How to Avoid Pesky Shin Splints

 

Runner injury shin splint

By: Megan Skelly

As the weather continues to warm up, downtown Indianapolis sidewalks are becoming busier and the Monon Trail is becoming a lot more crowded. Whether it’s simply to stay in shape or train for an upcoming marathon, more individuals are heading outdoors to get active and run.

Running is a popular activity for those who are looking to get in shape without going to the gym. However, like any activity, runners do experience a variety of injuries. There are very few runners that haven’t, at some point in their running career, had a case of shin splints.

Shin splints are due to stress across the tibia (shin bone). Typically, shin splints are the result of repetitive impact activity such as running or jumping on hard surfaces.

According to Dr. Michael Thieken, OrthoIndy sports medicine specialist, individuals that participate in activities or sports that occur on harder surfaces are more susceptible to shin splints; such as running or playing basketball.

“Pain in the tibia or shin is the most common symptom of shin splints,” said Dr. Thieken. “Typically it’s a dull aching pain that occurs in the posterior medial tibia just below the mid-portion of the bone; this area is often tender to touch. The pain is usually heightened during activity and relieved by rest.”

So what can you do if you are experiencing this pain?

Treatment is almost always nonsurgical. A period of rest is the best way to treat shin splints. It may take several months and involve decreasing training intensity or duration, changing the training surface or completely eliminating the activity altogether. Non-steroidal anti-inflammatory medications, ice, heel cord stretching and use of orthotics may also be advised.

“Unfortunately, there is no absolute way to prevent shin splints,” said Dr. Thieken. “The most important controllable factors are a gradual conditioning program and regular stretching. Shin splints usually follow a sudden increase in frequency, intensity or duration of athletic training. One should always slowly increase their training regimen over a realistic time period.”

To schedule an appointment with Dr. Thieken please call (317) 802-2863 or request an appointment online.

Is gluten-free for me?

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By: Melissa Foor, Clinical Nutrition Manager and Registered Dietitian Nutritionist at OrthoIndy Hospital

By now almost everyone has heard of the phrase, ‘gluten-free’. It is a huge craze right now and there have even been multiple comedy spoofs of people claiming to be gluten-free despite not knowing exactly what gluten is.

One that comes to mind is a video where Jimmy Kimmel asked people in Los Angeles if they were gluten-free. When they answered yes he asked them what gluten was. Jimmy received a variety of responses including:

  • “This is pretty sad, because I don’t know.”
  • “Gluten’s in bread, a flour derivative. It’s like a grain, right?”
  • “It’s the wheat in products such as bread, pastas or rice. I haven’t researched it to the fullest. I have a girlfriend from Russia who got me into it. She’s reading a book about it.”
  • “It is a part of the wheat that… I really don’t know.”

For the record, gluten is a combination of two proteins: gliadin and glutenin. It is found in wheat, barley and rye products. It is responsible for the elasticity in dough and helps provide that chewiness you find in pizza, which is usually made from high-gluten flour.

A lot of people hear gluten-free diet and think that it’s a diet for weight loss. A gluten-free diet is actually prescribed for people who have celiac disease or a gluten intolerance. Celiac disease is an auto-immune condition where the gluten does not cause damage, buttriggers the immune system to attack the small intestine. As a result, villi in the small intestines can be damaged. Symptoms include: malnutrition, pain and discomfort in the gastrointestinal tract, diarrhea, fatigue, anemia, constipation and atopic dermatitis, a skin disorder.

Vitamin deficiencies and malnutrition can occur in those with celiac disease since the small intestine is a main site of absorption for many nutrients. Many people with celiac disease may also be lactose intolerant because the lactase enzyme that digests the lactose in milk is normally on the villi of the small intestine. The only known treatment for celiac disease is a 100 percent gluten-free diet.

Gluten intolerance is a condition where the body is unable to digest gluten fully resulting in bloating, abdominal pain, diarrhea, constipation and fatigue. It is usually less severe than celiac disease and gluten is what actually causes the symptoms. Research is still being conducted on these two conditions as gluten intolerance remains highly controversial.

Maybe you have tried a gluten-free diet and decided that you felt better. Does that mean that you have celiac disease or a gluten intolerance? Not necessarily. A true diagnosis can only be given by a physician. Sometimes the same symptoms may be irritable bowel syndrome (IBS).

Often you may just feel better because your grain consumption changes from around 90 percent wheat products to all different types of grains including certified gluten-free oats, rice or brown rice and quinoa, just to name a few. Varying your food intake will help you feel better because moderation is important. If you are eating a large amount of anything, eventually you will start to feel bad.

A lot of people claim that they can lose weight on a gluten-free diet. Sure, that is a possibility, but it’s definitely not a guarantee. You may make healthier choices when eating out because the only thing a restaurant offers that’s gluten-free may be a salad without croutons or grilled chicken with vegetables. Or you could make worse choices when buying groceries because a lot of gluten-free processed foods amp up the sugar and fat content to help improve the flavor. A comparison of one cup of regular flour and white rice flour shows that white rice flour is higher in calories, has more carbohydrates and less protein:

All-purpose Wheat Flour                                                     White Rice Flour
455 Calories                                                                         578 Calories
95.4 g Carbohydrates                                                         127 g Carbohydrates
3.4 g Dietary Fiber                                                               4 g Dietary Fiber
12.9 g Protein                                                                       9 g Protein

A lot of times gluten-free processed foods have minimal dietary fiber making it hard for people to reach the recommended amounts.

Following a gluten-free diet is hard, especially when eating out. Many restaurants may not realize that they are cross-contaminating foods that could be gluten-free by using the same fryers for breaded products and French fries, or using the same knife to cut bread and lettuce. If you are diagnosed with celiac disease or gluten intolerance, this can be frustrating to make sure that you are consuming an entirely gluten-free diet.

Although a gluten-free diet may not be required for you, there are some healthy practices you can adopt. When eating out at a restaurant, choose to order healthier dishes that could be gluten-free such as grilled chicken or fish with vegetables or a salad without croutons and plenty of vegetables. Incorporate different types of grains into your diet instead of relying almost exclusively on wheat. Serve up a side of brown rice or risotto with your meal instead of macaroni and cheese. Put together a quinoa salad with vegetables and a sauce instead of having a breadstick as a side.

Listed below are recipes that include other types of grains:

Mexican Brown Rice
1 can (12 ounce size) chopped tomatoes, keep the juice
1 cup uncooked brown rice
1 cup corn
1 1/2 cup water
2 tbsp olive oil
1/2 package taco seasoning mix
2 tsp sugar
1 onion, finely chopped
1/2 tsp garlic powder
1/2 tsp onion powder

  1. Add the water to a large pot and bring to a boil. Add all the ingredients, except the corn. Reduce to a simmer, cover and cook until water has been absorbed into rice.
  2. Average cooking time is 60 minutes. Let stand for 10 minutes, add in cooked corn, and fluff with fork.

The great thing about quinoa is that it works great at any temperature, hot, room-temperature or cold from the refrigerator. It’s a great grain to make ahead and pack for lunch or a snack. It also contains protein.

Quinoa with Roasted Garlic, Tomatoes, and Spinach
1 whole garlic head
1 tbsp olive oil
1 tbspn finely chopped shallots
1/4 tsp crushed red pepper
1/2 cup uncooked quinoa, rinsed and drained
1 tbsp dry white wine
1 cup fat-free, less-sodium chicken broth
1/2 cup baby spinach leaves
1/3 cup chopped seeded tomato (1 small)
1 tbsp shaved fresh Parmesan cheese
1/4 tsp salt

  1. Preheat oven to 350°.
  2. Remove papery skin from garlic head. Cut garlic head in half crosswise, breaking apart to separate whole cloves. Wrap half of head in foil; reserve remaining garlic for another use. Bake at 350° for one hour; cool 10 minutes. Separate cloves; squeeze to extract garlic pulp. Discard skins.
  3. Heat oil in a saucepan over medium heat. Add shallots and red pepper to pan; cook one minute. Add quinoa to pan; cook two minutes, stirring constantly. Add wine; cook until liquid is absorbed, stirring constantly. Add broth; bring to a boil. Cover, reduce heat, and simmer 15 minutes or until liquid is absorbed. Remove from heat; stir in garlic pulp, spinach, tomato, cheese and salt. Serve immediately.

Quinoa Salad with Artichokes and Parsley
1 tbsp olive oil
1 cup chopped spring or sweet onion
1/2 tsp chopped fresh thyme
1 (9-ounce) package frozen artichoke hearts, thawed
1 cup fat-free, low-sodium chicken broth
1/2 cup uncooked quinoa
1 cup chopped fresh parsley
5 tsp grated lemon rind
1 1/2 tbsp fresh lemon juice
1/4 tsp kosher salt

  1. Heat oil in a medium saucepan over medium-high heat. Add onion and thyme; sauté five minutes or until onion is tender. Add artichokes; sauté two minutes or until thoroughly heated. Add broth and quinoa; bring to a simmer. Cover and cook 18 minutes or until liquid is completely absorbed.
  2. Remove pan from heat. Stir in parsley, rind, juice and salt. Serve warm or at room temperature.

This works great if you prep everything except the popped amaranth the night before for a quick breakfast!

Honeyed Grapefruit Yogurt Parfait with Popped Amaranth
½ cup wide-flake unsweetened coconut
1 grapefruit
1 cup plain yogurt
¼ cup raw amaranth
4 tsps honey or 1 Tbsp + 1 tsp

Preheat oven to 350 degrees and toast the coconut until golden brown, five to seven minutes.

  1. Segment the grapefruit.
  2. Toast the Amaranth – Use a taller pan than you think, pour the dry grains into a dry pan, cook over medium-high heat until they gently pop, three to five min. They won’t grow in size but they’ll turn white, like tiny beads of popcorn. They can burn quickly so be sure to watch the pan closely. Once most have popped, some will still be golden brown, pull the pan off the heat.
  3. To assemble the parfaits, spoon ¼ cup yogurt into the bottom of a glass or jar. Top with a few segments of grapefruit, 1 tbsp popped amaranth, 1 ½ tbsp toasted coconut and 1 teaspoon honey. Repeat. Enjoy soon after assembly.

You can prepare everything the night before leaving out the amaranth, and just add the amaranth on top if you would like.

Buckwheat Pancake Recipe
1 cup Buttermilk
1 egg
3 tbsp butter, melted
6 tbsp All-purpose flour (or Gluten-free All-purpose Flour)
6 tbsp Buckwheat flour
1 tsp sugar
½ tsp salt
1 tsp baking soda
3 tbsp butter

  1. In a medium bowl, whisk together the buttermilk, egg and melted butter.
  2. In another bowl, mix together the flours, sugar, salt and baking soda. Pour the dry ingredients into the wet ingredients. Stir until the mixture is just combined.
  3. Heat a griddle or frying pan to medium-hot and place 1 tbsp of butter or oil into it. Let the butter melt before spooning the batter into the pan. Once bubbles form on the top of the pancakes, flip them over and cook on the other side.

How do you stay healthy? Share your tips below!

IMG_5123Melissa Foor is the current Clinical Nutrition Manager and Registered Dietitian Nutritionist at OrthoIndy. Melissa is responsible for the nutrition management of all inpatients at OrthoIndy Hospital as well as assisting in management of the Food Services department. She graduated with her master of science in dietetics from Eastern Illinois University in 2014 while completing her internship at St. Anthony’s Memorial Hospital in Effingham, IL. Melissa attended Michigan State University from 2008-2012 graduating with a bachelor of science in dietetics. She has been with OrthoIndy since December 2014.

Preventing shoulder injuries during the baseball and softball seasons

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Spring is just around the corner, which means it’s time for baseball and softball players to start conditioning for the season. As athletes get in shape its common that injuries will occur. In baseball and softball, a shoulder injury can cripple the player’s performance. It’s important to know that there are quite a few different shoulder injuries to be aware of, as well as a variety of treatment options.

Shoulder injuries in baseball players and softball players are similar for field players, but different for pitchers. The most common shoulder problem from overhead throwing, for pitchers in either sport, is rotator cuff tendinitis. This usually occurs as a result of overuse or poor throwing form.

“For baseball pitchers, there can be high stress on the superior labrum, a gasket-type structure, where biceps tendon attaches in the shoulder, resulting in a labrum tear,” said Dr. Jonathan Shook, sports medicine specialist at OrthoIndy. “This is termed a superior labrum anterior posterior tear, better known as SLAP tear.”

Additionally, Dr. Shook explained that rotator cuff tears are very common in baseball pitchers as well. They usually occur in the posterior rotator cuff, versus most others outside of baseball injuries that occur in the frontal area. Softball pitchers are more likely to have injuries in the biceps tendon as a result of the unique ‘windmill’ style of underhand pitching.

So why do these injuries occur? “The most common reason for shoulder injuries is overuse,” said Dr. Shook. “I see many young athletes who are playing multiple games per week and practicing every day, even on the off-season. The lack of time off causes chronic fatigue and stress on the structures of the shoulder. Eventually something has to give.”

However, there is some good news. The majority of shoulder injuries can be handled without surgery. The first line of treatment is usually rest and physical therapy. According to Dr. Shook, if the player is having pain in his or her shoulder, then they need to stop playing. Furthermore, the player should be evaluated to determine if there is a flaw in their throwing form.

Along with physical therapy, the athlete may use non-steroidal anti-inflammatory medications (NSAIDs) such as ibuprofen or prescription medications to treat the pain. “Occasionally, we will use a cortisone injection to help reduce inflammation as well,” said Dr. Shook.

If the player is still experiencing pain, an orthopedic sport’s medicine specialist will usually obtain X-rays or, if necessary, an MRI. Those tests will help the physician determine the exact injury and treatment needed.

“If conservative treatment fails and the MRI indicates a tear of one or more of the structures of the shoulder, then surgery may be the best option,” said Dr. Shook. “This is usually done in an outpatient setting and can commonly be accomplished using an arthroscopic, minimally invasive technique.”

Rehabilitation of shoulder injuries in baseball and softball players can be a prolonged process depending on the type of injury. There is not a specific time frame for when an athlete will be able to return to the game.

“For an athlete that has shoulder or rotator cuff tendinitis, he or she might only miss a couple of weeks or months depending on the severity of the condition and response to treatment. For an athlete undergoing shoulder surgery, they are more likely to miss 6 to 12 months of competition.”

Pitch counting can also make a big difference in the prevention of shoulder injuries in young athletes. This limits Little League pitchers to a certain number of pitches they can throw a week. These principles can be applied to position players and softball players as well.

Prevention of shoulder injuries is not always possible, but there are certain things athletes can do to reduce the risk. According to Dr. Shook, weight training, stretching and understanding proper throwing techniques will benefit the player most. Additionally, it’s important for players to realize they shouldn’t play through the pain.

To schedule an appointment with Dr. Shook please call (317) 569-2514 or request an appointment online.

Ask the Doc: Common Racing Injuries

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Featuring: Dr. Kevin Scheid, OrthoIndy Orthopedic Surgeon, Orthopedic Consultant for the Indy Racing League and Indianapolis Motor Speedway

A lot of people think of racing injuries as big traumatic events, but what are the smaller less publicized injuries?
There are a lot of overuse injuries to wrists, hands and elbows, especially on road or street courses where the driver is fighting the wheel the entire race. Similarly, the pit crewmembers frequently have overuse injuries to the back, elbows and knees.

What are the most common racing injuries you see?
Thanks to the improvements in car safety, severe injuries are less frequent. Yet, in a severe crash we still see spine, leg and head injuries. Because more races are on road courses versus oval courses, minor overuse injuries are more common.

What is the typical treatment process like for these injuries?
When a major injury occurs, the driver’s injury is stabilized at the track hospital or in a helicopter transit to the local trauma center.

After a full assessment is completed, any urgent orthopedic procedures are performed. If the driver is out of town they are usually transferred back to Indianapolis for further reconstructive procedures. In rare cases this can involve up to 10 additional surgeries.

How long does it take to recover from some of these injuries?
Recovery depends on the type of injury. With multiple extremity fractures or spine fractures, or even both, a driver can be out of a car for two to four months and sometimes even longer. Fortunately, they heal and rehabilitate quicker than the average person due to their health and mental drive.

Are there certain precautions or conditioning practices a driver can do to avoid injuries?
Certainly. Nearly all the drivers have realized that working out regularly is a big help. Fatigue and secondary weakness or lapse of attention can be responsible for mistakes that cause accidents. Therefore none of them smoke, most don’t drink and all work out regularly.

To schedule an appointment with Dr. Scheid, please call (317) 917-4363 or request an appointment online.

High Impact Sports and Shoulder Dislocations

hockey

The most flexible joint in the entire human body is the shoulder joint. It is formed by the union of the humerus, shoulder blade and collarbone.  The shoulder is actually made up of two separate joints that work together to allow the joint to turn in many directions.

However, this advantage also makes the shoulder an easy joint to dislocate.

A shoulder dislocation is a common injury in contact sports, such as football and hockey, and in sports that may involve falls, such as downhill skiing, gymnastics and volleyball.

According to Dr. Scott Gudeman, sports medicine specialist at OrthoIndy, most dislocations are anterior, which means that the head of the humerus slips forward out of the joint.  A fall sideways on the arm can cause an anterior dislocation.

“Occasionally a dislocation can be posterior, where the humeral head slips backwards out of the joint,” said Dr. Gudeman. “This usually occurs from a different type of injury, in which the arm is struck while it is rotated inwards. Additionally, your shoulder can be extremely loose and cause pain without having an injury. This scenario may represent multidirectional instability.”

Usually your physician will examine your shoulder and may order an X-ray. To treat the dislocation your physician will place the ball of the humerus back into the joint socket. Severe pain stops almost immediately once the shoulder is back in place.

You may have to wear a sling or another device for several weeks following treatment. After pain and swelling go down you will be prescribed physical therapy exercises to help restore the shoulder’s range of motion and strengthen the muscles.

Symptoms include swelling, numbness, weakness and bruising. According to Dr. Gudeman, once you have dislocated your shoulder, the chances are high that it will happen again, particularly if you are under the age of 30. So it is important to follow your physician’s treatment plan.

“There are many different surgical procedures to repair the instability of recurrent shoulder dislocations,” said Dr. Gudeman. “Because one common cause of instability is a tear in the ligaments that attach to the socket, surgery is often done to repair this damage.”

To schedule an appointment with Dr. Gudeman please call (317) 884-5161 or request an appointment online.

What is Complex Regional Pain Syndrome (CRPS) or Reflex Sympathetic Dystrophy (RSD)?

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By, Dr. Kevin Sigua

Complex Regional Pain Syndrome/ Reflex Sympathetic Dystrophy is an uncommon form of chronic pain that usually affects an arm or leg. CRPS/RSD typically develops after an injury, surgery, stroke or heart attack, but the pain is out of proportion to the severity of the initial injury, if any.

The cause of CRPS isn’t clearly understood. Treatment for complex regional pain syndrome is most effective when detected and started early. In such cases, improvement and even remission are possible.

Symptoms may include continuous burning or throbbing pain, usually in your arm, leg, hand or foot, sensitivity to touch or cold swelling of the painful area. Other symptoms may include changes in the skin, including the skin’s temperature, color and texture. Changes in hair and nail growth, joint stiffness, muscle spasms and decreased ability to move the affected body part are also symptoms. Symptoms may change from person to person but not treated early these may become irreversible.

Diagnosis of CRPS/RSD is based on physical exam and history.  In addition tests like, MRI’s, bone scans, X-rays may help in diagnosis however there is no one single test that can give a definitive diagnosis.

Early detection is key to potentially successful treatment however treatment may include the use of oral medications like anti-inflammatories (Advil, Aleve), antidepressants (Cymbalta) and antivconvulsants (Gabapentin, Lyrica) and pain medications.  Sympathetic Nerve or Cervical Stellate Ganglion injections with local anesthetic can help diagnose and treat the disease.

To schedule an appointment with Dr. Sigua please call (317) 802-2872 or request an appointment online.

What can I do for my aching knee when I am not ready for surgery?

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By: Dr. Matthew Lavery, OrthoIndy Knee Specialist

In my practice I see quite a few middle-aged athletes with mild to moderate knee pain.  Many of these patients have very early signs of osteoarthritis, but are nowhere near ready for a knee replacement.

In reality, most of these athletes have a degenerative condition that has some likelihood of progressing over time.  Arthritis progresses at varying rates in different patients.  Despite this prognosis, there are a number of things patients can do to manage their knee pain non-operatively.

The first line of treatment should always involve the simplest, most cost-effective solutions.  Basic methods like rest, ice, compression, elevation and maintaining full range of motion should be included in any treatment plan.  In addition to these modalities oral anti-inflammatories, like ibuprofen or naproxen, can be used in patients experiencing acute flare-ups of pain who do not have a contraindication.

For more chronic aching patients can try glucosamine or fish oil.  Glucosamine is essentially like a vitamin for cartilage and has been studied in at least five separate placebo-controlled studies, which have shown some positive benefits to the supplement.  There is also newer information emerging to suggest that taking fish oil may lessen the production of inflammatory chemicals throughout the body, including in the joints.

Mild to moderate knee pain from early arthritis affects many middle-aged athletes.  Although the condition has potential to progress, the symptoms can often be lessened with appropriate treatment strategies, thereby allowing patients to maintain an active, healthy lifestyle.

To schedule an appointment with Dr. Lavery please call (317) 884-5170 or request an appointment online.