healthmedicinet

By
Martin Scurr

PUBLISHED:

20:39 EST, 16 December 2013

|
UPDATED:

20:39 EST, 16 December 2013

Could you give me some advice for my grandson Jake, who is 17 years old? Two
years ago, he developed shin splints. He is a brilliant footballer and a
Premier League club was very interested in him until he broke down in
training with the problem (despite resting and doing light exercises as
suggested by a physiotherapist).

He has made two or three attempts at
playing football again during the past two years but had to stop
because of the pain. He suffers mostly when the ground is hard. Hundreds of footballers must have suffered this, so am I right in assuming that there are cures?

William Findley, by email.

The correct medical term for shin splints is medial tibial stress syndrome

Shin
splints is a term commonly used to describe pain in the shins caused by
exercise. It is by no means confined to footballers, and is linked to
between 10 and 15 per cent of running injuries.

The correct medical
term is medial tibial stress syndrome, and even though the pain can be
considerable, this condition is not usually anything to worry about.

The phrase ‘shin splints’ is misused by many, often being applied to almost any recurrent cause of pain in the lower leg.

In
fact, the condition causes a particular sort of tenderness. This
specifically affects the area where the muscle at the front of the leg
joins the tibia (or shin bone). Firmly slide your thumb down the shin
bone to midway between the inner knee and the inner ankle joint: if the
problem is ‘shin splints’, the area where the bone and muscle meet will
be extremely tender to the touch.

In mild cases, pain (rather than
tenderness when touched) occurs only during exercise; but in the worst,
there can be pain when resting, too.
Medial tibial stress syndrome is essentially overuse – I think of it as a repetitive strain injury.

CONTACT DR SCURR

To
contact Dr Scurr with a health query, write to him at Good Health Daily
Mail, 2 Derry Street, London W8 5TT or email [email protected] —
including contact details.

Dr Scurr cannot enter into personal correspondence.

His replies cannot apply to individual cases and should be taken in a general context.

When
you run, the foot and shin bone should work together to absorb the
impact. If this doesn’t happen, the tissue that covers the surface of
the shin bone becomes inflamed, causing tenderness and pain.

A
number of factors can trigger medial tibial stress syndrome, including
minimal abnormalities between the hip and foot, the position and use of
the foot, problems around the knee, muscle imbalance throughout the leg
(as a result of running style, perhaps) and the type of shoes.

Other factors may contribute, such as an inadequate warm-up and running on hard or uneven surfaces.

Medial
tibial stress syndrome must be distinguished from stress fracture (when
there is a crack in the shin bone) and exertional compartment syndrome
(a muscular problem), which are both other common causes of lower leg
pain.

Stress fractures occur more often in the tibia of runners than
footballers. The pain is localised, can be intense and gradually
increases as exercise progresses. Rest eases it.

A stress fracture
cannot always be seen on a basic X-ray, and magnetic resonance imaging
or radioactive isotope bone scanning may be necessary to see the bone
damage.

By contrast, exertional compartment syndrome is when there
is increased pressure in an area of muscle in the lower leg that impairs
blood flow, reducing the oxygen supply and allowing the build-up of
waste products from exercise, such as lactic acid.

This causes an aching, cramping feeling, which will go completely with rest.
Because
medial tibial stress syndrome may be linked to a number of factors,
it’s essential to get expert advice from a physiotherapist with the
correct skills, as they can then properly appraise the way the feet and
legs work. I have referred patients to a sports injuries orthopaedic
physician for extra advice.

In severe cases, short courses of
anti-inflammatory medicines are needed, as well as strengthening and
flexibility training to correct any muscle imbalances caused by faulty
running habits.

The important point is that Jake should not give up.

When I’m in a plane, on landing I often get a terribly painful pressure headache that can last for hours afterwards. I
realise it is to do with the drop in air pressure and it often happens
at the same time that my ears pop. But it makes me anxious about
flying. I tend to suffer from headaches quite frequently (at least
two or three times a week), so I don’t know if that makes me more
susceptible.

Nicole Anderson, by email.

You are correct: the headache is triggered by the change in air pressure – but by an increase, not by a fall.

At cruising height, the air pressure in most aircraft is reduced to a level lower than that on the ground.

As
a result, air moves out from the sinuses and the middle ear (that’s why
we all find ourselves slightly deaf on the ascent and have to swallow a
few times to equalise the pressure in our ear with the lower pressure
outside our head).

Both the sinuses (hollow spaces in the skull that
are lined by one continuous mucus membrane) and the middle ear’s
eustachian tubes (which connect the middle ear to the space at the back
of the nose) help normalise this.

When the aircraft descends, the air
pressure increases again, and you have to swallow a few times to open
the eustachian tubes to allow air to pop into the middle ear. Air must
also enter the sinuses to balance up the pressure.

But if the spongy
membrane lining the nasal passages is swollen – and if the connecting
tubes between the sinuses and the nose are narrow – not enough air gets
in, so equalisation of pressure cannot occur.
This is most likely to
happen if the frontal sinuses in the forehead are especially narrow.
The consequence is a painful headache that is often referred to as a
vacuum headache.

Avoid anything that may increase blood flow in the
nasal lining and cause it to swell. Alcohol springs to mind: do not have
any prior to boarding or while in the air.

Second, use a nasal
decongestant spray such as Vicks Sinex or Otrivine. Squirt a dose up
each nostril in the departure lounge, again after take-off, then as soon
as you detect that the descent has started. This will minimise the
thickness of the nasal lining and hopefully prevent your vacuum
headache.

By the way…?I don’t trust these checks on GPs

The picture that emerged last week from the Care Quality Commission’s (CQC) visits to GP practices gave us all much pause for thought (posed by models

Maggots
in consulting rooms, patients given out-of-date medicines or
injections, nurses not trained in basic first aid – the picture that
emerged last week from the Care Quality Commission’s (CQC) visits to GP
practices gave us all much pause for thought.

It is fair and right and proper that such inspections are taking place, but is the regulator up to speed? Is it competent?

The
practices the CQC visited had already been identified as problematic.
But when it comes to identifying major problems, the regulator’s history
hardly impresses – just look at the Mid Staffordshire NHS Trust crisis,
where hundreds of patients are known to have died needlessly because of
poor care.

To say the CQC doesn’t inspire confidence in those of us who work with patients every day is an understatement.

It
doesn’t help that the organisation itself has undergone years of chop
and change and rebranding, as well as a lacklustre leadership. In that
atmosphere, how can the inspectors have any grip on their task? Indeed,
how do they learn to be inspectors – and who trains them anyway?

When
our practice was visited by CQC inspectors (private practices were the
guinea pigs for the scheme), it was patently clear they were learning on
the job – and mainly missing the point by a focus on what sort of soap
we were using and whether there was a sign above the washbasin warning
that the hot water was hot.

Now that NHS practices are in the
spotlight, the latest wheeze has been to appoint a GP, Professor Steve
Field, to invent a new approach to inspections.

The good news is
that inspectors are going to attempt to observe if practices are caring
and whether they really bother about their patients. This is a start,
but ultimately difficult to judge.

It’s also good that inspection
teams will now include a GP and a nurse, though if they hope to visit 25
per cent of practices within six months from April 2014 they are going
to have to train up large numbers very smartly.

But from where will
they recruit them? And is it right to remove senior personnel from the
workplace to do this, given that we are short of experienced GPs, with
so many choosing to retire early because they are disenchanted?

And
when the CQC does suspend a practice for poor care, what happens to
their patients? Continuity of care will be lost, and they will be dumped
onto another nearby practice that may be less than willing to accept a
forced uplift in its workload.

My heart sinks.

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