Mohammed Alo Blog: Medical student, doctoring, osteopathic, Chicago, stories and adventures 2013-03-01T21:40:11-05:00 Copyright 2004-2005 Ublog Reload 1.0.5 Mohammed malo@thealo.nojunk http://www.thealo.com/maloblog/blog_comment.asp?bi=293 2006-04-21T07:03:01-05:00 2006-04-21T07:03:01-05:00 2006-04-21T07:03:01-05:00
So, I will go back to my regimen.]]> Mohammed http://www.thealo.com/maloblog/blog_comment.asp?bi=291 2006-04-13T00:43:53-05:00 2006-04-13T00:43:53-05:00 2006-04-13T00:43:53-05:00
First of all, if you've never had shin splints they are awfully painful. On the medial (inside) of your leg from the ankle to your knee you feel excruciating pain on exertion.

There are many theories on shin splints. The word 'shin splints" is a catch-all phrase that denotes any anterior leg pain. There are three main causes of shin splints.

1. Medial Tibial Stress Syndrome (most common)
2. Tibial Stress Fractures
3. Overuse compartment syndromes

So, what causes this?

Medial tibial stress syndrome is commonly seen in athletes who suddenly increase their duration or intensity of training. This type of shin splints may also be seen in athletes who have very high demand training levels, such as marathon runners, even if their training levels are not dramatically increased.

I got these shin splints last week on Thursday. I played basketball Saturday, Monday, Tuesday, and Wednesday before I developed the shin splints. We played each night for a good 2-3 hours, and sometimes did not hydrate enough.

So, mine are probably an overuse problem. I have played this intensly before, but it just happened that I now got shin splints.

If you've had shin splints, they are extremely painful. I mean with every step, you feel like some one is taking a baseball bat to your shin and pounding away.

How do you normally treat these?
The first thing you need to do is stop running. Stop whatever you are doing that is causing this problem.

Ice down your shins and take plenty of anti-inflammatory medications. Some physicians also recommend massage and stretching your calf muscles.

That's all traditional medicine has to offer. Physical therapist have their own way of massaging muscles and I found a picture of a guy doing a massage, he kinda had the right idea, here is his idea:



He says you should grab the leg and pull on that muscle up and away to help stretch the fibrous sheath that surrounds it. He says that shin splints is caused by the swelling and bleeding in the anterior tibialis muslce and hence it gets too big for the sheath that surrounds it and become painful. This would be the anterior compartment syndrome cause of shin splints, which is usually pretty rare. A lot of people mistakenly seem to subscribe to this theory. Most people don't have that type of shin splints.

This is all good and well, but if you are an athlete that wants to get back to playing, waiting a week or two or taking a break is not good enough. So here is my technique:

Please do not consider this medical advice, it's probably bad advice and may harm you:

1. Start taking Naproxen and Asprin everyday. Take them at double the usual dose (prescription strength).
2. Ice your shins.
3. Use the Alo Shin Splints OMT technique daily (described below).

Alo's Shin Splint Osteopathic Manipulative Treatment (OMT):
1. Sit on a chair or the floor and bring one leg in to your body, bent at the knee. Grab your shin with both hands making contact with your palms to the painful area. Move the skin overlying the painful area away from your body. (as pictured) Maintain contact with as much of your hands as possible.


The anterior tibialis muscle is highlighted in red. Move the skin in the direction of the arrows and hold it in that position for 90 seconds. If your hands slip off just reposition them and keep doing it.

2. Go up and down your leg pushing the skin away.
3. Then pull the skin in toward your body and hold for 90 seconds.
4. Do the other leg.
This is called myofascial release, and damn does it feel good.

Next, you want to do the same thing, but this time go deeper pushing the muscle and tendons away. Go up and down your leg pushing away. Then pull the muscle and tendons towards yourself. Do both legs.
This is called soft tissue treatment. Basically, you push perpendicular to the muscle fibers (across them) to stretch them out.

Next, before you start playing again, stretch your calves out really well. Stretching your calves will shorten the tibialis anterior muscle and calm the fibers down.
This techniques is called counterstrain.

Before you play:
Warm up the tibialis anterior by sitting on a chair, making contact with the ground with your heal and tapping your toes rapidly, while your heal stays in contact with the ground. Kinda like rapid toe lifts, but heal stays on ground.

That's all folks!

I have done this and have been able to tolerate playing afterwards. The very next day, I skipped this and could barely move after the first two minutes of play. The next day, I did this treatment again... and walla! I could play without pain.

So, I think I have made my contribution to the world of medicine. Hopefully athletes all over the world will benefit from this and be able to play without having to take time off and rest.

I know that this still needs more testing, so I will have to try to find more people with shin splints to test this on. Hopefully, I can reproduce my findings and maybe publish something.]]> Mohammed malo@thealo.nojunk http://www.thealo.com/maloblog/blog_comment.asp?bi=263 2006-02-13T00:23:06-05:00 2006-02-13T00:23:06-05:00 2006-02-13T00:23:06-05:00
For the longest time, I have been talking about Dr. Kappler the team Doctor for the Bears in the 1980s when they won their superbowl. The Miami Dolphins football team also had a DO team doctor back in the day. But what about today?

Last year in the NBA Finals the Pistons were playing the Spurs, both team doctors were DOs.

The surgeon that kept re-attaching Kurt Schillngs tendon in the MLB playoffs against the NY Yankees... was a DO.

The physician that treated the speed skater Ono at the previous Winter Olympics after he fell and screwed up his ankle, and everyone thought he was done.... and ended up comingback and finishing and winning... he was a Do as well.

The physician that treated Kerri Strugg, the little olympic gymnast that screwed up her ankle, came back and stuck the last jump on one foot to win gold.... he was a DO too!

The Virginia Tech University uses a DO as team doc for a bunch of their sports.

And all over the country, a ton of team doctors are DOs. It just seems natural. We are good with our hands, we manipulate and treat injuries in a very hands on and unique way, we diagnose uniquely... hence, it just seems to fit us.

Also, the first professional sports medicine organization was started by osteopathic physicians.

I can't list all the team physicians that are team doctors, but I found an article in The DO magazine that does an amazing job of discussing the history of team doctors and where and how many DOs are team doctors. Very nice long article with great stories and details.

Here it is: PDF File
]]> Mohammed malo@thealo.nojunk http://www.thealo.com/maloblog/blog_comment.asp?bi=241 2005-12-29T23:51:36-05:00 2005-12-29T23:51:36-05:00 2005-12-29T23:51:36-05:00
Traditionally, most physicians and trainers will tell you to stretch out your injured groin or hamstring. This is absolutely wrong! You should never do this and it will prolong the healing process. I kinda figured this out on my own after a number of these injuries, but I never knew why. I noticed that if I didn't do anything, my injured groin/hammy healed much faster than all the stretching.

Fast forward to medical school.

Dr. Kappler is the chairman of our school's osteopathic medicine department (or was at the time). He was also the team doctor for the Chicago Bears in the 1980s when they won the Superbowl. He taught us that you never stretch out torn hammies and groins. He shared tons of stories of when he used to treat and work on the Bears star players, Michael Dean "Refrigerator" Perry and Walter "sweetness" Payton. Media reports and other teams would expect a player to be out for 5-6 weeks, and they were back on the field in 2 weeks.

He has worked on huge athletes and small ones (in terns of size) and has years and years of experience. He has published research articles, written chapters and books on OMT and treatment of injuries and other topics. He is a great teacher and an asset to our medical school.

A "pulled muscle" is a tear in the muscle fibers. You have different degrees of torn muscles, but usually they aren't the extremely severe type. When you tear muslce fibers, an inflammatory process ensues and you have to try and contain it, before more tissue damage occurs. Stretching a torn muscle only causes more tearing, more injury and more trauma. If you pulled your hamstring, then start stretching it, you are just adding insult to injury by tearing more muscle fibers.

He taught us that these type of injuries need to be treated by shortening the muscles, not over stretching them. So, if you pull your hamstring, you need to shorten it, by bringing the ankle towards the buttock on that side. Shorten the muscle. Same with the groin. Don't stretch it out and spread your legs and tear more fibers, just relax, bring your leg towards the center and give it a rest.

I never knew why, but not doing anything always seemed to allow me to heal faster. When I used to do the stretching routine and so on, it just didn't seem to heal as fast and added weeks to the process. Yes, my highschool football coaches and medical trainers were wrong. In fact, till this day many college programs still have it backwards. (In the NFL it seems that most programs have it figured out, except for the Minnesota Vikings, I guess)

My advice to anyone with a hammy/groin pull:
1. Shorten the muscle. Don't stretch it.
2. Take lots of anti-inflammatory drugs.
3. Ice for pain in first 24 hours.
4. Heat pads for relaxing the muscle (allows quicker healing)
5. Rest!]]> Mohammed malo@thealo.nojunk http://www.thealo.com/maloblog/blog_comment.asp?bi=254 2004-10-22T22:32:15-05:00 2004-10-22T22:32:15-05:00 2004-10-22T22:32:15-05:00
The rotator cuff is made up of four muscles. The teres minor, supraspinatus, infraspinatus, and subscapularis.


When someone injures their rotator cuff, its usually supraspinatus that is injured. It usually happens when falling on an outstretched arm or while lifting weights improperly. Usually during football or some other type of sports injury. It happened to me when I was carrying the football and got tackled, I landed on my elbows with the ball craddled in my arms. The other few times it happened landing on one arm falling sideways.

So what do you do?

Previous physicians I went to sent me to rehab. It was painful. They made me stretch and move and use my shoulder and it hurt like made. It took well over 6 months to heal.

The next time this happened to me, I refused to go to rehab, because I thought it took too much energy and effort, and I could just do those excercises at home. So, I didn't end up doing them and my shoulder healed within a month. I was amazed but didn't think much of it. Even though this injury was worse than the first one, it healed faster.

Finally, when I got to med school this all started making sense. Dr. Kappler, the 1985 Chicago Bears team doctor began talking about rotator cuff injuries and I was in awe. It made so much sense.

He explained to use how to figure out if it is a rotator cuff injury or not. You hold out your arms in front of you with your thumbs down.

The doctor pushes down on your wrist or hand and you can't keep your arm up, or it is painful. That is the best test for a rotator cuff.

Dr. Kappler began to explainthat sending people to physical therapy made this injury worse and prolonged the healing process.

"Ah, ha!" I shouted to myself! "I knew it!"

This had confirmed my suspicions. There is no need to send people to physical therapy. Physical therapy usually caused more pain, stressed the muscles and tendons and just made things worse. Obviously, if you are elderly, the fear of frozen shoulder may change your management, but with young athletes, just let the darn thing heal.

So what did I do?
I took anti-inflammatory medications (Aleve or Ibuprofen) for a while. That calmed everything down in there, and then I just let it heal.

Eventually everything came back to life and worked perfectly. After that really bad one that lasted 6 months, I thought I may need surgery, because it was not healing. Thank God I did not go that route.]]>