Shingles: Episode 50

  • In this episode: Shingles, not the most typical physical therapy topic but somehow it keeps showing up at the clinic. (00:20)

  • Chip Review: Doritos – Nacho Cheese (09:10)

  • Trivia question of the week: If you head south from Detroit which foreign country do you hit first?

  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.

  • Thanks for listening!!

 

*** At certain points the sound quality of this episode is below our standard (Djimmer had to call in and the internet connection was poor).

Shingles, Herpes-Zoster, Varicella-Zoster Virus. This is the reactivation of chicken pox. Now a day everyone gets vaccinated for chickenpox but when Djimmer and Christiaan were kids the vaccine had not yet been developed. The version of “vaccination” that we received was to be placed in a room with a child who had chickenpox so that we would get it. Since shingles is the reactivation of chickenpox hopefully its presents will continue to decline as chickenpox becomes a thing of the past.
I’m sure you are asking why a couple of physical therapists are discussion shingles. Well, prior to the hallmark rash forming there can be 2-3 days of burning along a dermatome. Dermatomal pain may be present in the cervical, thoracic and lumbar spine. In these cases it may feel a lot like sciatica, cervicalgia, a muscle pull any other radicular pain. Some one who has experienced this before may set up an appointment for physical therapy and when they come in the rash is now presents.
When shingles is seen in a patient it is something that needs to be treated medially. This will include an anti-viral medication as well as potentially some pain medication. Once the rash clears if the patient continues to experience thoracic, lumbar or cervical pain now physical therapy can be initiated and a clear picture of what is causing those symptoms can be found.
Increased age and compromised immune system are common factors in developing shingles. Interestingly enough, and this may contribute to why we are seeing shingles more often, is that prolonged corticosteroid use has also be associated with increase prevalence of shingles.

Other episodes you might be interested in:

 

Pain: Episode 29

Pain: Episode 29

Radicular Pain: Episode 22

 

Morton’s Neuroma: Episode 49

  • In this episode: Morton’s Neuroma. Pain in the forefoot and between the toes, sometimes numbness and/0r tingling. Usually related to tight footwear. (01:06)

  • Chip Review: Pop Chips Potato – Crazy Hot, Thank you to Skylar and his Mom (12:45)

  • Trivia question of the week: What names were given to the three tunnels in the movie The Great Escape? (11:10)

  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.

  • Thanks for listening!!

Morton’s neuroma symptoms, typically pain in the foot, worse with shoe wear or boot wear or stake wear, any kind of compression of the foot. It is most common in middle age. More common in women, but that could just be footwear related. Most commonly seen a the 3rd digital nerve. However, any of the digital nerves are possible. More or less the middle of the foot.
A neuroma is typically caused by an enlargement of the nerve ending, almost like a benign tumor of the nerve ending. This enlargement then causes compression, which results in pain, numbness, and/or tingling. Historically surgery, minimally invasive, to remove the growth was an early treatment option.
Much more recently physical therapy treatment and other non-surgical options have been found to be as if not more effective. Intrinsic foot strengthening, getting the muscle of the foot stronger as well as doing a shoe assessment and looking at the daily activities that are causing pressure on the forefoot are the places to start working to correct.
Generally speaking unloading the forefoot will help. Djimmer has been using a very simple taping technique where you pinch the bottom of the foot together. This causes the top of the foot to open up and reduce the pressure on the neuroma. 99/100 times this will relieve the neuroma. This is a temporary solution but it allows for patients to be comfortable and then work on strengthening, balance and the other aspects of treatment.
If taping is helpful often times an off the rack orthotic will be appropriate. You don’t always need a $3-400 orthotic custom made for it to be affective. This is something you can cut to length and move from one shoe to the other.
Shoes and getting shoes that fit properly is one of the easiest and quickest ways to help yourself. Reducing pressure on the forefoot is going to be the primary cause of a Morton’s neuroma so reducing that pressure is part of the long term solution.

Other episodes you might find useful:

 

Stress Fractures: Episode 43

Foot & Ankle Health with Dr. Mohammad Rimawi: Episode 40

Plantar Fasciitis: Episode 11

Ankle Sprain_Inversion Type: Episode 3

 

Shin Splint: Episode 17

    • Shin Splint also known as tibial stress reaction comes in two types, muscle; which will affect the tibialis anterior or tibialis posterior and bone; which is the pre-cursor to a stress fracture
    • This week we are reviewing 3 different chips from Ireland. The Irish trio consists of O’Donnells of Tipperary Irish Cider Vinegar and Sea Salt, KP Mega Meanies Pickled Onion and Tayto Smokey Bacon. Hand delivered by Mr. and Mrs. Schneider
    • Trivia question of the week: What is special about the 37th parallel in the USA?
    • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional information related to Shin Splints throughout the week.
    • Thanks for listening!!

Three bags of chips! This is going to be a crazy episode. This is very highly specialized episode. We can’t thank Matt and his wife enough for bringing in three specific flavors. Schlepping them all the way back from Ireland. They are all in surprisingly good shape considering the state of transported chips we’ve had in the past. I’m thinking these have been in the carry on. Yeah definitely.

Today we are going to be covering shin splints, also known as tibial stress reaction and we are are going to be cover, what we are calling the Irish trio. Which is the Tayto Smokey Bacon, KP Mega Meanies, which is pickled onion flavored, and the O’Donnells of Tipperary Irish Cider Vinager and Sea Salt. Yeah, the Taytos are also known as breige pratai blaistithe, which is gaelic I am assuming for smoky bacon. That would be my guess. Maybe they are just messing with us.

Tibial stress reaction, is the more formal name for shin splint. So we kinda see a little bit of two sorta shin splints. One will be the muscle, which is tibialis anterior, which is the muscle that sits right along the front of your shin. That can get irritated, strained or bothered just like any other muscle in your body. When that is the case treatment is a little quicker then if you have a true tibial stress reaction. Which is basically the precursor to a stress fracture.

This is a very common problem with runners. It’s a very common problem with sprinters. This is something that is usually an overload or an overuse problem or a mechanical weakness is involved.

I remember a case about two years ago when Newton’s came out. Which was a running shoe in Boulder. That was more like six years ago. Yes, like I said two years ago, because I’m not that old. This was a forefoot running shoe, everybody had to go away from heal striking. So we all went to forefoot running, forefoot toe running, toe landing. The Newton shoe came out and before you knew it half of Rocky Mountain Tri Club (RMTC) came in with shin splints. So a lot of times if you have shin splints there is a mechanical component that needs to be addressed. Just fixing the inflammation, is usually not enough. We have to do a mechanical assessment a running assessment and what have you. To figure out why is my shin all of a sudden getting irritated, why is my muscle being overused so much.

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