Shin Splints or Stress Fracture?

This is a common question that comes up with athletes who are training in any sport.  Shin splints can affect anyone who does a lot of running, from marathoners to soccer players, and it is one of the most common ailments I see in my office.

Shin splints are known by many names, but the correct terminology is medial tibial stress syndrome, or MTSS.  As the name implies, the condition involves stress or overload of the inner, or medial, border of the shin bone—the tibia.

We usually see MTSS when someone abruptly changes their training routine.  The bone is overstressed and begins to remodel.  It also develops a tiny amount of fluid between the main layer of bone and the outer jacket, called the periosteum.

On examination, the inside of the leg is very tender, especially along the bone.  X-rays usually don’t show any abnormalities. And bone scans and MRIs, while helpful to confirm the diagnosis, are usually unnecessary and expensive.

So what do you do about shin splints if you have them?  The answer is simple, but is one that athletes don’t like to hear.  REST!!  That doesn’t mean sitting on the couch all day and resting, but rather changing the exercise to a cross-training activity like swimming or biking to maintain cardiovascular fitness while allowing the bone to heal.

Other things that may help include anti-inflammatory medicines, ice, compression sleeves, and arch supports.  However, there is no clear evidence that any of these things work.  Generally, rest is key!

It’s usually just better to avoid getting shin splints.  The most important way to do that is to increase training gradually, allowing for plenty of time to reach your goals.  A high quality shoe and limiting running on really hard surfaces also helps.

If you suspect you have shin splints, try giving it some time to rest.  But if there is one small area on the shin that is a lot more tender than the surrounding bone or if your pain is not improving over time, it may indicate a stress fracture, and you should have your doctor take a look.

"I Just Got My Bell Rung."

I recently had the opportunity to speak with the coaches of the Tony Glavin Soccer Club about concussions.  The coaches are very interested in the health of their athletes and how best to take care of them if such an injury does occur.   Stories of head injuries have dotted the sports pages and often the front pages quite a bit lately, as more and more athletes, parents, and coaches attempt to understand the injury.  We are figuring out that getting “dinged” or ‘rung” may actually be a more serious injury.

A concussion is a traumatic injury to the brain.  It can occur from a blow to the head or even to the body if that hit causes movement of the brain inside the skull.  It results in any number of symptoms because of a change in how the brain is working.  It does not cause a structural injury, so you can’t see a concussion on a CT scan or MRI.  And you don’t have to get knocked out to have a concussion.  In fact, a brief loss of consciousness doesn’t even mean an athlete has suffered a more severe injury.

Evaluating head injuries can be tricky, as symptoms are often explained away as another illness or injury.  Coaches are often the first responders to an injured athlete, and they should be conservative when it comes to head injuries.  They are taught, “when in doubt, sit them out,” even if they aren’t sure of the diagnosis.  A medical professional, such as a doctor or athletic trainer, should evaluate an injured athlete as soon as possible after a head injury.  The risk of much more serious injury is very high if an athlete suffering from the effects of a concussion is allowed to continue playing and endures another hit.

Not every injury causes the same issues.  The signs and symptoms of concussion vary between individuals.  These can include balance problems, dizziness, concentration and memory issues, drowsiness, mental fogginess, headache, feeling emotional, nausea, irritability, light or noise sensitivity, trouble falling asleep, and vision problems.  If your athlete is describing any of these symptoms after a head injury, get them to the doctor.  Be careful not to judge the severity of the injury yourself.

When a concussed athlete comes into my office, I perform a very thorough evaluation.  I talk with both the athlete and his or her parents about how the athlete is acting.  I examine the nervous system from head to toe.  I include memory and concentration tests, as well as balance and visual tests as part of the visit.  Then we spend a great deal of time discussing the injury and how to minimize the time the athlete is suffering.  Often I have to recommend shorter school days or make changes to the work the student does at school while having symptoms.

Once an athlete is feeling back to normal at rest and then at school, they move through a progression of physical activity to test their readiness to return to sports.  If he or she is successful and does not have a return of their symptoms, I allow them to return to play fully.

Concussion is often an uncertain situation for athletes, parents, and coaches.  A little understanding of the injury helps to decrease the anxiety if you or your athlete gets hurt.  I will be talking more about concussions at the Tony Glavin Soccer Club Parents Meeting on Sunday, September 14^th.  I’ll be able to arm you with more knowledge and answer any questions you have.  Hope to see you there!

Preventing Soccer Injuries

I see a significant number of injuries from soccer in my office.  Most of them involve the lower extremities.  They may be from a traumatic injury like a kick to the leg or a twist to the knee, or may result from overuse.  Sprains of joints and strains of muscles and tendons are the most common injuries, but cartilage tears, fractures and contusions do occur.  Shin splints, patella tendinitis and Achilles tendinitis are the most common overuse injuries.  In these cases, there is no one event that causes the pain.  Instead, the pain builds up over time.  I also see several stress fractures every year.  These occur when the bone becomes weak from overuse.  It’s often pretty tough to distinguish between soft tissue injuries and injury to the bone, so if leg pain does not improve after a few days of rest, you should consult your physician.

Treating soccer injuries can be tricky.  I strive to limit the time lost from training while ensuring a safe return to play.  For most acute injuries, a short period of rest with ice and elevation will do the trick.  For some of the longer term injuries, especially overuse injuries, relative rest is possible.  This means that the athlete can continue to do some modified training while avoiding painful activities.  For example, I will often have players work on drills, but avoid scrimmaging.  Sometimes I have to put them on a bike or in the pool to maintain cardiovascular stamina while avoiding a lot of weightbearing on an injured leg.  Rarely are players completely restricted from activity for a long-term basis.

Prevention of soccer injuries often involves just using common sense.  Use well-fitting cleats and shin guards.  Watch out for mobile goals that can fall on players.  Remember to hydrate adequately.  Maintain proper fitness—we know that athletes who are stronger and more prepared physically have lower risk of injury.  If an injury does occur, returning to play after a player is healed needs to be gradual, progressing through aerobic conditioning, strength training, and then agility training.

Staying fit for the field is easy with proper preparation, but injuries do occur.  Playing through pain is often not the answer.  Never hesitate to consult your physician if you are unsure. 

Arthritis Foundation's Jingle Bell Run Hits the Airwaves

The 2013 edition of the Arthritis Foundation's St. Louis Jingle Bell Run takes place in November at Hollywood Casino in Maryland Heights.  I've been named a medical honoree for the last two years, and part of the job includes a media blitz to help publicize all of our Jingle in July activities.  So I've been visiting the local news stations to talk about arthritis and how fundraising efforts like these help us to conduct research that will help us decrease pain in current arthritis sufferers and decrease risk in those who are yet to develop the disease.

We've visited Show Me St. Louis on KSDK and Fox2News in the Morning to talk about the events.  We even got to cuddle with some mice in a warm-up to this weekend's mouse races in St. Peters.

The Arthritis Foundation is an integral part of fundraising for research that helps us battle all types of arthritis, from Juvenile Idiopathic Arthritis to Osteoarthritis.  These conditions affect millions of Americans.  Consider donating or better yet, consider joining the Advanced Bone & Joint team at the Jingle Bell 5K run/walk this fall.  It's a lot of fun.  Costumes abound, and there is an all you can eat pancake breakfast that's pretty incredible.  Bring the family and help us win the fight against arthritis!

Computerized Baseline Concussion Testing Continues in the Fort Zumwalt District for a fifth year!

I had the opportunity to speak to the Fort Zumwalt School District School Board Meeting last month to detail the results of the district's ImPACT neurocognitive testing.  The program allows us to ensure that athletes are not returned to the field too soon, helping to decrease risk of further injury.

The conversation was detailed in an article in Mid Rivers Newsmagazine this month.  Congratulations to Fort Zumwalt, as well as Francis Howell and Wentzville, two other districts who have instituted the program.

Advanced Bone & Joint Quick Care Center is available on a walk-in basis!

We are now Advanced Bone and Joint!

If you’ve been around the office lately, you’ve probably noticed us wearing buttons featuring the phrase “Ask me why we are advanced!”  It’s a great question, because we know you have a choice in who you trust to care for your injuries.  We have been asking ourselves the same question a lot lately, along with “why should our patients choose our practice and allow us to help them?” 

It’s not an easy answer, because a lot goes into not only getting you better, but into making sure the experience you have while you are with us is as smooth and enjoyable for you as possible.

When the people who make up St. Peters Bone and Joint sat down and really thought about it, we had many ideas about what makes us advanced and why so many people come back to our practice, and send their friends and family to us.  In our office, everyone with whom you come in contact treats you as a guest.  Not a number.  Not a diagnosis to fix.  As a person, just as we would treat you in our own home. 

We are skilled specialty physicians, with talents that span not only bone and joint injuries, but include management of concussions, overuse injuries, and chronic pain.  What makes us advanced?  We employ cutting edge diagnostic and treatment strategies to get you better.  And we do this with you as our guide.  Every guest’s treatment is individualized to his or her goals and desires. 

Want to run a marathon but have some knee pain?  We’ll talk with you about why you have that pain, how you can fix it, and how you can avoid having it ever again.  Have a shoulder that keeps you up at night?  We’ll show you what is going on, help control the pain, and educate you on how make it go away forever.  Together, we will come up with a plan and help you execute it.  You are in charge.  We are here to help you meet your goals and live your life.  And we hope that while you are with us, you will actually enjoy being at the doctor’s office.

So when it came down to it, we felt the name “St. Peters Bone and Joint Surgery” didn’t illustrate to our guests what makes our practice special.  It tells you where we are, but it doesn’t describe the incredible things that are going on here.  It doesn’t express why we should be your ally in meeting your goals.  So welcome to the new “Advanced Bone & Joint.”  We are happy to be your partner in health.  When the need arises, come on in and let us show you why we are advanced!

Check out the new Advanced Bone & Joint!