Recently, I have been seeing lots of blog articles about shin splints, which I believe have been rather generic in nature. I would like to submit my thoughts about the subject, which are a little more unique in nature.
“Shin splints” is a common problem, affecting athletes of all ages. The pain in the shins can be gradual in intensity and debilitating in nature. It can be an injury that gets worse and could lead to a stress fracture.
“Shin splints” is really a “catch-all” terms that refers to pain on the inside of the shin bone (tibia). It really seems to be caused by tension of three muscles on the fascia of the bone. This friction between the muscles and the fascia causes an inflammatory state (fasciitis), which can occur during walking or running. If this inflammation continues, the bone could get involved, and you can get periositis (inflammation of the covering of the bone) and then potentially a stress reaction/fracture of the bone itself.
Like any overuse injury, the adage, “Doing too much, too soon”, certainly applies to “shin splints”. The body that is unaccustomed to increased stress will breakdown. It is usually seen in overweight individuals who are beginning to run as exercise, especially on hard surfaces, i.e., sidewalks. The pain appears when starting out for a run and gradually disappears, only to reappear after the run is complete. The pain can usually be replicated by hopping on the affected side.
Individuals prone to this injury may have either a “flat foot” or “high arch foot”. A “flat foot” already has increased tension of two of the muscles involved in “shin splints”, in addition to increased internal (turning in) rotation of the legs. Running or walking places increased force on the feet, exacerbating the “flat foot” position, i.e., increasing the muscular tension and internal leg rotation. A “high arch foot” places tension on the other muscle involved in “shin splints”, in addition to the commonly restricted ankle joint motion. This type of foot is rigid and running/walking activity creates more forces, leading to more pressure on the foot and more muscular tension.
Treatment and prevention of this injury involves a multifaceted approach. The key is that the inflammation must be reduced and controlled. One way to do this is the usual ice, rest, compression and elevation; the other way is by reducing the tension of the affected muscles causing the inflammation. I usually do both of these and tailor the treatment plan according to the individual. To reduce the muscular tension, an insole or even an orthotic can be used to allow the affected muscles to “rest” for up to six to eight weeks. Activity modification is also emphasized, i.e., limited exercise-related weightbearing activity.
Individuals with “flat feet” can benefit from hip strengthening exercises, specifically hip abductor strengthening (http://runninginjuryclinic.com/resources/exercise-videos/), short foot protocol (http://vimeo.com/43187129) and intrinsic foot exercises (http://www.youtube.com/watch?v=2OOJ9AQ1AEg). Individuals with “high arch feet” benefit from hip strengthening exercises, specifically hip adductor strengthening and calf muscle stretching. These exercises work to reduce tension on the affected muscles, by mobilizing and utilizing other ones. Once inflammation control is achieved, a slow gradual return to activity from low stress, i.e., short job to high stress, i.e., hopping, jumping.
Of course, prevention is the key for “shin splints”. It is important for beginner runners to follow a structured workout plan, conceived by a knowledgeable running coach. Running on softer surfaces is also recommended, in addition to flatter surfaces.
As always, if you have any questions, please contact me.
Health and happiness!
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