3 Step Solution: Shin Splints

The term shin splints is commonly used to indicate pain in the lower leg. Technically, medial tibial stress syndrome (MTTS) are true shin splints. There are other issues which may be misclassified as shin splints, some of which can be life threatening so it’s important to get a diagnosis from a qualified health provider.

Your shin bone (tibia) is the larger of the 2 lower leg bones. You know the one I’m talking about if you’ve ever banged you lower leg against furniture or had some misbehaving toddler kick you!

What’s your shin splint risk level? The more "yes" answers, the higher your risk.
  • You are a beginning runner or you’ve had a previous occurrence of shin splints. usually attributable to biomechanical issues as well as training intensity mistakes
  • Do you participate in repetitive lower body activity (running), or activity which requires sudden or high impact maneuvers (basketball, tennis, soccer)?
  • You are age 19 to 40 (with a gender bias toward women)
  • You suffer from poor ankle mobility

STEP 1 Assessment

Signs and Symptoms of shin splints
  • Usually along the inside of the shin bone (lower third)
  • Initial Pain usually comes on slowly over time
  • Not usually painful upon weight bearing (walking, standing) but may become painful upon more strenuous activity
Seek medical attention if experience any of the following:
  • Your limb is swollen or hot
  • Your pain occurs suddenly or is severe
  • There is muscle weakness, pins and needles sensation etcetera
  • Tender to touch or upon normal weight bearing activity or movement (standing, walking)

STEP 2 Treat the Pain / STEP 3 Prevent Shin Splints

Have patience, rehab may take a week in very mild cases or several weeks in more severe cases. Cure and Prevention are virtually identical.
General Actions to alleviate pain:
Rest – rest doesn’t equal no activity. Modify your activity (reduce, non-weight bearing activity etc). Cross Train - Consider adding swimming to your activities especially in severe cases of shin splints. Bring down the intensity of all lower body focused workouts.

Ice, Ice Baby – Religiously ice your shins after your workout

Compress and Elevate - try this as a combo if you have minor swelling due to shin splints.

Massage – seek a provider who specializes in sport massage therapy, Swedish massage is too general and non-specific for your needs. A sport’s massage therapist has been trained in a variety of orthopedic issues and is your best ally. Tap into their expertise regarding self-massage  and stretching for between treatment use!
Prevention tip: massage therapy is an excellent way to identify muscular imbalances, improve flexibility and speed your recovery. 

Specific Action Identify your unique cause of shin splint pain
  • Have you suddenly increased the duration, intensity, or frequency of your workout? 
Prevention tip: In the running world the rule of thumb is don’t increase your goals more than 10% per week.
  • Are you biomechanically challenged?: inflexible ankles, over-pronation (ankle rolls inward), rigid arches, flat feet, too long a stride, muscular imbalances etcetera. 
 Prevention tip: see link to flexibility test
- find a massage therapist to help increase flexibility
- find a personal trainer to strengthen weak muscles
- Are you a runner? Join a running club such as the New York Road Runner's Club for coaching and camaraderie.

Prevention tip: a calf compression sleeve worn during your activity may eliminate or reduce mild discomfort
  • Is your footwear appropriate and in good shape? You wouldn’t dance in football cleats, nor would you wear super old running shoes.
Prevention tip: Replace running shoes every 300- 500 miles.

Move Happy! - Denise Williams
Licensed Massage Therapist

Medical Massage Reimbursement

Just in time for income tax preparation in case you don’t qualify to receive a tax deductible credit via federal income tax filing? Consider one or more of the following health related spending accounts to lower the cost of medically related massage treatment.

The 3 Most Common Health Account Types are
  1. Health Reimbursement Arrangement (HRA)
  2. Flexible Spending Account (FSA)
  3. Health Spending Account (HSA)

Health Reimbursement Arrangement – HRA accounts are established and controlled by the employer to reimburse qualified medical expenses (QME) for the employee only. Only the employer contributes to this account. Other restrictions may apply.

Flexible Spending Account – FSA accounts are the most commonly known type of healthcare spending account. You may hear it referred to as a cafeteria plan because of its many options that allow you to customize the plan a bit. FSAs are created to reimburse qualified medical expenses, health insurance premiums for premium-only accounts, as well as dependent care expenses.

Health Savings Account (HSA) - HSA accounts are accounts created to pay for qualified medical expenses of the account holder, his/her spouse and/or dependents. Any individual may open an HSA. There are other unique provisions that must be adhered to. The major difference with this type of account is that the money belongs to YOU! 

When recommended by a health care professional for a medical condition, the cost of massage therapy may be a qualified medical expense. You may be asked by your insurer to provide proof of medical necessity (e.g., prescription, doctor’s note) with the request for reimbursement. 

I've found that the best way to phrase the question of massage reimbursement is: "Under what circumstances do you reimburse for massage therapy?". If you merely ask "Do you pay for massage therapy?", the answer is far more likely to be "No".

When the cost of massage therapy is for “general health”, it is not a qualified medical expense.

In all cases be proactive by getting a prescription from your doctor and keep a record of all of your receipts and always check with your tax adviser.

A recently published New York Times’ article (1) about running injuries by author Gretchen Reynolds provides new discoveries and useful actions regarding prevention of running injuries! Here’s my take and additions.

This is the time of year I start to see more runners on my massage schedule. Most are coming in for pre-race season treatment which focuses on improving the runner’s performance as well as injury prevention. A few receive orthopedic sports massage for niggling issues such as tight ITB, shin splints, pain in the feet etcetera.

Ms. Reynolds points out that as many as a whopping 90 percent of runners miss training time every year due to injury! A very recent stud(2) set out to find out the effect of impact loading. Impact loading is the amount of force we create when we strike the ground and is inevitable in running. A group of 249 experienced female recreational runners was tracked for two years. This group was chosen in part BECAUSE they all struck the ground with their heels, as do most runners.

Here is the real news: Previous studies (and common belief) are likely to attribute running injury to increased mileage, over-striding, weak hips, hard running surfaces and the like. While these issues contribute to running injuries, there is another far more reliable predictor of running injury risk.

The study went a step further and took a close look at the 21 runners who remained uninjured during the two year study.

According to the article’s author “The never-injured runners, as a group, landed far more lightly than those who had been seriously hurt, the scientists found, even when the researchers controlled for running mileage, body weight and other variables.That finding refutes the widely held belief that a runner cannot land lightly on her heels.”

Harvard researcher, Irene Davis, noted that one of the women in the uninjured group pounded far less than many runners who landed near the front of their feet. Dr. Davis went on to say “When you watched her run, it was like seeing an insect running across water. It was beautiful.”

Study conclusions
  • Contrary to popular belief - It’s not terribly relevant whether you land on your heel, mid-foot, or forefoot! Nor is the shoe type or barefoot the best predictor or injury
  • The harder the strike impact on any part of the foot, the more likely it is that the runner will sustain an injury.

My takeaway
I’m not going to worry so much about heel vs. midfoot vs. forefoot landing. My mental image has been running across water with the wings of mercury upon my feet.

I’ve only just recently put this thought into practice during the running portion of my walk/run interval training exercise while also remaining cognizant of injury producing habits, which I’ve dubbed the “Terrible Toos” (too much, too fast, too long – you get the idea).

Only time will tell if this more common sense approach keeps me on the run! I hope it helps you too come race time.

Happy trails,
Denise Williams
NY State Licensed Massage Therapist
  1. NY Times- NY edition 2/16/2016 pg D6 headline: Why We Get Running Injuries
  2. December in the British Journal of Sports Medicine

FootPainMassageFoot Pain Callous Pattern
Suffering from ball of foot pain? Try this cost-effective fix. If it works for you, then it may indicate that a foot orthotic (custom or store bought) may provide a more durable option.

As a massage therapist, I often check the condition of people’s feet especially when they complain of orthopedic pain whether the pain is in their feet, knees, hips, low back, all the way up to the neck! 
Read more... or contact me for an appointment

Schedule a week in advance for an evening appointment. contact me

TUESDAY, WEDNESDAY, FRIDAY: as early as 9AM ending by 7PM sharp

THURSDAY Christmas Eve and News Years Eve as early as 9AM ending by 3PM sharp which is 2 hours earlier than usual for a Thursday. I am out of the office Friday Dec 25 & Jan. 1. Regular schedule resumes Tuesday Jan 5, 2016.
By advance appointment - No walk-in.

Many thanks from Much Kneaded of NYC,
Denise Williams
New York Licensed Massage Therapist

7 Sleep Positions For Pain Prevention & Relief

Pictured below are multiple options depending on whether you sleep on your back, side or even stomach. Use singly or in combination as needed.

Strategic Pillow Talk 
During initial massage therapy intake, I usually enquire about preferred sleep position. We spend approximately 1/3 of our life asleep, sleep position can impact how we feel the following day and over time - for better or worse.

Pillow placement can prevent or alleviate certain types of musculoskeletal and nerve pain. Don’t have an extra pillow? Try a rolled up towel or consider a body pillow. A body pillow is approximately four feet long. Skip the one that is 6 feet or so and u-shaped unless you sleep alone. See the sidebar for body pillow and matching body pillow cover.

Back Sleeper
1. neck pain Drape pillow in a “shawl” fashion to prevent your head from rolling too far to either side thus easing the strain on the neck.

2. low back injury
Place a pillow under  your knees. This position serves double duty by reducing stress on the low back as well as the knees.

Side Sleeper
3. neck / shoulder pain
The pillow is between the head and the shoulder (not under shoulder) keeping the upper back in one line parallel to the floor. This position may lift the head enough to keep it from cutting off circulation and nerve sensation to the arm that is on the bed. 
Yay - no more pins and needles!

4. Low back / top hip / knee /ankle pain
Use a small pillow under the low back. For the lower leg arrange the pillow lengthwise to  cushion from thigh to ankle.

5. Sidelying Full Body Alignment:
This is my personal favorite and it's not just for pregnancy massage. If you haven't tried this position, ask about it the next time you schedule a massage appointment.

Pillow between head and shoulder and body pillow hugged to chest at one end and between knees at the other. This is how I would set you up for sidelying massage.

Stomach Sleeper (sigh - if  you must go there!)
This is the most problematic sleep position for your cervical (neck) spine and can make lumbar (low back) pain worse.
6. neck pain / spine
The first pillow is under the head and collar bones to keep the head from excessive rotation. The second pillow is under the stomach and hips to take pressure off the low back.

7. calf / foot cramp prevention
Place a pillow under your ankles so that your toes don't touch the bed. This position is great if you have plantar fasciitis or are prone to calf cramps at night.

TIP: Don't have an extra pillow? Scoot down so that your feet hang off the edge of the bed leaving your tootsies pressure free!

Recover from low back pain with massage and smart exercise. Check out Much Kneaded Massage NYC - November Newsletter

Massage NYC Holiday Schedule
Schedule a week in advance for an evening appointment.

TUESDAY, WEDNESDAY, FRIDAY: as early as 9AM ending by 7PM sharp
THURSDAY as early as 9AM ending by 5PM sharp

THANKSGIVING WEEK - I will be in the office Tuesday Nov 24 only

Many thanks from Much Kneaded,
Denise Williams
New York Licensed Massage Therapist

Sports Deep Tissue Massage in NYC
The phrase deep tissue massage and sports massage are often used synonymously though not all sports massage is deep and not all deep tissue massage is a sports focus. In either case these tips still apply regarding massage therapy treatment.

Before your massage
  • Allow enough time for your session - deep tissue massage strokes are delivered much more slowly. Sessions of 90 minutes should be sufficient. (60 minutes for a smaller area)
  • Arrive 15 minutes before your appointment to be assessed and to discuss your goals and treatment focus.  Example: runners usually have tight calves, or want to have their hamstrings stretched whereas swimmers often prefer a focus on shoulder range of motion issues
During your massage
  • Keep your therapist informed regarding your level of pressure tolerance. One person’s version of light is another’s version of too deep. Additionally, you may have different pressure tolerances on different parts of your body or a problem area may be hyper-sensitive. If the intensity is too great (or too light), the pressure and/or speed of the stroke can be adjusted accordingly.
  • A good gauge of sensitivity is on a scale from 1 to 10. Level 1 is you barely feel any sensitivity; pressure level 8 means your muscles are protectively tensing up in resistance. The sweet spot level is 6-7: “yeah - ouch stay right there”.  If the excessive pressure causes you to tense up for more than a few seconds, just say “I need for you to lighten up there”. Sensitivity perception is totally subjective therefore your pain scale is unique to only you. 
Post massage
The positive effects of massage are cumulative. If you are experiencing a nettlesome issue, such as the numbness and tingling of carpal tunnel, sciatic pain, or frozen shoulder schedule a  weekly series of deep tissue massage appointments. As your condition starts to improve, change to an every other week schedule with the aim of gradually increasing the time between appointments until your condition is resolved or you are in a maintenance mode.

Attention NY desk jockey! Stuck at your desk? Can't get an a massage appointment? Here's an easy way to temporarily address neck and shoulder pain.