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Shin Splints | Physio Guide to Medial Tibial Stress Syndrome

Shin Splints | Physio Guide to Medial Tibial Stress Syndrome

by | Nov 27, 2019 | Ankle and Foot, Return to Sport, Running Injuries, Sports Injury

SUMMARY

  • Shin splints are essentially an overuse injury
  • Numerous factors contribute to symptoms but mainly involving the poor control of force through the lower limbs
  • Important to stop symptoms to avoid developing stress fractures, which require lengthier time away from activity
  • Corrective strengthening exercises, relative rest, and workload management all seem to be treatment mainstays
  • Physiotherapy has a significant role to play in getting back to running and sport
Mid Potion Achilles Tendinopathy Location

SHIN SPLINTS

Shin splints, or as it’s referred to as in the literature, medial tibial stress syndrome (MTSS), is a common injury seen in the recreationally active and army populations. Symptoms typically consist of an aching pain to the lower medial (inside) part of the shin, that can be sharp when running or when inflamed. There can also be some pain and stiffness when you first walk around in the morning, or when you first start your activity.

Risk Factors:

Over 100 potential intrinsic risk factors of MTSS were identified in a recent systematic review [1] involving 21 different studies. Of those risk factors, nine were identified as having a moderate to strong occurrence in clinical practice. Out of these nine, the risk factors that result in the greater loads on the body (such as body mass index) or poorer acceptance of load with running were the most important.

A number of range of motion parameters were also identified. For example, larger plantar flexion range of motion (the movement of pointing your foot down) was identified. It has been hypothesized that the increased plantar flexion results in a greater likelihood of the individual landing on their forefoot rather than their rearfoot while running, possibly increasing the strain on the rear inside leg (posteromedial tibia). Forces on the inside of the shin bone explain the why pain may be present in that area.

Treatment:

Most people tend to simply rest which may decrease symptoms in the short-term, but it doesn’t address the direct cause! The condition is very commonly seen in recreational runners and not as much in your higher-level athletes. Why is this? It’s quite simple! As mentioned in our previous running blogs, the adherence to well-planned running workloads is what separates recreational runners from the competitive or non-injured. Planned training leads to adequate adaptation of the body to the demands placed upon it.

One of areas patients with shin splints focus on is poor “foot posture”. It is very common to hear the same old story, “I have shin splints because my feet are flat, I need orthotics to correct that”. The biggest problem with that approach is that not a lot of people realise that the reason that they are flat footed is not necessarily because of a defect in their feet! It may be because they have strength and control of their hips which is in turn is causing over pronation or flattening of their feet.

The diagram below demonstrates that perfectly!

As the hips cannot stay level during running, this may cause the knees to fall inwards and in turn causes pronation or flattening of the foot. Then, voila! You have increased tractional stress on the medial aspect of the tibia/shin bone. Yes, there is some evidence that poor foot posture can cause the problem, but only in combination with extrinsic risk factors such as over-training and rapid increases in workload.

Poor hip control and strength is also a precursor for many other musculoskeletal conditions such as lower back, hip, knee and Achilles pain. So if we could reduce the risk of these outcomes occurring in the future, why wouldn’t we try!

It is possible that MTSS is a condition where the simple treatment of rest is enough to reduce symptoms. Until proven otherwise, relative rest remains the number one treatment option for reducing your symptoms. However, If addressed early, MTSS can be managed with the combination of targeted strength routines, running workloads, manual therapy and ensuring adequate recovery time between training sessions.

If you are experiencing shin splints or are looking to prevent such injuries from reoccurring, please feel free to book online or give us a call (07) 3102 3337. You’ll receive an in depth assessment and treatment plan to help you achieve your goals and run better for longer!

Till next time, Praxis what you preach.

The Praxis Team.

PREVENT | PREPARE | PERFORM

Images:

The above images are owned by the “Trainer Academy (https://traineracademy.org/) ” and used in this article with thanks.

References:

[1] Winkelmann, Z., Anderson, D., Games, K., & Eberman, L. (2016). Risk factors for medial tibial stress syndrome in active individuals: An evidence-based review. Journal of Athletic Training, 51(12), 1049-1052. 10.4085/1062-6050-51.12.13

Fact or Fiction – Strength Training

Fact or Fiction – Strength Training

by | Nov 15, 2019 | Uncategorized

I’ve been doing my exercises for two weeks religiously and I’m no stronger! This will never work!

ANSWER: Fiction

How long does it take to have strength gains? The answer is actually in two parts. Increasing muscle size (hypertrophy) takes a minimum of 6 weeks, and repetitive exposures to fatiguing loads. BUT, neural adaptations can occur over the first 1-2 weeks.

What the heck is neural adaptations? Imaging you have a small car battery trying to start a truck. It will struggle to do a good job again and again and fade easily. Now try using 10 of those same smaller batteries, which makes the engine start easier. A similar type of thing happens with our nervous system as we train. We become much more efficient with our neural firing to the muscle.

As you can see in the picture below, you have a long way to go in your strengthening after those first two weeks. That is often why we often need to see beyond when the pain goes away as we know that there is so much more work to be done!

If you have been troubled by niggles and pains, don’t hesitate to contact us to ensure we can help you prevent prepare perform! Book online or call us on (07) 3102 3337.

#factorfictionfriday #praxisphysio #physioeducation #knowledgeiskey

Sale, D. G. (1988). Neural adaptation to resistance training. Med Sci Sports Exerc, 20(5 Suppl), S135-145. doi:10.1249/00005768-198810001-00009

Pilates: Mat vs Reformer Pilates (Part 2 of 3)

Pilates: Mat vs Reformer Pilates (Part 2 of 3)

by | Jun 21, 2019 | Reformer Pilates

In part one, we unearthed that pilates has a role to play in reducing the severity of chronic lower back pain. In part two, we tackle a common question from our patients and delve further into the research to see if there is a difference between mat and reformer pilates.

SUMMARY:

  • A reformer is a large piece of pilates equipment that utilises a spring mechanism to apply load in various positions and degrees of loading from gravity.
  • Both forms of exercise are better than the ‘wait and see’ or pharmacological approach with respect to chronic lower back pain
  • The use of reformers may provide a larger stimuli to the sensory system which facilitates proper performance due to better stabilisation
  • Pilates promotes the restoration of the function of muscles involved in lumbopelvic stabilisation, that is, transversus abdominis, multifidus, diaphragm and pelvic floor muscles (the “core”)
  • Reformer pilates provides more options for strengthening, ideal for those recovering from injury, pregnancy or surgery

 

As a general rule, the aim of pilates is to restore or sustain the motor control of the lumbar spine and proper body posture. Joseph Pilates (the founder of pilates) believed beginning exercise in the horizontal plane was important to relieve the stress and strain on the joints, and to align the body before adding additional gravitational forces while standing, sitting or kneeling.

Both mat and reformer are popular types of pilates which both focus on strengthening. Mat pilates, as its names suggests is a floor based method that tends to use bodyweight as the chief form of resistance.

Reformer, is the most popular equipment of Pilates. The design of Reformer utilises a spring mechanism that the person works to control while moving in various planes (Bulguroglu et al 2017). Reformer pilates allows more exercises compared to a mat and it provides the option of performing exercises numerous body positions – from your back, side, stomach and being seated — and also on your feet or knees.

COMPARE THE PAIR

Not a great deal of research has been conducted on differentiating the two forms of pilates. What studies do exist tend poorly define what equipment was used or whether individual tailoring of the sessions occurred.

Luz et al compared the effectiveness of Pilates mat and equipment-based Pilates exercises (with the use of Reformer) in a group of 86 individuals with chronic lower back pain. The 6-week routine included individual, 1-hour sessions performed twice a week and supervised by a Pilates-experienced physical therapist. The outcome measures were: pain intensity, disability, global perceived effect, patient’s specific disability and fear of movement, known as kinesiophobia (Luz et al 2014). The assessment was recorded after 6-week intervention and 6 months. A significant difference was noted in both groups after a 6-week programme in all of the areas evaluated. After 6 months however, a significant difference was found in disability, specific disability and kinesiophobia in favour of equipment-based Pilates exercises (Luz et al 2014; Eilks et al 2019).

 

In the study by Cruz-Diaz et al, the influence of Pilates mat exercises and equipment-based Pilates exercises (with reformer) on pain, disability, kinesiophobia and activation of transversus abdominis (expressed as a change in muscle thickness and assessed by real-time ultrasound examination) was assessed. The trial involved 98 patients with chronic lower back pan (CLBP) allocated to three groups: Pilates mat exercises, Pilates apparatus or the control group. The programme was conducted in groups of four participants during 12 weeks with 50 min sessions (twice a week). The evaluation was carried out during intervention (6 weeks after baseline) and after 12 weeks. As with Luz et al, significant improvement were shown in both groups for all outcome measures after 6 and 12 weeks. However, in the comparison between groups, the superiority of equipment-based Pilates was noted (Cruz-Diaz et al 2017). In both studies, it was suggested that the finding may be an effect of the use of apparatus in exercises that provides larger stimuli to the sensory system, resulting in larger feedback, which facilitates proper performance due to better stabilisation (Eilks et al 2019). According to da Luz et al, this result may also be caused by a placebo effect inherent for the application of equipment. As noted earlier however, reformer pilates offers a larger scope of exercises to draw upon for those who are limited by pain, weakness or fear of movement. So there you have it. What little research there is suggests that any pilates is good for your rehabilitation or as a part of your ongoing strength program. However, it appears that reformer pilates is more effective, and allows a greater degree of variability of training. For more about what makes Praxis Pilates special, check out our website here. Join us for part 3 next week where we look at what the research suggests regarding the frequency of pilates. Is more actually better? Till next time – Praxis what you preach Prevent. Prepare. Perform

References:

  1. Eliks, M., Zgorzalewicz-Stachowiak, M., & Zeńczak-Praga, K. (2019). Application of Pilates-based exercises in the treatment of chronic non-specific low back pain: state of the art. Postgraduate medical journal, 95(1119), 41-45.
  2. da Luz Jr, M. A., Costa, L. O. P., Fuhro, F. F., Manzoni, A. C. T., Oliveira, N. T. B., & Cabral, C. M. N. (2014). Effectiveness of mat Pilates or equipment-based Pilates exercises in patients with chronic nonspecific low back pain: a randomized controlled trial. Physical therapy, 94(5), 623-631.
  3. Bulguroglu, I., Guclu-Gunduz, A., Yazici, G., Ozkul, C., Irkec, C., Nazliel, B., & Batur-Caglayan, H. Z. (2017). The effects of Mat Pilates and Reformer Pilates in patients with Multiple Sclerosis: A randomized controlled study. NeuroRehabilitation, 41(2), 413-422.
  4. Cruz-Díaz, D., Bergamin, M., Gobbo, S., Martínez-Amat, A., & Hita-Contreras, F. (2017). Comparative effects of 12 weeks of equipment based and mat Pilates in patients with Chronic Low Back Pain on pain, function and transversus abdominis activation. A randomized controlled trial. Complementary therapies in medicine, 33, 72-77.
Pilates: Reforming our back pain rehabilitation (Part 1 of 3)

Pilates: Reforming our back pain rehabilitation (Part 1 of 3)

by | Jun 3, 2019 | Lower Back, Pain, Reformer Pilates

With our 30 day pilates challenge starting today, we thought we would take a look at why we love pilates so much for our patients, and what some of the benefits are. Part 1 looks at how pilates affect those with chronic lower back pain. Part 2 looks at the difference between mat and reformer pilates and part 3 looks at how often is required to see the benefit of pilates.

SUMMARY:

  • Back pain is extremely common, multifactorial, and often reoccurs
  • Strengthening interventions appear better for long term suffers of lower back pain
  • Pilates has been shown to improve muscular strength and endurance of key pelvic and postural musculature associated with lower back pain
  • Specifically, pilates promotes the restoration of the function of muscles involved in lumbopelvic stabilisation, that is, transversus abdominis, multifidus, diaphragm and pelvic floor muscles
  • As little as 2 sessions per week for 6 weeks has been shown to see improvements in pain and function for those with longstanding lower back pain, even after stopping pilates

Chronic low back pain (CLBP) is one of the commonest musculoskeletal problems in modern society (Anderson 1999) and is a highly prevalent in both the sporting and general public. CLBP is experienced by 70%–80% of adults at some time in their lives (Crombez et al 1999) and as such, the costs associated with LBP and related disability are enormous, causing a major economic burden for patients, governments and health insurance companies (Dagenais 2008).

Lower back pain has been one of the most extensively studied musculoskeletal conditions as a result of the prevalence and debilitation nature. Its management comprises a range of different intervention strategies including surgery, drug therapy and non-medical intervention like rehabilitation (Paolucci et al 2018). Within Physiotherapy, exercise therapy is probably the most commonly used intervention for the treatment of patients with chronic non-specific LBP due to its plausible biological rationale and low cost.

Whilst general conditioning programs to train strength and endurance of the spine musculature have been shown to reduce pain intensity and disability (Rainville et al 2004), the popularity of pilates (both mat and reformer) has helped provide an accessible and supervised form of therapeutic exercise.

EVIDENCE FOR PILATES

The Pilates method, using functional exercises aims to improve muscular strength and endurance. Specifically, the pilates method have promotes the restoration of the function of muscles involved in lumbopelvic stabilisation, that is, transversus abdominis, multifidus, diaphragm and pelvic floor muscles. Using the principles of progressive overload, your body adapts to the incremental loading week after week and consequently results important postural control improvement. In 2009, Curnow and colleagues showed that the Pilates method improves load transfer through the pelvis, something that intuitively helps those with CLBP.

However, a systematic review (Patti et al 2015) reported evidence that Pilates method-based exercises are more effective than no treatment or minimal physical exercise interventions in the management of chronic nonspecific LBP. Further, they pointed out that the effects of the Pilates method are only proven for patients with chronic nonspecific LBP in the short term.

A recent study by Natour and colleagues (2015) showed that the group of participants that were practicing Pilates method resulted statistically better compared with the a non exercising group who only used inflammatory medication. Those who were in the pilates group used less pain medication at 45, 90 (conclusion of the Pilates method), and 180 days, 90 days after the conclusion of the exercise program.

In conclusion, Pilates as an exercise choice is more effective than minimal physical exercise or drug based interventions in reducing pain and disability in the short-term period. There is agreement that exercise “helps” in the treatment of chronic pain, but it is still not clear exactly which factors or particular kind of exercises may be responsible of such improvements (Natour et al 2015; Patti et al 2015). Praxis Physiotherapy has always been a strong proponent of movement and loading early in rehabilitation (more on this in later blogs!).

In the next instalment, we discuss the difference between mat and reformer pilates and perhaps find some more answers regarding which exercise regime reigns supreme!

Check out all our other reformer pilates services on our website

Until next time,

Prevent. Prepare. Perform.

References:

  1. Andersson GB. Epidemiological features of chronic low-back pain. Lancet. 1999;354(91789178):581–585.
  2. Crombez G, Vlaeyen JW, Heuts PH, Lysens R, Crombez G. Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability. Pain. 1999;80(1-2):329–339.
  3. Dagenais DC, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. The Spine Journal 2008;8(1):8‐20.
  4. Paolucci, T., Attanasi, C., Cecchini, W., Marazzi, A., Capobianco, S. V., & Santilli, V. (2019). Chronic low back pain and postural rehabilitation exercise: a literature review. Journal of pain research, 12, 95.
  5. Rainville J, Hartigan C, Martinez E, Limke J, Jouve C, Finno M. Exercise as a treatment for chronic low back pain. Spine J. 2004;4:106-115
  6. Patti, A., Bianco, A., Paoli, A., Messina, G., Montalto, M. A., Bellafiore, M., … & Palma, A. (2015). Effects of Pilates exercise programs in people with chronic low back pain: a systematic review. Medicine, 94(4).
  7. Curnow, D., Cobbin, D., Wyndham, J., & Choy, S. B. (2009). Altered motor control, posture and the Pilates method of exercise prescription. Journal of bodywork and movement therapies, 13(1), 104-111.
  8. Natour, J., Cazotti, L. D. A., Ribeiro, L. H., Baptista, A. S., & Jones, A. (2015). Pilates improves pain, function and quality of life in patients with chronic low back pain: a randomized controlled trial. Clinical rehabilitation, 29(1), 59-68.
Pilates Launch Day! Northside Clinic

Pilates Launch Day! Northside Clinic

by | Mar 7, 2018 | Uncategorized

OPENING DAY || Exciting times at Praxis! We are stoked to be launching our reformer pilates classes @clubcoops on Saturday March 17. We have FREE 30min classes starting at 8am with Emma and Tara! Opening day specials available! Email admin@praxisphysio.com.au or call (07) 3102 3337 or chat to the Club Coops front desk to secure your FREE class today! www.praxisphysio.com.au