Category Archives for "Leg Pain"

Shin Splints Simon Kelly

Mark: Hi, it's Mark from Top Local. I'm here with Simon Kelly of Insync Physio in Vancouver. One of Vancouver's most popular physiotherapy clinics, many time winners of best physiotherapists in Vancouver. And today we're going to talk about a really common issue shin splints. How are you doing Simon?

Simon: How's it going Mark,  thanks for having me today. Yeah, shin splints Mark. I'll talk a little bit generally about the topic and I might relate it to a recent case study, I had a bit as well. We've all heard about shin splints, the layman term, but we call it ATSS, which is anterior tibial stress syndrome, which sounds a bit fancier. 

That's more so pain to the front of the shin and more to the outside of the shin. And then you have MGSS, which is media tibial stress syndrome. That's probably the more common one where you feel it more distally or at the end of your leg sort of on the inside of the shin bone. So a lot of people kind of get this pain when they're kind of increased their running too quickly essentially. A lot of pain down the inside of that shin, or sometimes it can be a change in footwear a change in surface and things like that. So it's important obviously to diagnose, did the person take up running or any sort of activity, like lots of jumping, lots of high-impact activity, that's kind of leading is kind of pain.

And it's also very important not to run through this pain because you can develop stress fractures or another thing called exertional compartment syndrome. So our job would really be deciphering, is it actually true shin splints because that's like an umbrella term or is it one of those other two things. But very important not to run through that pain. Some injury yes, it's okay to run through it a little bit and just kind of monitor it, but certainly if you keep going, you can develop that stress type fracture and the pain is very on the shin. Shin splints is more diffused where you kind of feed it along the shinbone for like three or four inches. That's kind of how we decipher that a little bit as well.

And obviously an x-ray will tell you if you do have a stress fracture and the exertion and compartment syndrome, usually pain just comes on after you start the exercise, because blood is filling into the compartment of the lower leg. And then it expands and there's a mesh around the lower leg and it can expand out actually.

So that's when you know, that's the difference in it. And you might have tingling in your lower leg. It's very important not to continue that because you can create nerve damage and things like that. 

Mark: So how do you diagnose it, just by the pain? 

Simon: Yeah, good question Mark. Well, first of all, you'd take the history and you kind of ask them are they doing lots of running. It doesn't have to be running necessarily. It can be like lots and lots of walking even. A lot of people are doing 10,000 steps lately. I don't know why humans have a fixation on it. You do 10,000 steps every day and you're not used to it, you can benefit from walking as well, or even just a combination of running and walking might just throw you over the edge to develop this, too.

 When the person comes in, they usually say, yeah, I feel this at nighttime or sometimes after the walk, you don't always feel it while you're doing the activity actually. So will you feel it at rest and you will feel it when you push along the inside of your shinbone or the outside of your shin bone.

So that's kind of how we diagnose it. As opposed to exertional compartment syndrome is more, you just feel it after a few minutes of getting into the exercises that increased the blood flow, but the minute you stop, there's no pain at rest. There's actually no pain when you push it either.

So there are kind of too big differentiating factors. And you don't want to keep running through it. Like I said, it's very important that you don't. I know it's important that we look at the footwear and the surface, if you're, a lot of the times people run on concrete, which is quite unforgiving under the foot, and it's better to run on maybe grass and some trails are sometimes better if there's not huge amounts of inclines and declines. So we try and alter that as well. 

Usually for the treatment part of it, I just stop them running for maybe a week or two completely, and then just reload it very, very gradually. And we do a lot of stuff here in the clinic, a lot of  massage, some needling of those muscles that join onto of the inside of the shin especially, it usually stays behind the calf muscle that joins in at the back, which is responsible when we come down from running or from the jump.

Just micro tearing on the inside and basically the micro tears aren't getting a chance to heal before somebody goes running again. And then it just develops into this lots of pain. 

Mark: So the treatment protocol is pretty straightforward, but what if I wanted to prevent it? If I'm going to up my mileage, I'm going to engage in a new fitness program. Is there things that I could do that would help it? Would rolling my shins, very unpleasant experience, but would that help? 

Simon: Yeah, you could roll out your shins Mark and honestly it really is just listening to your body a little bit. You know how much you can load, how quick, you know, and there's no real magic answer to that. There's every individual is slightly different on how much, but usually people will come in and say, they might say something like after my fifth kilometre, it starts to come on a little bit and then it's worse afterwards. So you kind of have an idea in relation to that individual, like five kilometres is kind of where we're at right now. So that's your limit, and maybe they might take a day off and back again, or they might do it again the following day. So you'd really have to just, a bit of trial and error there really. Rolling it out, strengthening up your calf muscles in particular are definitely stuff to do to try and prevent it from happening.

Sometimes if it's more chronic or you've tried a few techniques here in physio, you can go maybe to a podiatrist and look at insoles. There is a bit of a link in some of the literature saying like an over-pronated foot or a flat foot, and definitely predispose you as well. So I'd like to try and not give people insoles right off the bat and see if we could get it right but that's something I might come back here with, if we tried everything in our tool bag and it didn't work, that would be something I'd look into. 

Mark: And this is just from a personal interest kind of point. Is there any research around the new kind of movement towards going more towards barefoot shoes? Like the really non-supportive shoes that you wear that strength your foot has to strengthen rather than being over supported? 

Simon: Yeah. There's a lot of research out there, Mark, and even there's, I think it's like everything in the world, you can find 10 research papers that say that for the pros of barefoot running and that's how we were back in the wild, back in the day, running her own hunter and gatherers. Like there was no need for all the support. Why do we have it now? But then there's other arguments saying like, well, we didn't have tarmac and concrete and a lot of hard surfaces that we're running on now.

So that's a very good question. It's a very good question. When I started my physio career, I was sort of told that insoles where to where to go. But as I developed throughout my career, I sort of, it's only from a personal perspective that I don't want someone to have something in their foot, forever. If they really don't need it. But I'm not negating getting an insole or if you've tried everything else, then I kind of go back to the insoles, as I think it is beneficial indefinitely some scenarios, for sure. Especially someone who's an athlete and really want to continue through their running or they're in competition and they can really afford to wait, then we go towards insoles for sure.

Mark: And what kind of length of treatment are we looking at? What's a typical, I know it's individual, of course, maybe this is really individual, but what would be the, is it three weeks? Six weeks. 

Simon: Yeah. And you're on the money there, Mark. You know, some people like literally, if you just stop running for two weeks and you just slow gradually, it could just literally be four, six, eight weeks. It just really depends. Every physio might be slightly different. It might get you to run and just cut down your mileage and you still might be okay. I just like to go for two weeks, just give it a total break, until it's not too tender on to palpation or on touching clinic here. And then we'd obviously do all the strength and exercise in those sessions. And then we'd go back to do more higher impact stuff because it has the higher impact stuff. 

So like running and jogging that really do create a lot of tension on the inside of that shin bone. So yeah, you're probably looking at four, six, eight weeks max, for sure. 

Mark: So there you go. If you got shin splints, the guy to see is Simon Kelly. You can reach him at Insync Physio in Vancouver. You can book your appointment at (604) 566-9716 or check out the website insyncphysio.com. You can book online there. Or if you're in North Burnaby or the Burnaby area, they have a clinic there as well. You can reach them at (604) 298-4878 or again, book online at insyncphysio.com. Thanks Simon. 

Simon: Cheers Mark. Thank you.

Simon Kelly – Lower Leg Tendinopathy

Mark: Hi, it's Mark from Top Local. I'm here with Simon Kelly of Insync Physio in Vancouver, BC. He's a physiotherapist at one of the top rated physiotherapy clinics. Many time winners of best physiotherapists in Vancouver as voted by their customers. Today we're going to talk about something that I'm sure a lot of people run into. Especially if they're very active with walking or running it's lower leg tendonitis. Pain in your lower leg. What's the deal going on here, Simon? 

Simon: I'm Mark, thanks for having me. Yeah, I just going to talk through a case study that I had there during the week. A guy who had something called peroneal tendonitis.

Basically it's a tendon that runs down the outside of the leg. A lot of walkers aggravate this tendon and it can be due to a number of different factors really. Sometimes it's maybe they changed their footwear. Might've changed the surface they're running on. Or they just might've increased their workload. And then a little bit too quickly, which I know a lot of people do this. That's the most common thing as well. So it can be debilitating and a little bit scary to someone who hasn't had it before. 

So this guy was 25 years old. He actually had a spontaneous pneumothorax, which means his lung spontaneously collapsed on occasion. So he had a long period of time out from running. And he was just trying to get back into running, I think a month after this collapse and he was starting to do two to four kilometres running. Where he was running, they had made a new path where he usually runs and it was an uneven surface because of COVID, they wanted to keep the paths kind of socially distance.

So that was kind of the angle, I kind of thought maybe he went a bit too quick and maybe to surface he's running on a bit of a camber. And no roads we run on are actually truly flat. If you want to be honest about it, they're all a little bit slightly at an angle, not incline decline, but more of an angle of the foot so it would be turned sideways.

So he came into clinic. That was his kind of background story. We did a few tests to prove it was this peroneal tendonitis, where you kind of evert the foot out against resistance and that creates pain in the foot. Sometimes going up onto your toes can also create a little bit of discomfort because it does what the calf must've does as well.

So that was kind of a the general diagnosis and how we diagnosed him initially. 

Mark: So what was the course of treatment? 

Simon: The course of treatment Mark, there's four reasons really peroneal tendinitis can go up. If you're running on a surface, like I said, like a camber, we really needed to tell him to stop running. But eventually we would add back in running, but on a flatter surface as possible. Usually it's tight calf muscles as well. So not just the pernoneal itself, but all the calf muscles in the back are usually a bit tight that can predispose you to excessive use of this tendon. And like a lot of volleyball players and dancers, if you can imagine them up on their toes. 

He wasn't in this case up on his toes, but that was one of the reasons that you can get peroneal tendonitis. So initially stop all the aggravating factors, stop running and let's load this tendon progressively. Isometrically is how we load it first. Isometrics are where you move the tendon against the resistance, but you're not moving through range.

So that just helps decrease the pain, settle down all the inflammation. And then we got him back in running, into a running program, but a little bit slower. Would footwear, because sometimes it can be from over pronation as well. I meant to mention that earlier on, actually. Just good footwear or good support.

And then we told him to stop running. When he does go back running to run on a flat surface, not running the track that he was running on. And to just go a little bit slower, maybe just try a couple of hundred metres in a straight line, and then we just took it from there, Mark. That's how he presented over the coming weeks.

Mark: And so after the of course of treatment, what was the result? 

Simon: Absolutely Mark, so obviously when his lung was re-inflated at this point, that was another thing I meant to say, for his endurance. We had to keep an eye on his breathing and his endurance. So that was actually fine. I asked him that every time he came in. He went back into proper pairs of shoes. His calf was relaxed and he was back running, you know, five to six kilometres every other day, without any pain. Just best afterwards, few adjustments that we made. 

Now he doesn't have to not run in that path ever again. But I told him that he'd have to start adding in uneven surfaces just towards the end. So he'd just run on that path again, and he had no problems whatsoever. So he's back up and running and back into action. 

There you go. If you need some help with your lower leg, if you're having some issues with a change in your fitness program, that's causing you some pain or any part of your body, give Simon Kelly a call. You can reach him at the Vancouver office of Insync Physio. You can book there at insyncphysio.com either in Vancouver or Burnaby. The Vancouver office number is (604) 566-9716. Burnaby is (604) 298-4878. Give him a call. Simon will get you straightened right out. Thanks Simon.

Cheers, Mark. Thanks very much.