them."

An easy way to start: Search for stealth sugar, which Dr. Katz says is found in many packaged foods. "Once you get rid of that hidden sugar, you’ll start to prefer less-sweet foods," he notes.

4. Sit down—and slow down. Which today's high paced society it might be too much to cook every meal. But we can sit at a table to eat our takeout instead of scarfing it down in the car. Savor each bite as the French do; stretch your meals out for 20 whole minutes. You’ll end up eating less and enjoying more.

5. Get up The longest-living people don’t think of exercise as a chore. Instead, little bits of movement are a constant part of their everyday lives. Make like a French woman and take a short walk after dinner.

6.Get out. Every Blue Zone is known for its strong social and family bonds. Besides spending quality time at home with family, surround yourself with healthy-living friends—good health habits are contagious, research shows. Be sure to get involved in your community, too, whether it’s at church, a gardening group, or a volunteer organization. These connections can add years to your life.

7.Take it easy. Even the world’s healthiest people get stressed out sometimes. What they all have are daily strategies to shed stress. Meditate, go for a run, make a dinner date with your best friend.

It’s OK to enjoy the occasional cheeseburger. What matters is a cumulative lifestyle pattern of enjoying healthful food, staying connected to others, and keeping yourself moving.

Technology for your Health

Have you ever wished you could ask your doctor a non-urgent medical question without waiting for a call back or check your lab results from your smartphone? .  If your physician uses an electronic health record system that includes "patient portal" capability, these scenarios could already be at your fingertips.  An electronic health record or EHR is a digital version of a patient's health history. This system provides benefits for doctors and patients.  It may include test results, medications, illnesses, family health history, etc. Some of these systems allow patients to access their information electronically and schedule appointments or renew medication.  The number of physicians who are using this type of system is increasing rapidly. Although this is fairly new technology it is expected to become common in most doctors offices in the near future. Taking an active roll in your healthcare can be a major advantage. Studies have shown that patients with diabetes and high blood pressure are better able to manage their conditions when they use this technology.

Time Out for your Health!

Why Is Physical Activity and Taking Time for Yourself Important?

Regular exercise and physical activity are important to the physical and mental health of almost everyone, including older adults. Being physically active can help you continue to do the things you enjoy and stay independent as you age. Regular physical activity over long periods of time can produce long-term health benefits. That’s why health experts say that older adults should be active every day to maintain their health.

In addition, regular exercise and physical activity can reduce the risk of developing some diseases and disabilities that develop as people grow older. In some cases, exercise is an effective treatment for many chronic conditions. For example, studies show that people with arthritis, heart disease, or diabetes benefit from regular exercise. Exercise also helps people with high blood pressure, balance problems, or difficulty walking.

One of the great things about physical activity is that there are so many ways to be active. For example, you can be active in short spurts throughout the day, or you can set aside specific times of the day on specific days of the week to exercise. Many physical activities — such as brisk walking, raking leaves, or taking the stairs whenever you can — are free or low cost and do not require special equipment. You could also check out an exercise video from the library or use the fitness center at a local senior center.

Talk to your therapist about the  many types of exercise and physical activity. They can also give  lots of tips to help you be active in ways that suit your lifestyle, interests, health, and budget, whether you’re just starting out, getting back to exercising after a break, or fit enough to run a 3-mile race or even a marathon! Exercise is for everyone* — people who are healthy and those who live with an ongoing health problem or disability.

*talk to your physical therapist and/or doctor before beginning any new strenuous exercise program.