Welcome to the spring edition of Healthy Sports, the newsletter that we send out four times a year to try and keep you updated on current trends, thoughts, programs, and other cool stuff in the world of sports medicine and fitness.

Athletes of the Month

We get many entries each month for the athlete of the month. We love all of the pictures and stories. In fact, all of the photos that you send us end up in the digital frame in our office. We see you all every day. Please keep ‘em coming!  We’d love for you to send one or two of your favorite photos to Meghan in our office. I don’t care what the sport or your age, just send us your pictures and we’ll put ‘em up! Race photos, sports photos, whatever you want is fine with me.

As for the athletes of the month, we’re still looking for your stories. I don’t care if you are first place or last place, as long as you are trying!  Send us your story with a photo and you too can be the athlete of the month. Please send your photo and entry to Meghan in my office.

Brian Knott

Eighteen-year-old Brian Knott is a senior at Horace Mann School in Riverdale. A lifelong gymnast, Brian has used his brain and his body to land one of the most coveted awards in college gymnastics- a scholarship to Stanford University. Having pushed through a number of gymnastics injuries, Brian has always worked hard in all aspects of his sports and academic career. The result- he is headed to California. Great work, Brian! If you want to see Brian in action, have a look at this clip from the 2010 Junior Olympic Trials.

Lauren Howe

A ninth grader at LaGuardia High School, Lauren is just what we hope for in our scholastic athletes. In addition to her terrific academic and sports performance, Lauren has developed an interest in Autism. In addition to playing high-level and travel volleyball, she is a mentor in the Best Buddies program where she partners with an autistic teen and offers support and guidance each week. This is a great program, Lauren. Way to go- you are a star!

Douglas Brierley

Our third Athlete of the Month is Douglas Brierley, an 11-year-old ballet dancer at the School of American Ballet. Douglas started dancing at SAB when he was eight and has already appeared in more than 100 shows at Lincoln Center. He has shown remarkable dedication in overcoming injury and he’s on track for a serious career in dance. Great job, Douglas! Keep dancing!

Med Tent: Shin Splints

I’m excited to announce that I’ve started a new series called Med Tent with Triathlete Magazine to complement the written column that I’ve been doing for the past four years. These are two-minute videos that cover topics of interest for runners and triathletes. Of the many injuries we see in the office around this time of year, one of the most common injuries in patients of all ages is shin splints.  Click here for a link to the video on shin splints and the column is included at the end of this newsletter. I hope you enjoy it!

If you’d like to see more, you can find these in the Triathlon section on the Competitor Group website under Training, or on my website, www.DrJordanMetzl.com, under Educational Videos.

Baseball Injuries: Little League Elbow (Thrower’s Elbow)

If you, someone at home, or a friend on your team is having elbow pain while throwing a baseball this spring, please read this article and watch the video. Unfortunately, we see many kids this time of year with elbow injuries from throwing too many pitches. As you see from the video and text, the key to preventing throwing injuries in kids is often recognizing that pain in the elbow, especially under the age of 15, is worrisome. I hope you find this information helpful as a way to prevent kids’ throwing injuries.  As an additional resource, physical examination videos of the elbow and other joints can be found on my website.

Wrap Up: Multisport World NYC 2011

Thank you all so much for showing up en masse for Multisport World NYC 2011 on March 12th at Columbia University. We had more than 1,600 people attend this amazing one-day seminar that covered all aspects of triathlon and general fitness including nutrition, preventive conditioning, and performance optimization. All in all, the day was a complete blast and I’m so appreciative for your enthusiasm and for making the day so much fun. The expo was killer, as were the indoor bike time trial and swim sessions.

In the next newsletter, I’ll attach some of the links to specific lectures from the program as they are currently being edited. In the meantime, I’ll plan on seeing you next year!

Can Exercise Really Keep You Young?

Well, I sure think so! If you’re out there slogging it out, day after day, month after month, you have science on your side. Keep moving and use this information from the New York Times to keep you motivated.

Lacrosse Helmets for Girls: Is it Time?

Ok, I admit to a bias on this subject. Having just finished a research project on the incidence of head and face injuries in female lacrosse, I am now a firm proponent of putting girls in a lightweight helmet for lacrosse. I know there are some coaches out there who are against this, but, my vote is for helmets. Have a look at this article and see what you think.


I’m proud to be a part of a great new initiative from ESPN called espnW. The W is for women; this is a new platform at ESPN that caters specifically to the female athlete and fan of women’s sports. The site is terrific and will have all sorts of cool things to learn about. Check it out for yourself: www.ESPNW.com

Recipe of the Month: Shrimp and Mango Tacos

This recipe just sounded too good to pass up! If anyone wants to try this, I’m here all week to taste test! Healthy and delicious! Enjoy!

Shin Splints Article

This is the print article that goes along with the video link above. Enjoy!

Shin Splints: What Are They?

Allison is a 27 year old scientist and runner who comes to the office complaining of shin pain. “Doc, my shins hurt when I run”, she says. When asked, she describes a tightening pain in the soft, outside, muscular part of the shin. “Do your shins hurt more during exercise?” I ask. “Yes, once I get past 10 minutes or so, I get this tightening feeling in my shins. It has become so bad that I can’t run anymore. The weird thing is that twenty minutes after I stop running, the pain goes away, but it comes back the next time I try to run.”

Jennifer, a 25 year old physician’s assistant student and triathlete, comes in also complaining of shin pain. “Doc, my shins hurt when I run”, she says. “I’ve been building my running mileage, and over the past few weeks, my shins have been aching like crazy.” When asked, she describes a pain on the bony part of the shin, the tibia, which not only hurts during exercise, but hurts when she pushes on her shin. “Ouch, that’s the spot”, she says, when I push on the inside of her tibia, the bigger bone in the lower leg (the smaller is the fibula).

So what do these two stories tell us about shin pain? Although both are characterized as ‘shin splints,’ pain in the shin from running, the pathophysiology, meaning the biological cause of the pain, is quite different with these two stories.

Allison, the first patient, is describing muscular shin pain known as exertional compartment syndrome (ECS). ECS can occur in the front, the side, or the back of the lower leg, and is characterized by a tightening in the shin that worsens during exercise. Eighty percent of ECS cases happen in the front (anterior) part of the shin, as is the case with Allison.  When the leg is pushed, there is no specific location of pain; the leg is pain free except during activity.

The treatment of ECS is initially manual therapy, using a physical therapist or certified athletic trainer to manually loosen the wrapping around the muscle, as well as instituting a good stretching program. Orthotics (arch supports) and motion control running shoes can be used to correct any existing mechanical problems in the feet. In some cases, despite these measures, the pain with exertion simply doesn’t go away. With these patients, the sports medicine doctor will perform an exertional compartment test, a test using a needle to measure the pressure inside the leg before and after exercise, looking for a large pressure buildup which confirms the diagnosis. When the pressure difference is high, and when the other treatments don’t work, a surgical procedure called a fasciotomy is performed to open the wrapping of the muscle and give it room to expand. Patients can generally return to running within two months of this operation.

Jennifer, the second patient, is describing bone-related shin pain. Bone-related shin pain is a spectrum- from a stress injury, irritation of the bone, to a stress fracture, an actual crack inside the bone. Bone pain in the shin is different than muscular pain in that it hurts during, and especially after, exercise, and the tibia actually hurts when it is pushed. Bone-related shin pain is more common than muscular shin pain, and generally is the result of three variables: body mechanics, amount of activity, and bone density. Body mechanics, how someone is built, is the biggest set of variables. This includes foot type, often corrected with orthotics or shoe type which limits pronation, as well as running style, which can be influenced by hip and core muscle strength.  Amount of activity is problematic in the athlete who advances mileage too quickly.  A helpful rule here is the 10% rule, no more than a 10 percent increase in mileage per week, but it is important to remember that everyone is different and no rule is the same for everyone when it comes to running mileage. Lastly, bone density is very important. It’s key to realize that softer bones break easier, so if there is a stress fracture that can’t be explained by poor mechanics or rapidly increased training volume alone, bone density might be the problem. Low bone density is called Osteopenia, and very low bone density is called Osteoporosis. The causes of low bone density include genetics (it tends to run in families), poor dietary calcium intake (more than 1500 mg/day is the recommended daily amount, 3-4 glasses of milk or equivalent sources), and a history of menstrual disorders, meaning not getting a period for more than six months in a row, which causes low levels of circulating estrogen.

Once a diagnosis of bone-related shin pain is made, the key is to figure out the level of severity of the injury, meaning a stress injury or a stress fracture. An MRI is often used to make this diagnosis since stress fractures don’t show up on x-rays unless they are very severe or healing. However, catching these early, especially in the stress injury phase, is optimal. An MRI can help with that.

Once the diagnosis is made, fixing the problem, and preventing the next one, is key. This might meaning correcting foot mechanics with a pair of orthotics, fixing the training schedule, or getting a bone density test called a DEXA, which look for low bone density as a cause of the injury.

So you see, shin splints are more complicated than they might appear at first glance. Figuring out the correct diagnosis, and then instituting the best treatment, can make all the difference. It sure did with Allison and Jennifer, both of whom are running faster than me these days.

Ok, that’s it for this spring newsletter. I hope you enjoyed it! I’ll see you out on the roads this spring and summer and wish you all the very best of luck in your sports endeavors.

If you’ve been fowarded this newsletter and want to sign up for yourself, just subscribe on our website at www.DrJordanMetzl.com and you’ll get the next one in July!

With best wishes,

DR. Jordan Metzl


This post was written by: DGG

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