2/7/07

“Shin Splints – Compartment Surgery”

Jon Beyle wrote me this: “I would also like to get your thoughts on something. I just got off the phone with a girl who has been playing field hockey at Princeton and her career is being threatened by lower compartment syndrome. She had the release surgery and it did not help much as of yet. she has a friend who plays D1 soccer who has the same thing. She told me also that she ran into a D1 field hockey coach at another major university who said this is becoming epidemic (shin splints, lower compartment, etc.). What are your thoughts on this?”

This surgery was quite the rage a few years ago. I actually thought it had gone out of favor. This is a classic example of reductionist medicine – focusing on the symptom rather taking a giant step back and looking at the big picture. Because there is pain and swelling there then you operate. Bottom line is that 9 times out of 10 the operation does not work. Think global, look above and below the problem. I am of the opinion that the problem really stems from the inability to properly shock absorb, the big shock absorber that needs to be developed is the butt. Movement mechanics must be addressed – how they stop and change direction. Look at the foot, more specifically is the subtalar joint locked up.If it is then mobilize it.

As far as the shin splint issue it is much the same answer. I know field hockey must play on a very firm and generally unforgiving surface, so look at opportunities to train off the surface for non technical work. Look at foot wear, I have found that rigid shoes often are the culprit. In collegiate and national team environment the players are often forced to wear sponsors shoes and all of one style. That shoe and style may not be correct for the individual athlete. The common solution for “shin splints” is to dorsi flexion exercises which can cause more harm than good because the anterior tibialis main job is to help decelerate the foot. Once again work above and below. Excessive weight is another issue, tough to address with the female athlete. When they are too heavy gravity wins! Not an easy problem to solve, but with work it can be done.

4 Comments:

At 2/7/07, 12:11 PM, Blogger Joe P. said...

Fosamax has become quite the rage among marathoners as a method of building BMD. MTSS is usually an undiagnosed stress fx. In Vern's latest book he gives three solutions to prevent them- Include a general fitness module in your training, don't sink into the quicksand that is the volume trap, and include remedial work in your warmup. And don't forget good 'ole axial loading exercises to build that BMD. Sand bags is a convenient way to get it done.

 
At 2/7/07, 7:04 PM, Blogger jbeyle said...

Thanks Vern!!!

 
At 2/8/07, 9:06 AM, Anonymous Anonymous said...

Aren't there some interesting lawsuits out there suggesting that Fosamax does not build bone but only gives the appearance of increased bone?

Mark Day D.C., CSCS, DACBSP

 
At 2/8/07, 2:33 PM, Anonymous GMGolden, MS, ATC, CSCS said...

A couple thoughts on compartment syndromes. First, we really need to distinguish between anterior, lateral, and deep posterior compartment problems. I find Vern's suggestion of shock absorption being the culprit intriguing, especially if we are talking about a posterior compartment problem. Substitution from ankle plantar flexors to absorb force and additionally, the possible role of the soleus as a knee extender and being called upon to perform a function not particularly designed for in the presence of weak hip extenders and knee extenders makes sense. However, we are seeing discrepancies in when the symptoms of the compartment syndrome are arising w/i a training session, particularly with anterior compartment problems. No longer are onsets later in a workout when it was thought sufficient muscle volume was reached due to blood flow etc to increase compartment pressures. A select population of athletes develop symptoms at the onset of the session (w/i 10-15 mins). Often times upon evaluation it is evident the athlete lacks sufficient gastrocnemius and soleus flexibility. Imagine how hard the anterior compartment has to work to clear the toe during gait when it's working against tight antagonists. Most athletes have insufficient posterior leg flexibility so we make sure to start addressing that first (of course avoiding the long time solution of strengthening the anterior compartment!). These are the athletes, when surgery is elected, but precipitating factors are not addressed, that will be more likely to have poor outcomes from the compartment release therapy. It is also possible, those athletes who have compensated for weak hip and thigh musculature by loading through the leg and ankle will also have poor outcomes if those weaknesses are not addressed for posterior compartment problems. Good stuff Vern!

 

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