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Shin Splints. 

What Are They. 

Shin splints is a common term used for a half a dozen lower leg problems ranging from nerve irritations to tendonitis to stress fractures.  The most common type that is experienced involves the tearing away of the muscle tissue that attaches to the front of the lower leg.  The beginner runner and the runner that resumes training after a long lay off are most susceptible to this injury.  The connective sheath attached to the muscles and bone of the lower leg becomes irritated, resulting in a sharp pain in the lower leg along the inside of the tibia or shin bone.  Shin splints can be felt anywhere from just below the knee down to the ankle.  The pain may diminish after warming up but then returns a few minutes after the completion of a workout. 

How Are They Caused.  

There can be several causes for shin splints.  Only when possible causes are identified can shin splints be eliminated. Possible causes include:

 ·        Tight Achilles and calf muscles.

 ·        An inexperienced runner just beginning to run.

 ·        Running on uneven terrain.

 ·        A sudden increase in faster running (speed work).

 ·        A sudden change from soft to hard running surfaces.

 ·        Running in the wrong shoes, or worn down shoes.

 ·        Excessive uphill running.

 ·        Poor running mechanics which include excessive forward lean, excessive weight on the ball of the foot, running with toes pointed outward, landing too far back on the heels causing the foot to flap down, and overpronation.  There is a drill that I do with my runners called silent running.  I have them run as quiet as possible.  With the feet landing properly very little noise should be heard.  Of all of the possible causes, pronation is the most likely to be overlooked.

Pronation  

It’s not what the foot does when it lands that causes difficulties; it’s what the foot does after it lands that causes problems.  Excessive overpronation is a major cause for shin splints.  Pronation is the motion of the foot once it lands.  For most people the outside of the heel touches first and then the foot rolls inward.  The amount of inward rotation should be between 4-6 %.  Too flat of a foot or too high of an arch can bring on a number of leg and knee injuries.  Once the foot lands it flattens out, and the ankle rolls inward or pronates.  The tibia (shinbone) is forced to twist slightly in the opposite or outside direction, stretching on the calf muscles.  Too much twisting can lead to a stress fracture of the tibia.  In other words, too flat of a foot results in the foot rolling inward too much transferring much of the pounding into the inner portion of the lower leg resulting in shin splints.  Research shows that females are more likely to suffer from shin splints than males because their hips, on the average, are wider than men’s.  Because of the wider hips, a women’s foot strike the ground at a greater angle resulting in overpronation.  As stated, 4-6 % pronation is ok.  More or less than this will lead to problems.  The flatter the arch the more support is needed.  If the heel tilts inward during running or if shoes appear distorted after you take them off with the heels tilted inward, moderate pronation occurs.  If the heel counters are broken down toward the inside, severe overpronation occurs.

 Overpronation and underpronation of the heels.

 Underpronation is the action of the foot, once it lands, hardly rolls inward.  This person usually has a very high arch.  Again too high of an arch or too flat of a foot can lead to numerous problems such as shin, knee, hip and foot injuries.  To check your arches, give yourself the wet test (see photo on next page).  When you step dripping from the shower, stand normally, then step away and check your footprints.  If you leave an impression of your whole foot, arch and all, you have flat feet.  If what shows up is mostly ball and heel, your arches are high.  If your footprint shows something in between the two extremes, with a moderate amount of arch, you’re blessed with a normal foot that shouldn’t cause you any problems.

                                                                 Wet Test  

Treatment  

In many cases one is able to continue training with a mild case of shin splints.  Time off from running may be required in severe cases.  In such cases rest and ice would be needed to decrease inflammation.  For the milder, yet painful cases, in which running can be maintained, certain treatment methods must be followed through.  Anti-inflammatory medications can be taken one hour before starting practice. (use as directed and note this not a prevention or cure, just pain relief). Just before practice the affected area should be heated up.  The use of hot towels, heat pack or whirlpool for 15-20 minutes should do the trick.  This will help loosen up the area as well as providing comfort but will not solve the problem.  Discovering the cause is the first step in treating an injury.  The changing of shoe may be necessary as well.  Stretching prior to running will be beneficial.  Training on soft surfaces will help alleviate excessive pounding.  Precaution should be made to running on uneven surfaces which could result in increased foot motion, a matter you are trying to correct.  Once the workout is completed, and after a good cool down, ice the affected area as soon as possible for 20 minutes.  Plastic cups filled with water and placed in the freezer as well as baggies of ice work well.  Normally, continued running, even if it is reduced, will help get rid of shin splints as running will help strengthen leg muscles.  A friction massage using the thumbs may prove to be beneficial.  Firmly rub the affected area from the bottom of the leg upward. 

Treatment in summary: 

·        Anti-inflammatory medications. 

·        Heat treatments prior to practice.

·        Proper shoes.

·        Stretching.

·        Running on soft even surfaces.

·        Ice treatments after practice.  

Prevention  

The best way to deal with shin splints is to do what it takes to prevent them in the first place.  There are several preventative measures that should be practiced by every runner.  Purchasing the proper shoe for your foot is the first step in preventing shin splints.  Knowing whether you are an overpronator or underpronator is very important.  The wet test will determine this. Go to a good running store like Stride Ahead or the running Room to get fitted, be prepared to pay $100+ for a good pair of shoes, it is worth it and your legs and joints will thankyou. Also a thing to remember is that shoes do wear out, replace them periodically when they lose their cushioning and wear out. A good tip is also to take the old shoes to the store with you when you buy a new pair, the wear patterns on the base of the shoe can tell a lot about how you run. 

Orthotics.

Depending on the amount of pronation a runner may have will determine whether or not they would benefit from orthotics.  Sometimes just a good pair of inserts found at a drug store to fit in the shoes, or a pair of anti-pronators in which you could receive through a podiatrist may do the trick, and are much more inexpensive than orthotics.  In any case though a good arch support will be needed. 

Warming up and cooling down. 

As mentioned earlier a good warm up is important to help prevent injuries.  Jog easy for a few minutes to increase the heart rate and blood flow to the muscles, spend a couple of minutes stretching.  When you start to run increase you pace slowly during the 1st mile, when doing an interval workout, jogging between repetitions will help eliminate the tightening up of the leg muscles.Cooling down is the opposite of warming up, the purpose of it is to bring the heart rate down and return the body back to it’s pre workout state, jog lightly until your breathing returns to normal and run through some active stretching drills, high knees, heel flicks etc and then move into static stretches we use in the running clinic. Strengthening exercises should also be used to condition the legs for running, simple exercises like squats, lunges, calf raises can be employed. 

Prevention in summary: 

·        Proper Shoes

·        Warming up and cooling down.

·        Stretching

·        Strengthening exercises

·        Proper running mechanics