Shin-splint diagnosis should be retired
DEAR DR. DONOHUE: My 15-year-old son returned from three weeks at a basketball camp with a sore leg. He says they told him it was shin splints and that all that was needed is rest. I would like to hear from a more official source about shin splints. What are they, and how are they treated? — R.W.
ANSWER: “Shin splints” is a term that ought to be permanently retired. It has little meaning. People use it to describe any shin pain. The shin is the front of the tibia, the lower leg bone, which you can easily feel. It runs from the ankle to the knee.
One cause of shin pain is stress fractures. These are hairline breaks in the bone. They come from too much use with too little rest, and they happen to just about any bone. Every time a bone is in action, parts of it break down. When given enough rest, the bone restores the broken-down parts. Without rest, cracks appear in the bone — stress fractures. The involved area hurts within a few minutes of use, and the pain lets up with about 10 minutes of rest. The pain of a stress fracture or fractures is localized to a relatively small area of bone. Pressure on that spot of bone with one or two fingers elicits pain. In the early days of stress fractures, X-rays are normal, but the fractures can be spotted in a week or two after their occurrence. Bone scans demonstrate them early on. However, scans are expensive and rarely needed. Rest is the cure. It can take four to six weeks for the bone to heal.
A second major cause of shin pain is medial tibial stress syndrome. It, too, comes from overuse. It’s an inflammation of the bone covering, the periosteum. The inflammation results from traction on the covering by leg muscles. Medial tibial stress syndrome produces an area of pain larger than the area involved in stress fractures. Rest is also the treatment for this syndrome. It heals somewhat faster than stress fractures do.
If your son is in pain and needs to take something for it, Tylenol would be a good choice.
By the time you read this answer, your son’s leg problem should be resolved. If it hasn’t, he needs to see the family doctor. Lots of conditions cause shi3.n pain.
DEAR DR. DONOHUE: I am a 71-year-old man, very active and of Japanese descent. I weigh 160 pounds and exercise regularly. I go to the gym at least three times a week, and I am an active skier.
I am concerned that I am exceeding the maximum heart rate for my age and would like to know if I am endangering my health. My resting heart rate is 80. When jogging, I can get my heart rate to 150 and keep it there for 20 minutes. Please advise if I am unduly concerned. — J.H.
ANSWER: You’re following the rule that says a person’s maximum heart rate is 220 minus the person’s age. For you, that is 149 beats a minute. The rule’s second instruction is to exercise at a heart rate that ranges from 60 percent to 85 percent of the maximum heart rate. That sets the upper limit for your heart rate at 127. This rule is not infallible. The only way to answer your question with certainty is through a stress test, the test where a person runs on a treadmill at ever-increasing speeds while an EKG continuously monitors the heart.
Other ways of arriving at an answer are less expensive. If you’re not having chest pain or undue breathlessness when you run, then the implication is that the exercise is safe.
I can’t give you 100 percent assurance. Only your doctor can.
DEAR DR. DONOHUE: I got the shock of my life when I saw two long black patches on the backs of my heels. They don’t hurt. I play tennis daily. What is it? — L.B.
ANSWER: I bet that it’s talon noir, French for “black heel.” It comes from broken blood vessels in the heel surface. The blood cells leave a residue of pigment that turns the skin dark. It gets better on its own.
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.