Chronic Leg Pain in Athletes- Part 3

Part 3 of these mini series of Chronic Leg pain in athletes based on this research article, Chronic Leg Pain in Athletes.

Stress Fractures-

Stress fractures come from repetitive microtrauma to the bone. In the lower extremity, the most common bone for a stress fracture is the tibia, it may be in other bones depending on the activity. Runners tend to have a higher rate in the area of the tibia closer to the ankle while volleyball and basketball players get it closer to the knee.

Individuals that are at a higher risk of developing a stress fracture are those that have a history of eating disorders, menstrual irregularities, or previous stress fractures. The pain is usually described as a pain that doesn’t have a particular starting event or day and seems to creep up slowly in a specific area of the bone. This pain gets worse when weight bearing activities are being done, but gets better with rest.

Most stress fractures are able to be managed with non- operative options. These options include rest, pain relief and modification of risk factors. In addition to the risk factors noted above, the limb and foot alignment need to be evaluated as well as muscle tone and limb length discrepancies which should be addressed in managing the stress fracture. Management will also include limiting weight bearing activities, limited and reduced to the point that pain is no longer being experienced. Progressing back to play is guided by pain and a full recovery can take 8 - 16 weeks.

Seated Version of the Cat and Cow Yoga Stretch (When There is No Way to Get on All Fours)

https://www.youtube.com/watch?v=KwRPAac2Vto

The cat and cow yoga stretch is a mainstay of many routines we recommend for patients with lumbar and generalized spine pain. It is a combination of active range of motion, gentle core muscle firing and segmentation of the spinal segments that stimulate normal proprioception at the level of the brain.

The cat and cow is accessible to a lot of people, minus the logistical challenge of being able to get on all 4’s to do it. That is not always accessible to patients during the daytime when away from home.

The seated variation is an effective way to get in a similar maneuver during the daytime, it can be done on most any chair and even while driving. One of the keys is to be close to the edge of the chair and be able to open the knees in a V position to allow for full trunk movement in flexion and extension.

Chronic Leg Pain in Athletes- Part2

Part 2 of these mini series of Chronic Leg pain in athletes based on this research article, Chronic Leg Pain in Athletes.

Chronic Exertional Compartment Syndrome- 

As an exercise leg pain present in the front of the leg 27% of the time is due to CECS. Even with knowing this percentage there usually is an average of 2 YEARS from when symptoms first began to the correct diagnosis. Most patients are in their early 20s with pretty equal chances between men and women.

The volume of a muscle can increase nearly 20% which would create additional pressure in these compartments and if the surrounding fascia is unable to expand, compartment syndrome can occur. There is a high recurrence rate as well as high chance some symptoms not be fully resolved based on the condition itself. .

Nonoperative management would include ice, massage, stretching, ultrasound, shoe modification and some gait modifications. The nonoperative management with greatest strength includes activity changes or subsiding of the activity creating the compartment syndrome pain. Operative management includes a surgical release of the compartment to release the pressure.

For additional information on chronic leg pain in athletes and specifically chronic exertional compartment syndrome you can check out the research article listed above

Keep Your Cleats on the Ice

https://www.youtube.com/watch?v=_piMthxaJvQ

The first few patients who hit the ice are hobbling into the door of the office this (those are the lucky ones, those with fractures and concussions won’t show up for a bit). I get blue in the face reminding people that the soles of their shoes are a deal breaker at this time of year in MN. Many shoes are ill equipped, but just about any shoe can be retrofitted with a grip bottom with strap on cleats that are readily available online. Just remember to be careful when you walk into a building with a smooth floor, since wet cleats can be slippery on that kind of surface.

Pregnancy/ Postpartum "Must Haves"- Clothing Edition

With my recent return back to the clinic, I have been working on my “must haves” over the last few months. All new moms or moms with littles tend to get a lot of advice they never asked for and a handful of times, they never knew they needed. Here is my current list of things I wish I had in early pregnancy and earlier postpartum. I will attach a google doc to the bottom in case I update it as we navigate through the craziness called parenthood.

First, during mid-late pregnancy I finally ordered a couple pairs of Blanqi support pregnancy pants. These helped with additional support and compression at the end of some busy clinic days. These pants and shorts were very helpful in feeling a bit of extra support around the abdomen especially when I wasn’t able to get my supportive tape (previous blog) on by myself. Pregnancy belly taping & Blanqi support pants were my best supportive friends by the end of this pregnancy, of course in addition to regular adjustments.

Second, postpartum. I actually packed a pair of the Blanqi postpartum pants in my hospital bag, which when I packed them I really had no idea if I would actually ever use them, but just like the pregnancy pants they did really well with support and compression. The weird jiggly belly sensation after just having a baby was definitely lessened by the support and compression these pants provided. The other product which arguably the most important had been the pumping/nursing bras I found. Kindred Bravely is the brand I decided to try out because I am exclusively pumping, the cheaper Amazon ones were certainly not cutting it and the weird zip up thing most Target’s or Walmart’s carry were almost just as bad. I wish I would have known about this after our first one, because they are game changer.

Also, if you’re interested in any of the Kindred Bravely products we have a 20% off discount for you! Use the code: BWCLINIC20

Here is the Google Doc that I will keep updating, so check it out or stay tuned as I will probably have another blog similar in the future :).

WHY DO I HURT MORE WHEN IT’S COLD?

Cold weather is associated with several biological responses in your body:

• There is a decrease of blood flow to non-essential tissues, and the decrease in oxygen perfusion of the tissues like joints and muscles can aggravate both acute and chronic pain.

• Certain collagen rich tissues tend to shorten in colder temperatures and resist normal stretching. This is especially true of tendons.

• The lubricating fluid of joints (synovial fluid) is more sticky under cold conditions and joints will not move as smoothly. This is especially true for joints that suffer from any degree of degeneration.

• Cold exposure results in involuntary protective postural changes such as scrunching your shoulders into your ears, aggravating existing chronic postural problems of forward head posture.

Chronic Leg Pain in Athletes- Part 1A

With winter sports season beginning, so does the season of more chronic leg pain in our athletes. I am going to start a mini series of Chronic Leg pain in athletes based on this research article, Chronic Leg Pain in Athletes.

Medial Tibial Stress Syndrome or MTSS is an exercise induced leg pain, more familiarly known as true shin splints. This is the most common chronic leg pain in athletes and actually occurs for almost 5% of all athletic injuries. MTSS is “described as exercise- induced pain along the middle to distal posteromedial aspect of the tibia, estimated incidence between 13-22% of injuries in runners and dancers and 35% in naval recruits.” With MTSS, there may also be an increase in discomfort with resisted ankle plantar flexion, such as jumping. 

Basically MTSS is a boney overload injury where the load on the bone causes “the tibia to bend during weight bearing activities causing a strain”. Then this strain will cause small damages inside of the bone which ultimately leads to changes and adaptation in efforts to strengthen the bone to decrease bending to occur.

Initially with MTSS most studies support rest as the most important recovery tool in early phase, others include cryotherapy, compression, elevation, stretching, physical therapy and pneumatic leg bracing. 

It is also recommended that “modifying training routines, stretching and strengthening the lower extremity, wearing appropriate footwear, using orthotics and manual therapy to correct biomechanical abnormalities, and gradually returning to activity.” 

Stay tuned for some stretches and exercise videos to help you at home.

Children, Junk Food and Some Alternatives (For "Big Kids" Too !)

https://www.npr.org/2021/08/11/1026816658/study-us-kids-diet-ultraprocessed-junk-food

The article published in JAMA this fall hit a raw nerve for me, as much as it was an affirmation of a project I have been brewing on for a while.

The stats on nutrition in the US are absolutely abominable. The average American, when honest, admits that their diet is not ideal, but the reality is much worse. A whopping 2/3 of the average food intake is “ultra processed foods”. In other words, junk with no nutritional values and a lot of toxic effect.

We could spend a lot of time bemoaning the issue, and going into the technicality of what is an ultra processed food (hint: a lot of things you probably consider not so unhealthy because our minds have been so desensitized to the concept of real food ). But I feel like my time could be better spent offering some solutions to the problem.

After 27 years of practice, I never cease to be surprised by how many times I get it totally wrong. This has played out often in the area of guiding patients to better nutrition. Offering solutions to the wrong problem is guaranteed to flop. In this instance, it means intensely bombarding patients with well intentioned nutritional information in great details, and badgering them about not following through.

After 25 years of this approach, it occurred to me that I was not offering the right solution, because I was not asking the right question. Even worse, I was not asking questions at all. The questions were are simple as: “What are the barriers preventing you from eating well when you state a strong desire to do so?”

It turns out that you do not always need to reinvent the wheel, or, as a great friend of mine describes, engage in the process of kicking open doors. There is a lot of good research on the barriers to healthy eating. Some of them are more complex to address (those pertaining to our deep rooted relationship to food taste, culture, upbringing and emotional support), while some others are more logistical and thus easier to resolve.

The LaZ Kitchen project was an organic reaction to the awareness of 4 major “barriers”:

• People have very little time to cook, they do not know how to cook, they do not like to cook, prep or clean up (the “lazy” rule of the LaZ Kitchen).

• People are concerned about the cost and affordability of cooking healthy meals (the “thrifty” rule of the LaZ Kitchen).

• People have ultimately little genuine knowledge of what is a healthy balanced meal. And they do not have a lot of time or interest in finding out (the “healthy” rule of the LaZ Kitchen).

• People DO NOT KNOW HOW TO MAKE THE PRACTICAL TRANSITION BETWEEN WHAT THEY KNOW OF GOOD EATING AND TRANSLATE THAT INTO FOOD SHOPPING AND PREPARING.

For the past three months, I have been quietly cooking up a storm in my own kitchen and coming up with a docket of recipes recorded in short videos with the patient help of my home videographer Pauline. There is nothing very polished about the end product, but it is the way real folk like you and I come up with real food to put on the table, that will not send us to the grave prematurely. I hope that you will find this a useful resource in bridging your gap to sound eating, and stay tuned for the content that we are continuing to upload every other week.

https://www.bwclinic.com/laz-kitchen