How do you get shin splints from skiing?

Something came along that surprised me the other day – a ski instructor with shin splints. Now you’d imagine that with your feet and lower legs locked into a pair of ski boots, shin splints would be an unexpected eventuality. However, in this case the boots didn’t fit properly. They were brand new, top spec boots (Salomon) in November, but were basically too big for the occupant. Over the period of a few weeks of heavy training the inner boot began to disintegrate because of the amount of movement inside and things went downhill (forgive the pun) from there.

The person concerned felt the pain but pressed on, not really knowing what else to do, until she got to the point where she simply couldn’t ski any more and went to see a boot fitter who asked her how many years she’d had the boots for because they were so knackered! With the boots diagnosed, she still had no idea what was wrong with her lower legs (and lower back), hence we met. Basically, her poor tibialis anterior and posterior had been working so hard to stabilise her feet against the forces produced by her skis they were going the same way as the boot linings. Three weeks of rest and rehab and she’s now pretty much back to normal.

And the moral of the story is…you may prefer the feel of larger boots when you try them on in the shop with warm, relaxed feet, but ski boots must fit firmly. They are not meant to feel like slippers! Salomon replaced the boots with a brand new pair – of the correct size.

Recover properly, don’t save your injuries for later.

Last week I was in Manchester where I have a group of extremely active clients in their 60s and 70s. Amongst them are golfers, skiers, walkers and swimmers; all have been extremely good athletes in the past, participating competitively to a high level. They are fit, but after a lifetime of sporting endeavour they’ve naturally picked up a few injuries along the way and it’s later in life that these really come back to bite.

When we’re in our teens, twenties or even thirties it can seem reasonably easy to recover from injuries such as sprains, strains and impacts. Sometimes we may not even notice much of a problem, so most of the time we just take a bit of a rest, maybe do the exercises prescribed by a physio and when the pain has gone we get back on with our activity. It may be some years before we start paying the price for this and the problem then is that often, as discovered by my older clients, the medical profession isn’t really interested, because they regard musculo-skeletal aches and pains as a standard feature of ageing.

For example, one culprit I see frequently is scar tissue. Following an injury the body lays down a repair quickly but randomly – a bit like a DIY bodge! Muscle fibres need to run in parallel in order to work effectively and they need assistance beyond remedial exercises to regain their proper structure and function. Deep transverse friction is a massage technique which breaks down random scar tissue and adhesions, enabling massage combined with stretching and strength work to realign fibres and restore full functionality. It’s painful, but effective and will save you from potentially bigger problems later. Scar tissue is prone to re-injury and repeated micro-tears mean it just keeps on accumulating over time without you even noticing – until one day something else starts to hurt. Often, it is something else because your body has adapted to the weakness by transferring the load elsewhere, creating postural changes and muscular imbalance.

If you’re an enthusiastic and talented amateur, the risks of carrying the legacies of your sporting mishaps forwards as your body ages are considerable. Whilst many of the resulting problems – restricted mobility, muscular weakness and pain – remain treatable, you’d be naive to expect state healthcare to come to your aid. Instead, you may well be hearing the phrase “What do you expect at your age”. So make sure your rehabilitation is complete, no matter what your age when the injury occurs, and don’t accept ageing as an excuse to put up with pain. Just bear in mind that when you reach your seventies and can’t exercise because of injury past or present, your feelings of frustration will be just the same as when you were younger.

‘ipad shoulder’ – does it exist?

A client came to see me recently complaining of a nagging shoulder problem. Her right shoulder ached ‘inside’ and she pointed to a spot in the middle of her deltoid muscle. It had been going on for some time and wasn’t showing any signs of getting better. We ran through some tests which were positive for a shoulder impingement (sometimes known as ‘swimmer’s shoulder’). Ironically, she’d first noticed it when swimming, although she’d be the first to admit that she’s no athlete!

Shoulder impingement typically affects athletes who make repetitive arm movements in or above the horizontal plane and is caused by trapping the soft tissues between the head of the humerus and the space under the acromion process and the coraco-acromial ligament.Lifting the arm forwards to an angle of 90 degrees to the body and rotating it inwards produces pain as the tendons of the rotator cuff muscles, the long tendon of the biceps and the bursa which overlies the supraspinatus tendon are compressed.

Forty five minutes of deep-tissue massage to the shoulder and scapula area, involving trigger point release within the infraspinatus and teres minor resulted in improved mobility and reduced pain over the following few days and treatment is still continuing. It’s not a debilitating problem, but shoulder issues such as this should be resolved as early as possible, as they can develop into tendinitis and bursitis as well as ‘frozen shoulder’. Part of that resolution is finding out what has caused the problem to arise and my client had an interesting theory; she thought it could be the result of the way in which she uses her ipad, propped up in front of her with her arm raised to touch the screen.

Not long afterwards, a report in the Daily Telegraph highlighted the problem of neck and shoulder pain caused by ipad users holding the devices in their lap or putting strain on hands and wrists if propped up too high. Whilst this wasn’t quite the same as my client’s experience, it does demonstrate the chronic effects of repetitive activity that we often don’t realise we are spending as much time on as we actually are. Scrolling down to the reader comments following the article, reveals an individual who himself complains that he is unable to raise his arm above halfway and puts it down to using his ipad. Coincidence, or might there be a connection between using an ipad propped up on a desk and shoulder impingement?

There are certain risk factors that may predispose an individual to shoulder impingement, such as age (typically more people over 40 are affected), imbalances in the scapular muscles, tightness or weakness of the posterior rotator cuff muscles and the biceps. Interestingly, my client is over 40 and has hypermobility of the shoulder joint, which is also a risk factor. At the end of the day it’s going to be a combination of such factors together with our uniquely individual ways of using our bodies that results in the onset of a chronic problem like this. However, it highlights the importance of being aware of our posture and how we maintain our bodies in order that they can cope not only with athletic activity, but also with activities that on the face of it appear unlikely to cause injury.