Monday, September 19, 2016

Shin Splints No More

Whether you're new to running or training for a marathon, runners can fall victim to ouchy shins. This pain down the inner or medial portion of the lower leg along the shin is commonly referred to as shin splints. Often a runner experiencing shin splints will first notice the pain after the run. Overtime, the pain will surface during the run.

The correct term for what you're experiencing is medial tibial stress syndrome

The cause of medial tibial stress syndrome is often debated, but most agree that it's caused by overuse. 

Experienced runners think of shin splints as a new runner's problem. So, they're often baffled when they experience the symptoms themselves. A seasoned runner can experience shin splints with a sudden increase in training frequency or intensity. Ahhh....sound familiar? That's why seasoned runners often experience shin pain during the early stages of race training or even later in marathon training if the runner starts to up the intensity or push too hard. 

Other causes can be lack of calcium, running on hard surfaces, running hills, ill fitted running shoes, or severe overpronation and heel striking. 

A runner who has a heel-strike foot landing, lands with the foot out front. When the foot lands in front of the body on the heel, the toes lift up. The muscles down the front of the leg are the muscles used in lifting the toes. So, new runners who heel strike usually experience this pain, because all of the sudden they are using these muscles a lot and as a result they're "talking back" to the runner.

Actually if you just sit in a chair, lift your foot off the ground, then continuously flex the foot at the ankle lifting the toes up and down for 30 minutes (about the length of a short run), the muscles along the front of the lower leg will more than likely become sore, if those muscles are not used to being used. Over time the runner will acclimate as those muscles get stronger. However, another way to alleviate the issue is for the runner to work more toward a midfoot foot landing where the foot lands flat underneath the runner's center of mass. This takes out the heel strike and toe lift altogether. It also helps the runner to run more efficiently since they are working with the oncoming ground pushing off instead of having to work against the ground when the heel strikes then having to pull the body forward before pushing off.

Experienced runners often experience shin splints when they ramp up training and widen their stride to increase pace. The wider stride causes more toe lift taxing the muscles down the front of the leg. So again, the muscles will acclimate over time, but reigning in the stride and working on increasing turnover and adding lean from the ankle will help them get that needed speed without taxing the shins.

Sometimes the pain, soreness, or swelling is felt on the outside or lateral side of the shin. This is called lateral tibial stress syndrome. 

So what do you do if you have shin splints? Recognize the symptoms and act promptly. If you notice soreness on either side of the shin after a run, ice and elevate the leg. Ice is great for reducing inflammation. I always tell my runners to keep a bag of frozen peas in the freezer. It makes a great ice pack. Just place the ice on for 5-minutes on 5-minutes off for about 20-30 minutes. Icing throughout the day may help as well. Anti-inflammatory painkillers may add additional relief. If it's still sore the next day, take a break from running. Swim, cycle, or do other low-impact exercise for a few days.

Evaluating your running shoes is a good idea too. Is it time for a new pair? Do you have 300-500 miles on your shoes? If so, it might be time for a new pair. Were you properly fitted and have the correct type of shoe for your feet? If you're not sure, go to your local running store and ask them to evaluate your feet and help you get the best shoe for your foot type. If you're a severe overpronator, custom orthodics may help with shin splint symptoms. Analyzing your stride can also be useful. Are you overstriding and heel-striking? If so, work on pulling-in that foot landing. Strive more for a mid-foot or fore-foot landing under your center of mass. This helps the body work with the oncoming pavement. It also helps the body work more like a shock absorber.

Some "pre-hab" exercises can help strengthen the ankles and lower leg which may help keep runners from experiencing shin splints. Check out the video below for some simple but effective ankle and lower leg exercises. If you're currently experiencing shin splints, wait until the soreness/pain has subsided for a couple of days before doing any exercises.

As with any pain/soreness that persists after a couple of days, check in with your medical professional immediately. If you're not able to put pressure on your lower leg, definitely head to the urgent care. Persisting pain along the inner shin could be a sign of an actual stress fracture in the bone. 

If lateral pain persists, it could possibly be compartment syndrome which can be pretty serious. This is more related to poor circulation in the affected area because of increased pressure in the area. 

If you're having to alter your stride to compensate for pain, then you need to check in with your sports doc immediately. Compensating for one pain can often cause other problems in other areas of your body.

Another tool that I've discovered that's useful in strengthening the muscles running along the shin is The SHINTEKK. This device uses a series of different strength resistance bands to help strengthen the anterior lower leg muscles.  The device basically does the same thing as the exercises I demonstrate in my video above, it just make doing them easier and handier. The device doesn't allow for much lateral strengthening of the lower leg muscles and ankle, but it's awesome for easily and quickly strengthening the anterior tibialis muscles in the lower leg.

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