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Shin Splints and How to Prevent Them

Clinician’s typically diagnosis shin splints as medial tibial stress syndrome (MTSS), or in layman’s terms: pain along the inside border of the shin bone caused from activity-related pain. A few other terms for shin splints may include: soleus syndrome, tibial stress syndrome, and periostitis. Shin splints can account from 4-35%, or even up to 50%, of running injuries in certain active populations.

Since the true cause of shin splints is unknown, however, there are a few theories of how they occur. This is including (but not limited to): inflammation of the surrounding tissue of the shin bone (periosteum), tenderness or injury to the surrounding musculature or tendons (e.g. soleus, tibialis posterior, tibialis anterior), reactions to repetitive stress or high weight loads causing bending of the tibia or increased strain, traction on the periosteum by an imbalance of lower leg musculature, and decreased bone density. Some risk factors that have been linked to shin splints include:

  • High body mass index
  • Flat feet
  •  Being a female
  •  Inexperience in running 
  • Previous history of shin splints
  • Changing running surfaces

So now that we know the potential causes of shin splints, how can we prevent them?

Although research has not come up with a perfect prevention program for shin splints, there are a few training strategies that have promise to work. First and foremost, however, is footwear. Insuring that your feet have proper arch support, cushioning, and/or durability to withstand the forces that are being placed on your body can be a tremendous help in preventing over-use injuries. Also, the mileage and overall wear-and-tear on the footwear may be an important factor, as older shoes lose support and harmful stresses can impact the lower body leading to injury. Cleats or turf shoes may not have the best arch support. It is recommended to have your feet evaluated by a specialist as you may require insoles or custom orthotics.

Training strategies in preventing shin splints include appropriate stretching and dynamic warmup exercises. Stretches that have shown to help shin splints would be stretching the two muscles that make up that calf muscle: the gastrocnemius and soleus. All of the stretches can be completed by performing 3 sets of 30 second hold; 3-5 times per day. The gastrocnemius can be stretched by leaning up against a wall in a lunge stance, while keeping the heel of the back leg on the ground, and with the back knee straight, lean into the wall. To stretch the soleus, assume the same lunge position, but instead of keeping the back leg straight, bend at the knee and lean. The soleus is the muscle that is usually forgotten when the calf is stretched, and this can create unequal stresses on the tibia or shin bone. Another muscle to stretch may be the tibialis posterior, this muscle can get overworked at times when there is not enough arch support. This muscle can be stretched best barefoot and by sitting in a figure 4 position with the ankle resting on top of the opposite knee, next grab the inside of the heel in one hand and push the heel down towards the floor, at the same time with the other hand grab the top of the foot and push towards the floor as well, you should feel the stretch along the inside of the shin bone.

FIFA 11+ is one dynamic warmup or training program that has been measured to have a decrease in injury risk rates by 35%. Additionally, teams that have added FIFA 11+ into their training have shown to have between 30% and 70% fewer players with injuries. FIFA 11+ has training that include stabilization of the core, eccentric movements for the thigh muscles, proprioceptive exercises, and proper postural alignment with dynamic stabilization and plyometric training. The only equipment used would be a soccer ball, and the program can be completed in 10-15 minutes when athletes are properly trained with the movements. Some of the specific exercises that would prevent shin splints would be the single leg stance, squats with either toe raise, walking lunges, or one-leg squats, jumping, and running exercises.

While there is no “gold standard” in 100% prevention of shin splits, proper footwear, stretching, and a dynamic warm-up with FIFA 11+, has been shown to have positive results in preventing overuse injuries. Additionally, having adequate rest time, not over training, and training on appropriate surfaces may also help to prevent shin splints from arising. Overall, by staying in tuned with your body and preparing well for practices and completions by stretching and warming-up in a balanced fashion are appropriate ways to prevent shin splints.



Barengo NC., Meneses-Echávez JF., Ramírez-Vélez R., Cohen DD., Tovar G., Bautista JE. The impact of the FIFA 11+ in football players: A systematic review. 2014;11: 11986-12000.

Bonasia DE., Rosso F., Cottino U., Rossi R. Exercise-induced leg pain. Asia-Pac J Sport Med. 2015; 2: 73-84.
Craig DI. Medial tibial stress syndrome: Evidence-based prevention. J Athl Training. 2008;43(3): 316-318.

Loudon JK., Dolphino MR. Use of foot orthoses and calf stretching for individuals with medial tibial stress syndrome. Foot Ankle Special. 2010;3(1): 15-20.

Pengel KB. Common overuse injuries in the young athlete. Pediatr Ann. 2014;43(12): 297-308.

No Gym Equipment Needed! Easy, Fun Exercises to do at Home

Staying active and fit indoors can be a big challenge during the winter months, especially if you don’t have gym equipment at home. This article aims to provide you with tips for staying active and healthy indoors using every day activities and your own body movements.

Activities of Daily Living

Over time you may have heard healthcare professionals refer to ADL’s or Activities of Daily Living. ADL’s are simply activities one commonly does over the course of day to day life. Examples of some common indoor ADL’s are washing dishes, doing laundry, or dusting the house just to name a few. If you are looking for easy ways to improve your fitness indoors without gym equipment, changing the way you approach your ADL’s can make a positive impact on your health.  Try doing housework at a pace that increases your heart rate and makes you feel like you are getting a workout. This will help burn more calories and improve your cardiovascular fitness while you get work done.

Using ADL’s To Improve Fitness

·         Increase the pace with which you perform the activities – doing this will force your body to work harder, therefore increasing your heart rate and burning more calories.

Make the most of TV time

Many people spend some part of every day in front of the TV, but this time is great for more than just watching the news. While watching your favorite program try doing some simple exercises that can give your body a great workout. Pushups, sit-ups, squats, lunges, and jumping jacks can all be performed in front of the TV. All of these exercises can be performed by healthy individuals of any age. If you have any questions it is best to check with a physician before starting new exercise.

Simple Exercises for TV Time

·         Push-ups

·         Sit-ups

·         Jumping Jacks

·         Lunges

·         Squats

Take the stairs

If you have a staircase in your home, use it to maximize your fitness. Walking or running up and down the stairs is a great way to work the lower body and the cardiovascular system at home.  Stairs can also be used for variation on different exercises, such as incline push-ups. Be careful and use good judgement when using stairs to exercise.

Simple Exercises Involving the Stairs

·         Walk up and down

·         Run up and down

·         Incline Push-ups

·         Calf raises


When you are inside at home with no gym equipment, finding ways to exercise can be a challenge. Using your creativity and finding ways to turn your home into a gym is another powerful tool you can add for increased fitness. Using your imagination and this article can guide you in the right direction towards getting fit at home without gym equipment.

Poor Posture with Sitting: negative effects and ways to improve

Most people do not realize how important posture is.  If you don't correct it, poor posture tends to keep getting worse as your body tries to compensate for it.  Poor posture also causes strain on the body and leads to weakening of the postural muscles, particularly given the amount of time we now spend sitting for our jobs and relaxation.  Poor posture can cause injuries like back/neck/shoulder pain, TMJ and even headaches.

Correcting posture requires retraining your brain to remember years of a “bad habit”, however it is worth it considering it will lead to less pain/injuries:

  • Awareness of your posture- straighten your back, lift your chest, roll your shoulders back and rotate your pelvis so your stomach and behind are tucking in – have all 3 curves in your spine
  • Take Breaks!!! Even if it is only 30 seconds – sit no more than 30 minutes!
  • Chair/Table set up: feet supported with no crossed legs with hip/knees at 90 degree angle and even weight between hips
  • Sit back in the chair so your buttock is touching the back rest and the back of the knee should be about an inch from the edge, potentially a small rolled up towel in your lower back,
  • Arms/Forearms Supported:  Rest your elbows/arm on your chair or desk or pillows keeping shoulders relaxed. 
  • Screen height should be eye level and close to you- potentially use books to stack screen up so you don’t have to move your head
  • Avoid rotating/twisting at the spine, keep objects close to you and rotate body as a whole

Snow Shoveling Safety Tips

Prepared by Kelly Calhoun LAT, ATC

With the winter season upon us, snow is right around the corner.  While it is all fun and games building snowmen, starting snowball fights, and making snow angels, there is also a chore that comes along with snow- shoveling.  When done correctly, snow shoveling can be a good way of getting exercise.  In fact, it is considered moderate exercise with just 15 minutes of shoveling.   But as with most forms of exercise there are always safety risks.  This article will provide tips to help keep your body healthy this winter.

  • Warm up and stretch
    •  As it is important prior to all exercise to avoid injury, it is especially necessary when you are going to be out in the cold. 
  • Bend at your knees and lift with your legs
    • Never lift with your back or twist your back when throwing snow out of the way
  • Avoid lifting the snow; instead push it all the way to the end.
  • If you do lift it, avoid collecting too much snow on the shovel at one time
    • To help remember this, either use a smaller shovel or fill a larger shovel only about halfway
  • Do not wait to start shoveling
    • The fresher the snow is, the easier it is to clear away because of it being a lighter substance compared to when it begins to melt
    • Shoveling in more frequent intervals will help avoid  lifting  too much at once
  • Use an appropriate kind of shovel
    • Use a shovel with a curved handle rather than a straight handle, this will reduce stress on the back
    • A shovel made of plastic will typically be a lighter weight than one made of metal therefore putting less strain on your body
  • If at any time you begin to feel any pain, stop shoveling and seek assistance


Dorfner M. Reminder Tips for Safe Snow Shoveling. http://newsnetwork.mayoclinic.org. http://newsnetwork.mayoclinic.org/discussion/tips-for-safe-snow-shoveling-2/. Published December 28, 2015. Accessed December 12, 2016.

In The Bleak Mid-winter: 10 Tips for Safe Snow Shoveling. http://www.coloradospineinstitute.com/. http://www.coloradospineinstitute.com/subject.php?pn=wellness-snow-shoveling. Accessed December 12, 2016.

The Winter Weather Workout. Rothman Institute Orthopaedics. https://www.rothmaninstitute.com/stories/news-and-blog/the-winter-weather-workout. Published February 5, 2011. Accessed December 12, 2016.

Skiing & Sledding Safety Tips

Skiing and sledding are longtime traditions of winter. Both are fun, enjoyable activities but both can present their own safety hazards if done improperly. An article published by the American Academy of Orthopaedic Surgeons stated that according to the U.S. Consumer Product safety Commission there were more than 52,000 sledding, snow-tubing, and tobogganing related incidents treated in 2014.

Injury Prevention for Skiing/Sledding

  • Ski/Sled at your own level. Always be in control 
  • Avoid sledding near trees, streets, and parking lots 
  • Young children should have proper adult supervision 
  • Make sure equipment is in good condition for safe activity 
  • Wear protective gear, especially when skiing. A quality ski helmet will not only protect your head from potential injury but will keep your head warm as well. While trauma can happen to any part of the body, “head and spine injuries account for 7% of alpine trauma”3 according to a study on skiing injuries conducted by Robert E Hunter MD. Keep hand warmers with you in case of extreme cold and if you ski at night wear reflective clothing and carry a small flashlight in case of emergency.

Proper Skiing/Sledding Safety Gear

  • Helmet
  • Bright colors w/ reflective patches
  • Gloves
  • Goggles

For all winter activities it is important to dress properly. The best option for cold weather exercise is layering. According to the Mayo Clinic Staff “dressing too warmly is a big mistake when exercising in cold weather. Exercise generates a considerable amount of heat, enough to make it feel like it’s much warmer than it really is.”2 While sweating out in the cold might make you feel like you are getting a great workout but be careful, “the evaporation of sweat pulls heat from your body and you feel chilled”2 according to the Mayo Clinic Staff.

Proper Layering for Cold Weather Exercise

  • Thin layer of synthetic material, such as polypropylene       
  • Fleece or wool for insulation      
  • Waterproof, breathable outer layer (avoid cotton)

During cold weather activities it is also a good idea to protect your extremities including head, hands, feet, and ears and know the warning signs of Frostbite and Hypothermia. Hypothermia is an abnormally low body temperature and is characterized by intense shivering, slurred speech, and loss of coordination. Frostbite is an injury that is caused by freezing and is most common on exposed skin such as ears, nose, and cheeks. Early signs of frostbite include numbness, tingling, or stinging sensations.

Warning Signs of Hypothermia

  • Intense shived
  • Surred speech
  • Loss of coordination

Warning Signs of Frostbite

  • Numbness
  • Tingling sensation
  • Stinging sensation


Skiing and sledding are fun wintertime activities that can be enjoyed by almost anyone. Following the safety tips presented above will help you and your loved ones ensure that you participate in these activities safely and enjoy them to the fullest extent.


1.         American Academy of Orthopaedic Surgeons. Sledding Injury Prevention. January 2016. http://orthoinfo.aaos.org/topic.cfm?topic=A00306
2.         Mayo Clinic Staff. Winter fitness: Safety tips for exercising outdoors. September 9, 2016. http://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/fitness/art-20045626
3.         Hunter Robert E. Skiing Injuries. Aspen Foundation for Sports Medicine, Education, and Research Orthopedic Associates of Aspen and Glenwood, PC, Aspen, Colorado. THE AMERICAN JOURNAL OF SPORTS MEDICINE, Vol. 27, No. 3 © 1999 American Orthopaedic Society for Sports Medicine

Treating Common Cold Weather Injuries

Winter is coming soon. Low temperatures combined with wind and dampness can leave athletes prone to cold injuries. The two most common cold injuries are hypothermia and frostnip/frostbite. 


Hypothermia is defined as a decrease in core body temperature below 95.6 F. As certified athletic trainers, we most commonly treat mild to moderate hypothermia. Prevention of hypothermia is most important and starts with: 

  • Dressing in thin layers of clothing that are able to be added or removed.  
  • Ensuring that the lower layers of fabric permit the passage of heat so sweat can evaporate.  Synthetic base layers are recommended so that they do not absorb and trap moisture from sweating.  
  • If possible, finding a waterproof and windproof fabric to wear as the top layer. (This may be more feasible in training situations than in game situations.) 

Signs and Symptoms:

  • Mild Hypothermia – Core Temperature 95 F to 98.6 F.  
    • Vigorous shivering, amnesia, lethargy, impaired fine motor control, cold extremities, excessive urination, pale appearance, runny nose, typically conscious, blood pressure within normal limits 
    • Moderate Hypothermia – Core Temperature 90 F to 95 F 
    • Depressed respiration and pulse, cardiac arrhythmias, skin appears blue or purple, athlete stops shivering, impaired mental function, slurred speech, impaired gross motor control, possible loss of consciousness, muscle rigidity, dilated pupils, and blood pressure decreased or difficult to measure.

Treatment of Hypothermia           
  • Remove wet or damp clothing. Insulate the athlete with warm dry clothing or a blanket, ensuring the athlete’s head is covered. Move the athlete to a warm sheltered environment, protected from wind and rain. 
  • Apply heat only to the trunk and to areas of heat transfer. This includes the armpits, chest wall, and groin.  
  • Provide warm foods and fluids that contain carbohydrates. This will help to sustain shivering and improve metabolic heat production. 
  • Avoid applying friction massage to tissues; if frostbite is present this could damage the tissues. 

Frostbite is the freezing of body tissues. This is a localized response and usually occurs when there is a high wind, severe cold, or both. Frostbite most commonly affects the extremities and happens because the body is redirecting blood flow towards the core to maintain temperature. The severity of frostbite is determined by the depth of the tissue that is freezing. Mild frostbite involves freezing of the skin and adjacent tissues. Deep frostbite is the freezing of the tissues below the skin and adjacent tissues, which could include muscle, tendon, and bone. Deep frostbite is a serious injury and requires immediate hospitalization.  Fortunately deep frostbite is rarely seen except with prolonged exposure in extreme cold weather conditions.  Frostnip is the precursor to frostbite, where only the superficial skin is frozen. There is no permanent tissue damage.  

Signs and Symptoms 

  • Mild Frostbite/Frostnip – dry, waxy skin, redness of skin, swelling, temporary tingling or burning sensation, skin contains white or blue-gray colored patches, affected area feels cold and firm to the touch, limited movement of affected area 
  • Deep Frostbite – skin is hard and cold, skin may be waxy and immobile, skin color is white, gray, black, or purple; burning, aching, throbbing, or shooting pain, poor circulation in affected area, progressive tissue death, loss of motor and sensory function, hemorrhagic blistering usually develops within 36-72 hours; muscle, nerve, and joint damage is likely   

Treatment of Frostbite 
  • Being prepared is the best way to prevent frostbite. Wear extra layers, winter gloves, and hats to stay warm and preserve core temperature.   ·  
Mild (superficial)  
  • Rewarming can occur at room temperature or by placing the affected tissue against another person’s warm skin. One can also use their armpits for the rewarming of frostnip of the hands. Rewarming should be a slow procedure. The use of warm water immersion is appropriate. Do not use water with a temperature greater than 98 F to 104 F.    
  • If the athlete is being rewarmed, then it is imperative that affected tissue is not allowed to refreeze. Refreezing could result in tissue death. o   Avoid the application friction massage to prevent tissue damage. ·         
  • Rewarming of affected tissues with deep frostbite is best done with warm water immersion. Clothing over the affected area should be removed.  Water temperature should be 98 F to 104 F with gentle circulation. The affected area should be immersed for 15 – 30 minutes. 
  • As the tissue is rewarmed, it should at first feel numb and then produce a burning and stinging sensation. If the athlete is being rewarmed, then it is imperative that affected tissue is not allowed to refreeze. Refreezing could result in tissue death.  Weight bearing should be avoided when feet are affected.  If refreezing is possible, delay rewarming until advanced medical care can be obtained. 
  • Do not use friction massage so as to prevent tissue damage.  
  • Do not use dry heat or steam to rewarm affected tissue. o   If not rewarming the tissue, protect the affected area from additional damage and transport the athlete to a medical facility.


National Athletic Trainers’ Association Position Statement: Environmental Cold Injuries Thomas A. Cappaert, PhD, ATC, CSCS, CES*;Jennifer A. Stone, MS, ATC, CSCS_;John W. Castellani, PhD, FACSM`;Bentley Andrew Krause, PhD, ATC;Daniel Smith, ATC, CSTS, ARTI; Bradford A. Stephens, MD, PC"                 

Prentice W. Principles Of Athletic Training. 14th ed. New York: McGraw-Hill; 2011:162-16

Do you need a referral to see an orthopedic surgeon?

If you’re like the majority of our patients, you don’t spend a lot of time researching orthopedic services until you actually need orthopedic services.  And when you do, you want access to these services quickly.  

This is not uncommon, which is why we’re committed to providing you with timely and convenient appointments.  Because at OAL, we believe that service to the patient always comes first.   

Our patients frequently ask if a referral is needed, from their primary care physician, before coming to our office.  Our response is to always check with your insurance company directly; but in most orthopedic care cases, a referral is NOT needed. 

We are committed to helping you get you back to life, sport or work.  To schedule an appointment, call us at 717-299-4871 (Lancaster offices) or 717-277-7005 (Lebanon office).

Protect Your Child from Sports Burnout

Written by Michael W. Gish, M.D. Orthopedic surgeon, fellowship trained in sports medicine

Burnout is another risk of overtraining. It can be viewed as a training stress syndrome and results from too much training with too little recovery. Burnout can start with what is known as “staleness,” in which an athlete has a clear drop in motivation and a plateau in performance.  Progressing beyond staleness, true burnout can develop, which has been defined as a response to chronic stress, in which a young athlete ceases to participate in a previously enjoyable activity. The young athlete may withdraw from the sport because they perceive it is not possible to meet the physical and psychological demands of the sport. 

A few warning signs of burnout are: ·         

  • Changes in emotions (e.g., irritability, moodiness, disinterest), cognitive functioning (e.g., difficulties concentrating) 
  • Decreases in strength and coordination 
  • Physiological changes (e.g., appetite loss, increased resting heart rate) 
  • Greater susceptibility to illness
Particular elements thought to contribute to burnout include: 
  • Extremely high training volumes and demands 
  • Demanding performance expectations (imposed by self or others) 
  • Personal characteristics such as perfectionism, need to please others and non-assertiveness. 
 Recommendations to minimize the risk of burnout include

  1. First of all, be aware of the risk of overtraining and the potential for burnout in today’s competitive sports environment. Be especially mindful during the adolescent growth spurt. 
  2. Do not play on more than one team at the same time. 
  3. Limit training time to less than 16 hours per week. 
  4. Vary training regimen and cross-train so as to provide varying stresses to your body. 
  5. Get adequate sleep and hydration (ages 6-13 should get 9-11 hrs./night; ages 14-17 should get 8-10 hrs./night) 
  6. Look for enjoyable activities other than sports for a mental diversion from the stresses of sports. 
  7. Practice stress reduction techniques such as meditation, visualization and breathing techniques.  Many apps are currently available to assist with this. 

While the level of competition in today’s sport, especially at the elite club level is high, it is key to balance the inherent training demands with time for rest and recovery. It is important to maintain a lifelong love for the “beautiful game” and stay healthy to be able to continue to play it as long as you would like. More is better continues to be emphasized in the world of sport, but the reality is that sometimes, less is more.

Tips to Avoid Overuse Injuries

Written by Michael W. Gish, M.D. Orthopedic surgeon, fellowship trained in sports medicine

Overuse injuries generally occur due to repetitive submaximal loading of the musculoskeletal system – when rest is not adequate to allow for structural adaptation to occur. Such injury may involve muscles, tendons, bones, joint cartilage or growth plates. When recovery between loading exposures is sufficient, tissue adaptation occurs to accommodate the imposed stress. However, excessive stress and/or an inadequate recovery period can overwhelm the ability of tissue to remodel, resulting in a weakened, damaged structure. Most overuse injuries will resolve with a period of rest and cause no long-term sequelae, but some may lead to lasting issues, causing difficulty with return to play. 

 Some risk factors for overuse injuries include: 

  • History of prior injury – prior injury is a strong predictor of future overuse injury
  • Adolescent growth spurt – overuse injuries appear to be more common during periods of rapid growth
  • Workload – while it is very difficult to define specific workload thresholds, one study showed that training more than 16 hours per week was associated with a significantly increased risk of injury
  • Scheduling – such as multiple competitive events in a short period of time
Although specific risk factors exist, in reality most overuse injuries result from a complex interaction of multiple risk factors in specific settings coupled with an inciting event.
Recommendations to minimize the risk of overuse injury/burnout include: 

First of all, be aware of the risk of overtraining and the potential for burnout in today’s competitive sports environment. Be especially mindful during the adolescent growth spurt. 

  • Do not play on more than one team at the same time
  • Limit training time to less than 16 hours per week. 
  • Vary training regimen and cross-train so as to provide varying stresses to your body. 
  • Get adequate sleep and hydration (ages 6-13 should get 9-11 hrs./night; ages 14-17 should get 8-10 hrs./night) 
  • Look for enjoyable activities other than sports for a mental diversion from the stresses of sports. 
  • Practice stress reduction techniques such as meditation, visualization and breathing techniques.  

Many apps are currently available to assist with this. While the level of competition in today’s sport, especially at the elite club level is high, it is key to balance the inherent training demands with time for rest and recovery. It is important to maintain a lifelong love for the “beautiful game” and stay healthy to be able to continue to play it as long as you would like. More is better continues to be emphasized in the world of sport, but the reality is that sometimes, less is more.

Turkey Carving Injury Prevention Tips

Did you know that 88% of Americans eat turkey on Thanksgiving?  And cuts from carving are one of the top five most common injuries on this holiday! 

According to Annette Bixler, Certified Hand Therapist with Orthopedic Associates of Lancaster, Ltd (OAL),
“Even minor cuts in the wrong area of you hand can cause complex injuries.  Some injuries involving tendons and nerves may require surgical intervention to restore hand function.”

Before you reach for the carving knife, take a minute to read through the following tips from the American Society of Hand Therapists:

  1.  Keep all cutting utensils sharp. If your knife is sharp enough, it should not need force in order to carve. A knife too dull to cut properly is still sharp enough to cause an injury
  2.  Dry your knife handles. A wet handle can prove slippery and cause your hand to slip down onto the blade resulting in a nasty cut
  3. Consider using an electric knife for carving. Use kitchen shears to cut the bones and joints of the turkey

If you are injured, bleeding from minor cuts will often stop on their own by apply direct pressure to the wound with a clean cloth. Seek medical attention if continuous pressure does not stop the bleeding after 15 minutes.