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Shin splints versus stress fractures. What’s the difference?

Shin splints versus stress fractures. What’s the difference?

12 April 2024

Close-up of a runner's lower legs and trainers on tarmac
Photo by Jakob Owens on Unsplash
Shin splints are characterised by inflammation of the muscles, tendons and bone tissues surrounding the tibia, also known as the shin bone. Stress fractures, on the other hand, are tiny cracks in the bone. However, both conditions are caused by the same problem, overloading.
Shin splints refer to pain along the shin bone and are common in athletes, especially runners, dancers, and gymnasts. This condition is also known as medial tibial stress syndrome, as it often occurs in athletes who have recently intensified their training routines, putting added stress on their shin bone. In the vast majority of shin splint cases, treatment involves rest, ice, and other self-care measures, as with most inflammatory and strain injuries. To prevent future recurrence of shin splints, it is advised that you wear appropriate footwear and modify your exercise routine accordingly.
Whilst shin splints are characterised by pain caused by stress to the bone; stress fractures cause actual damage to the bone. They are common amongst athletes, especially long distance runners, due to repeat force and overuse of the limbs. This injury is most common in the weight-bearing bones of the lower leg and foot. Treatment for stress fractures, as with shin splints, is lots of rest. However, you may be asked to wear a walking boot or use crutches to further reduce the weight-bearing load on the limbs.
It is worth remembering that, although predominately occurring in athletes, stress fractures and shin splints can also develop from the normal use of a bone that is weakened. This arises with conditions such as osteoporosis.

How to tell these two conditions apart?

The main determinant between shin splints and stress fractures is pain. With a stress fracture, the pain will get progressively worse as you run and will continue to persist at a localised point once you have finished exercising. With shin splints, on the other hand, the pain tends to present over a broad area and will cause swelling and significant discomfort, but does not stop physical activity. Once you have warmed up, shin splints also tend to dissipate. Moreover, shin splints exclusively occur in the lower leg; whereas stress fractures, although common in the weight-bearing bones of the lower leg and foot, can occur in any bone.

Treatment with regenerative medicine

As mentioned, treatment of these injuries tends to focus on rest and exercise modifications; however, you may experience persistent shin splints or stress fractures, which has a significant impact on your daily activities. This is where regenerative medicine, specifically platelet rich plasma (PRP), comes in. You can read more about how this treatment works here.

Preclinical studies have emphasised the potential value of PRP injections in stress fractures. This technique is capable of shortening the fracture healing time so you can be back on your feet in as short a time as possible. PRP injections have also shown great promise in the treatment and prevention of shin splints.

At Opus, we are able to thoroughly assess your condition and provide you with evidence-based techniques underpinned by the current research to ensure the greatest chance of success on your journey. Get in touch today to book a consultation with one of our world renowned doctors.

Lower Back Pain and Pelvic Floor Dysfunction

Lower Back Pain and Pelvic Floor Dysfunction

3 April 2024

Lower back pain (LBP) is the most prevalent musculoskeletal injury, as approximately 80% of the population will experience LBP in their lifetime (Arab et. al 2010). Transverse abdominus activation is often prescribed for LBP however pelvic floor muscle (PFM) is not always incorporated into treatment. PFM aids in supporting the abdominopelvic organs and there is an abundance of research on the role of the PFM in urinary and fecal incontinence. Nevertheless, it is important to remember the PFM role in lumbar and pelvic stability and intra-abdominal pressure (Mohseni-Bandepi et. al 2011). Research illustrates that the combination of pelvic floor exercise alongside routine treatment can provide significant pain relief in LBP compared to routine treatment alone (Bi et. al, 2013), demonstrating the importance of PFM exercises.

The link between LBP and PFM helps to provide insight into the correlation between LBP and pelvic floor dysfunction (PFD). PFD is an umbrella term to describe weakness, poor endurance and hypertonicity of the PFM which can impact incontinence, prolapses and pelvic pain. Dufour et al. found that 95% of women with LBP had PFD, ‘71% of the participants had pelvic floor muscle tenderness, 66% had pelvic floor weakness and 41% were found to have a pelvic organ prolapse’(Dufour et. al 2018), further highlighting the importance of incorporating PFM in treatment. Arab et al. also examined PFD in women with and without LBP. The results show PFD in participants with LBP compared to those without. This is valuable for health care participants when assessment and treating LBP (Arab et. al 2010). It is also important to recognize PFD in pregnancy-related lower back pain (PLBP). Pool-Goudzwaard et. al discovered ‘52% of PLBP, significantly more than in the healthy control group’ (Pool-Goudzwaard et. al,2005) and promote addressing both LBP and PFD during pregnancy.

There are a variety of methods to help activate, strengthen and relax the pelvic floor in order to aid recovery in PFD.  Kegels or reverse Kegels are often prescribed to promote awareness and strengthen PFM (Torgenu et. Al 2021). Transverse abdominus contraction has also been shown to help activate and strengthen PFM. Sapsford et al. found ‘that abdominals contract in response to a pelvic floor contraction command and that the pelvic floor contracts in response to both a “hollowing” and “bracing” abdominal command’(Mohseni-Bandepi et. al 2011), therefore proving the PFM can be activated by engaging the abdominals. Hypopressive exercises (HE) have also shown to aid recovery from PFD. HEs lowers the intra-abdominal pressure which enables an involuntary contraction of the PFM and transverse abdominus. Navarro-Brazález et. al suggests the combination of HEs and pelvic floor muscle training improves PFM strength and quality of life for patients with PFD (Navarro-Brazález et. al 2020).

Reference List

 

  • Arab, A.M., Behbahani, R.B., Lorestani, L. and Azari, A. (2010). Assessment of pelvic floor muscle function in women with and without low back pain using transabdominal ultrasound. Manual Therapy, 15(3), pp.235–239. doi:https://doi.org/10.1016/j.math.2009.12.005.

  • Bi, X., Zhao, J., Zhao, L., Liu, Z., Zhang, J., Sun, D., Song, L. and Xia, Y. (2013). Pelvic floor muscle exercise for chronic low back pain. Journal of International Medical Research, 41(1), pp.146–152. doi:https://doi.org/10.1177/0300060513475383.

  • Dufour, S., Vandyken, B., Forget, M.-J. and Vandyken, C. (2018). Association between lumbopelvic pain and pelvic floor dysfunction in women: A cross sectional study. Musculoskeletal Science and Practice, 34, pp.47–53. doi:https://doi.org/10.1016/j.msksp.2017.12.001.

  • Mohseni-Bandpei, M.A., Rahmani, N., Behtash, H. and Karimloo, M. (2011). The effect of pelvic floor muscle exercise on women with chronic non-specific low back pain. Journal of Bodywork and Movement Therapies, 15(1), pp.75–81. doi:https://doi.org/10.1016/j.jbmt.2009.12.001.

  • Navarro-Brazález, B., Prieto-Gómez, V., Prieto-Merino, D., Sánchez-Sánchez, B., McLean, L. and Torres-Lacomba, M. (2020). Effectiveness of Hypopressive Exercises in Women with Pelvic Floor Dysfunction: A Randomised Controlled Trial. Journal of Clinical Medicine, 9(4), p.1149. doi:https://doi.org/10.3390/jcm9041149.

  • Pool-Goudzwaard, A.L., Slieker ten Hove, M.C.P.H., Vierhout, M.E., Mulder, Paul.H., Pool, J.J.M., Snijders, C.J. and Stoeckart, R. (2005). Relations between pregnancy-related low back pain, pelvic floor activity and pelvic floor dysfunction. International Urogynecology Journal, [online] 16(6), pp.468–474. doi:https://doi.org/10.1007/s00192-005-1292-7.

  • Torgbenu, E.L., Aimakhu, C.O. and Morhe, E.K.S. (2020). Effect of Kegel Exercises on Pelvic Floor Muscle Disorders in Prenatal and Postnatal Women – A Literature Review. Current Women’s Health Reviews, 16. doi:https://doi.org/10.2174/1573404816999200930161059.

Woman performing a single-leg balance exercise indoors

Common shoulder injuries amongst athletes and how we treat them

Common shoulder injuries amongst athletes and how we treat them

12 March 2024

Black and white image of an athlete lifting weights
Photo by Quino Al on Unsplash

Acromioclavicular joint injury

The acromioclavicular (AC) joint is the point at which two bones, the collarbone (clavicle) and part of the shoulder blade (scapula), meet. An injury to this joint is characterised by shoulder separation and can be defined as one of six types. The severity of the injury also impacts the treatment approach.
1. Type I. The AC ligament is slightly torn; however, there is no significant damage to the coracoclavicular ligaments. Treatment often centres around rest and recovery, with the joint being iced and protected, often with an arm swing. Following this, range-of-motion exercises are recommended as soon as they can be tolerated. 2. Type II. The AC ligament is completely torn; however, there is little to no tear to the coracoclavicular ligaments. Initial treatment involves rest, ice, pain medication, and up to a week of shoulder immobilisation in a sling. Range-of-motion exercises are recommended alongside strengthening exercises.
3. Type III. The AC and coracoclavicular ligaments are completely torn, resulting in the collarbone separating from the scapula. Although treatment for this injury can be conducted non-surgically, as with type I and II injuries, the duration of recovery is significantly longer, with a sling being required for up to a month. 4. Type IV, V, VI. Treatment of these injuries almost exclusively involves surgical interventions, with specialists required to reduce the risk of long-term complications. In these cases, regenerative medicine may also be considered.

Rotator cuff tendonitis

Rotator cuff tendonitis is characterised by pain and swelling of the cuff tendons and the surrounding bursa (a soft fluid filled sack that cushions the joint). This injury, unlike an injury to the AC joint, does not occur all at once. Usually, rotator cuff tendonitis transpires over a substantial period of time following repeated irritation to the area. Although it can affect anyone, this injury most commonly presents in people with loose joints, abnormal bone anatomy in the shoulder, and those who do repetitive heavy lifting, such as weightlifters and powerlifters.
Treatment of rotator cuff tendonitis is predominantly non-surgical and involves plenty of ice, NSAIDS for pain management, including ibuprofen, and steroids. In the instance that surgery is required, the most common procedure is an acromioplasty. However, recent advances in regenerative medicine have permitted the accelerated and enhanced recovery of these injuries using mesenchymal stem cell therapy.

Beyond these individual conditions described, there are also activity-specific injuries, including thrower’s shoulder, swimmer’s shoulder, and rugby shoulder. At Opus, we ensure that your injury is fully assessed so that you receive the best possible treatment that is tailored to your needs. Get in touch to discuss your recovery with one of our world renowned specialists.

The Different Approaches to Treating Scoliosis through Physiotherapy

The Different Approaches to Treating Scoliosis through Physiotherapy

22 February 2024

Physiotherapy Scoliosis Specific Exercise (PSSE) is the umbrella term and model that encompasses specific education, physiotherapy exercises, psychological support and bracing for scoliosis (Berdishevsky et. al, 2016). PSSE approach has become a more accepted form of conservative treatment due research showing an improvement in cobb angle, posture and breathing function (Seleviciene et. al, 2022). The PSSE model incorporates a multidisciplinary approach and can be used as an adjunct to medical treatment (Berdishevsky et. al, 2016). There are currently 8 scoliosis schools which use PSSE, however the Schroth method, Scientific Exercise Approach to Scoliosis (SEAS) and Barcelona Scoliosis Physical Therapy School approach (BSPTS) are the most researched and shown to be the most effective in reducing Cobb angle and quality of life (Seleviciene et. al, 2022)

Schorth method

The Schorth method is the most studied approach with research demonstrating reduced prevalence of surgery, improved self-image and quality of life. This method uses ‘body blocks’ to help explain the scoliosis and therefore determine the most appropriate treatment. For example, the spine is split into hips, lumbar, thoracic and shoulder blocks to help assess the curvature and rotation of the spine. This provides a clear exercise programme and prioritises the manual therapy techniques. Education is used throughout the various exercises to help teach the patient to elongate the concave areas in order to improve posture. The four most common exercises include:

  • 50 X pezziball – The ’50 X pezziball’ involves the patient sitting on a swiss ball in front of a mirror and using a wall bar to self-correct the spine alignment. The patient uses the mind body connection and cues to aid spine elongation and core engagement.

  • Prone exercise- This exercise uses shoulder traction and counter traction to aid the thoracic curve while activating the iliopsoas for the lumbar curve.

  • Sail exercise- Sail involves stretching and elongating the thoracic cavity.

  • Muscle cylinder- This involves side lying on the convex side to engage QL and correct the lumbar curve against gravity. (Berdishevsky et. al, 2016)

SEAS

The SEAS approach focuses on increasing spine stability and is often used alongside wearing corrective braces to maintain range of motion and muscle tone. This approach is more functional by encouraging postural correction in different activities of daily living. Equipment such as balance boards are regularly used to aid muscle endurance and neuromotor function. (Berdishevsky et. al, 2016)

BSPTS

The BSPTS approach is based on the Schroth method and focuses on challenging the trunk with or against gravity. This includes supine exercises which remove gravity and allows the patient to focus more easily on posture corrections, as well as side lying exercises which concentrate on lumbar concavity by working against gravity. The various exercises use corrective pads and cueing to promote elongation, traction/counter traction and muscle activation to improve posture. (Berdishevsky et. al, 2016)

Despite the various research conducted on these approaches, there is still a lack of research (Seleviciene et. al, 2022); therefore, it is important to incorporate each method into clinical practice to aid posture and quality of life (Berdishevsky et. al, 2016).

Reference List

Berdishevsky, H., Lebel, V.A., Bettany-Saltikov, J., Rigo, M., Lebel, A., Hennes, A., Romano, M., Białek, M., M’hango, A., Betts, T., de Mauroy, J.C. and Durmala, J. (2016). Physiotherapy scoliosis-specific exercises – a comprehensive review of seven major schools. Scoliosis and Spinal Disorders, 11(1). doi:https://doi.org/10.1186/s13013-016-0076-9.

Seleviciene, V., Cesnaviciute, A., Strukcinskiene, B., Marcinowicz, L., Strazdiene, N. and Genowska, A. (2022). Physiotherapeutic Scoliosis-Specific Exercise Methodologies Used for Conservative Treatment of Adolescent Idiopathic Scoliosis, and Their Effectiveness: An Extended Literature Review of Current Research and Practice. International Journal of Environmental Research and Public Health, 19(15), p.9240. doi:https://doi.org/10.3390/ijerph19159240.

Doctor examining a patient lying on a treatment couch

Injury Prevention for Skiing

Injury Prevention for Skiing

31 January 2024

There are many risk factors that could cause injury when skiing which include equipment, technique, experience, education, awareness and snow related injuries (Hebert-Losier and Holmberg,2016). Research has shown that ski equipment (highly shaped, short and wide skis) has the most impact when preventing injuries (Spörri et. Al, 2017). Nevertheless, it is important to ensure professional and amateur skiers meet the physical demands of skiing to further reduce the risk of injury; this can be achieved through endurance training and strength and conditioning (Hebert-Losier and Holmberg,2016).

Sport specific strength training is key for improving technique and delay in muscle fatigue (Sandbakk, 2018). In order to formulate a ski specific strength programme, it is important to understand the most common injuries caused by skiing.  Spörri et. all established 80% of injuries occur while the skier is turning and 19% when landing. Upper limb injuries are caused by crashes (96%) and knee injuries are the most common in skiing (83%). Hewett et. al used a screening method to assess the valgus loading of the knee to predict the risk of ACL injuries. The athletes who sustained ACL injury had a higher valgus angle compared to the uninjured athletes (Spörri et. al 2017).  In order to reduce the valgus angle in the knee, it is important to focus on strengthening hip abductors, hip external rotators (Dix et. al 2019) and quadriceps to support the knee within the sagittal plane when skiing (Morrissey et. Al 1987). Additionally, recent studies have shown the importance of core strengthening exercises in preventing ACL injuries in alpine skiing. Raschner et. all found athletes with reduced core strength or core strength imbalance had an increased risk for an ACL injury (Spörri et. Al, 2017). Therefore, a strength training programme focusing on core and lower limb strengthening is key to reducing the risk of injury in skiers.

Endurance training for alpine skiing is crucial for performance (Neumayr et. Al 2003) and in reducing the risk of fatigue. The traditional recommendation for cardiovascular endurance training is a minimum of 20 minutes within 70%-80% of maximum heart rate (Morrissey et. Al 1987). However more recent research has shown high intensity interval training (HIIT) is also an effective method of improving endurance for skiers. Sandbakk et. al found aerobic HIIT improves endurance and ‘oxygen uptake at the ventilatory threshold’ (Sandbakk et. al 2013) in junior cross-country skiers. Furthermore, active on-hill recovery within training has shown to ‘optimize blood lactate clearance’(Spörri et. al 2017) and ‘increase run completion rate’ (Spörri et. al 2017) therefore highlighting the importance of endurance training in the prevention of injury.

Neuromuscular training for skiers is key to preventing falls. Jacopo et. al established that including a neuromuscular warm- up programme for skiers had a positive impact on dynamic balance by improving their lower limb awareness and control (Jacobi et. al 2018). However recent studies show neuromuscular training programs reduce the risk of ACL injuries apart from alpine ski racing. This is likely due to ski boots further challenging the athletes’ balance (Spörri et. al 2017).

Reference List

 

  • Dix, J., Marsh, S., Dingenen, B. and Malliaras, P. (2018). The relationship between hip muscle strength and dynamic knee valgus in asymptomatic females: A systematic review. Physical Therapy in Sport, 37. doi:https://doi.org/10.1016/j.ptsp.2018.05.015.

  • Hébert-Losier, K. and Holmberg, H.-C. (2013). What are the Exercise-Based Injury Prevention Recommendations for Recreational Alpine Skiing and Snowboarding? Sports Medicine, 43(5), pp.355–366. doi:https://doi.org/10.1007/s40279-013-0032-2.

  • Morrissey, M.C., Seto, J.L., Brewster, C.E. and Kerlan, R.K. (1987). Conditioning for Skiing and Ski Injury Prevention. Journal of Orthopaedic & Sports Physical Therapy, 8(9), pp.428–437. doi:https://doi.org/10.2519/jospt.1987.8.9.428.

  • Neumayr, G., Hoertnagl, H., Pfister, R., Koller, A., Eibl, G. and Raas, E. (2003). Physical and Physiological Factors Associated with Success in Professional Alpine Skiing. International Journal of Sports Medicine, 24(8), pp.571–575. doi:https://doi.org/10.1055/s-2003-43270.

  • Sandbakk, Ø. (2018). PRACTICAL IMPLEMENTATION OF STRENGTH TRAINING TO IMPROVE THE PERFORMANCE OF WORLD-CLASS CROSS-COUNTRY SKIERS. Kinesiology, [online] 50(1), pp.155–162. Available at: https://hrcak.srce.hr/ojs/index.php/kinesiology/article/view/6420 [Accessed 26 Jan. 2024].

  • Sandbakk, Ø., Sandbakk, S.B., Ettema, G. and Welde, B. (2013). Effects of Intensity and Duration in Aerobic High-Intensity Interval Training in Highly Trained Junior Cross-Country Skiers. Journal of Strength and Conditioning Research, 27(7), pp.1974–1980. doi:https://doi.org/10.1519/jsc.0b013e3182752f08.

  • Spörri, J., Kröll, J., Gilgien, M. and Müller, E. (2016). How to Prevent Injuries in Alpine Ski Racing: What Do We Know and Where Do We Go from Here? Sports Medicine, [online] 47(4), pp.599–614. doi:https://doi.org/10.1007/s40279-016-0601-2.

  • Vitale, J.A., La Torre, A., Banfi, G. and Bonato, M. (2018). Effects of an 8-Week Body-Weight Neuromuscular Training on Dynamic Balance and Vertical Jump Performances in Elite Junior Skiing Athletes. Journal of Strength and Conditioning Research, 32(4), pp.911–920. doi:https://doi.org/10.1519/jsc.0000000000002478.

  • White, G.E. and Wells, G.D. (2015). The Effect of On-Hill Active Recovery Performed Between Runs on Blood Lactate Concentration and Fatigue in Alpine Ski Racers. Journal of Strength and Conditioning Research, 29(3), pp.800–806. doi:https://doi.org/10.1519/jsc.0000000000000677.

Athletes training with battle ropes in a gym

Lower back pain in Golf

Lower back pain in Golf

23 November 2023

Lower back pain (LBP) is the most common injury for golfers as 34.5 % of all golfing injuries involve the lumbar spine. It is important to understand the golf swing in order to identify the cause of injury and provide optimum treatment. Most injuries occur due to the impact of the golf club and the follow-through phase. Follow-through phase promotes lumber extension and eccentric contraction of abdominals in order to generate force and rotation; this places increased pressure on the spine and intervertebral discs (Finn et. Al 2013). Hosea et. al found that the compressive load during a golf swing was considerably higher in professionals than amateur golfers, with a difference of 7584 N versus 6100 N. The compressive load in a professional golf swing is equivalent to 8 times body weight (Dale and Brumitt, 2015). It is important to compare this to cadaveric studies which have shown disc prolapses to occur at 5,500 N; this highlights that the golf swing (in both amateur and professional golfers) is able to generate enough force to injure the lumbar spine (Lindsay and Vandervoot,2014).

The golf swing is repetitive, asymmetric in nature and dependent on the dominant hand; this can determine the location and severity of LBP. For example, in a right-handed golfer, the right- sided external obliques, paraspinal muscles and abdominals take the most impact and therefore the right lumbar region is most commonly injured. Also, the end position of the golf swing is called reverse C position which promotes lumbar extension and increases the risk of facet irritation. In more severe cases, spondylosis and discogenic back pain can occur from poor technique and severe muscle imbalances. (Finn et. Al 2013)

It is important to focus on muscle imbalances, thoracic and lumbar mobility and technique to prevent and recover from LBP. From analysing the swing mechanics, core stability exercises are essential in LBP rehabilitation (Evans and Oldreive,2013). Horton et al. found a delay in muscle activation in abdominal muscle for golfers with LBP, especially the lead external oblique during back swings; this further highlights the importance of core strength and endurance in protecting lumbar spine. (Horton et. Al 2001). Hip stabilisation and mobility is equally important to aid trunk rotation and lumbar stability. Vad et. al demonstrated that reduced lead hip rotation (internal and external) and lumbar spinae extension were found in golfers with LBP; this may be due to decreased hip rotation in the leading lower limb causing more force to be directed into the spine (Vad et. al 2004). Therefore, ensuring glute strengthening exercises in rehabilitation are key to provide a base of support for trunk rotation. (Finn et. Al 2013)

Reference List

 

  • Dale, R.B. and Brumitt, J. (2016). Spine biomechanics associated with the shortened, modern one-plane golf swing. Sports Biomechanics, 15(2), pp.198–206. doi:https://doi.org/10.1080/14763141.2016.1159723.

  • Evans, C. and Oldreive, W. (2000). A Study to Investigate Whether Golfers with a History of Low Back Pain Show a Reduced Endurance of Transversus Abdominis. Journal of Manual & Manipulative Therapy, 8(4), pp.162–174. doi:https://doi.org/10.1179/jmt.2000.8.4.162.

  • Finn, C. (2013). Rehabilitation of Low Back Pain in Golfers. Sports Health: A Multidisciplinary Approach, 5(4), pp.313–319. doi:https://doi.org/10.1177/1941738113479893.

  • HORTON, J.F., LINDSAY, D.M. and MACINTOSH, B.R. (2001). Abdominal muscle activation of elite male golfers with chronic low back pain. Medicine & Science in Sports & Exercise, 33(10), pp.1647–1654. doi:https://doi.org/10.1097/00005768-200110000-00006.

  • Lindsay, D. and A. Vandervoort, A. (2014). Golf-Related Low Back Pain: A Review of Causative Factors and Prevention Strategies. Asian Journal of Sports Medicine, 5(4). doi:https://doi.org/10.5812/asjsm.24289.

  • Vad, V.B., Bhat, A.L., Basrai, D., Gebeh, A., Aspergren, D.D. and Andrews, J.R. (2004). Low Back Pain in Professional Golfers. The American Journal of Sports Medicine, 32(2), pp.494–497. doi:https://doi.org/10.1177/0363546503261729.

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