(Disclaimer: I’m not a doctor or any sort of medical professional. Don’t take any of the following as medical advice. It is my perspective based on my experiences, experiences of others that are on the forums, and internet research I’ve done. You never know – at some point in the future I may be writing something saying I was completely wrong.)
This topic seems to never get old. The Shin Splints blog posting I wrote 12 months ago, other than the blog’s home page, is by far the most accessed page on this site. Recently there seems to be an even greater uptick in interest. I presume because it’s Spring, and folks who haven’t been doing much over the cold months are getting back outside, this common problem is seeing a resurgence.
If you’ve been here before you know that my running world has changed dramatically in the last 12 months. As those changes (philosophy and experiences with running form, the positive way I’ve seen the feet respond by asking them to “step up”, etc.) have occurred my thoughts about how to deal with Shin Splints has evolved.
Before you start trying to make your shins feel better it’s critical you be sure you’re not dealing with a different problem. The big one in this category is a stress fracture. A stress fracture can create some really nasty problems if left untreated too long. From what I understand there are three things that tend to point more to a stress fracture. Stress fractures can be present with all or none of these.
- Pain is in one leg. With Shin Splints the pain is often in both legs.
- Pain is localized on bone. Stress fracture sufferers will sometimes say they can push on a very specific spot on the bone and feel significant pain. Shin Splint sufferers tend to describe the pain as being over an area of the shin, and tends to be in soft tissue.
- Pain increases with activity.
If those symptoms cause you to think you have a stress fracture step away from the computer and call your doctor. Now. Be aware a bone scan or MRI is the way to determine if a stress fracture exists. I’ve read a number of stories where a doctor cleared someone of a stress fracture with an x-ray. X-rays cannot see many stress fractures.
OK, you think you’re dealing with Shin Splints. A quick word on the term. In my opinion there doesn’t seem to be definitive understanding on what exactly occurs and causes the pain. You may have heard the term Anterior Shin Splints and Posterior Shin Splints. Anterior Shin Splints are an issue with the muscles on the front of the shin. Posterior Shin Splints cause pain on the inside (medial side) of the shin. For a while the thought was there was a problem with the Posterior Tibialis muscle which is located in this area, however new thinking is that it’s actually a problem with some other calf muscles that run close by. My point is this: There are lots of theories on exactly what and why is happening but there doesn’t seem to be scientific data on the topic – at least none that I’ve found.
There does seem to be consensus that Shin Splints (whether Anterior or Posterior) is rooted in some sort of imbalance between the calf muscles (plantar flexors) and the muscles on the front of the shins (dorsiflexors). There also seems to be consensus that it is an overuse injury that involves inflammation that contributes to the pain.
In my opinion there are two basic approaches to addressing Shin Splint issues. The mainstream way has the things you’d expect: Resting. Icing. Stretching. Etc. The second approach involves modifying how you run. Since I assume most reading this are interested in the mainstream approach I’ll start there.
Very broadly, the RICE protocol applies to getting over Shin Splint pain. I think, however, a few things can be added to that which help as well. Shoes, massage, strengthening and stretching can play a big role. Maybe it should be RICEMSSS.
- Rest. Many interpret this as “Stop running.” I don’t think, necessarily, this is a requirement. If you cut back on your mileage you are resting to a certain degree. That amount of rest may be sufficient. I would start by cutting back some, do the other recommendations described below, and see how things go. If you don’t see improvement, cut back some more.
- Ice. When I had Shin Splints I iced my shins a lot. Be careful: The skin on the shins is thin and it’s not very difficult to get an ice burn. Use a thin cloth in between the ice and the skin. Remove the ice every 10-20 min for a while to give them a break.
- Compression. Personally – I didn’t do much in this area. You can find compression sleeves in stores and on the internet. Others have said they work well. I don’t have any experiences with them.
- Shoes. If you’re not sure you’re in the right shoe it would be worth it to go to your local running store. They can assess what you need and ensure you’re in the right shoe. This is far from a guaranteed fix, but I’ve definitely seen stories of people changing shoes and having things clear up.
- Orthotics / Shoe Inserts. Some find relief by putting some sort of insert – either over-the-counter or custom made – into their shoes. I’d tread very very cautiously here. As I described here in a previous blog entry I believe orthotics should be used much more frequently as a temporary rather than long term solution. Yes, there are people who will say that orthotics cured their Shin Splints. That’s great. I think in these situations the gait may have been changed enough to help the muscle imbalance, but inserts will often set up other sets of problems longer term since they will inhibit the feet from moving as they should.
- Massage. Getting the blood flowing to the painful areas can help:
- Front of the shins: Get a tennis ball and kneel on the floor at the top of a step. Position your foot so it’s hanging over the edge of the step. Put the tennis ball under the shin and roll it around on those muscles. Also, this is one area where I think The Stick works well.
- Posterior Tibialis. Ozzie Gontang has a fantastic way to massage this muscle. Sit in a chair and put the ankle of the leg to be massaged on the opposite knee. Take one thumb and place it right behind the shin bone, down by the ankle. Wrap the fingers around the front of the shin. Take your other thumb and place it on top of the first, again wrapping the fingers around the front of the shin. Make small circles with the foot and you’ll see and feel the Posterior Tibialis muscle contracting and relaxing. While making circles with the foot push the thumbs firmly into the soft tissue behind the shin and slide the thumbs up along the shin toward the knee. When you first start doing this that muscle may get pretty sore. It’s a muscle that gets forgotten about.
- Calves. A foam roller is an invaluable tool to use for massaging the calves. YouTube has videos on good ways to use it on your calves.
- Strengthen
- Front of the shins: Put some sort of weight or resistance on the front of your foot and use the shin muscles to pull your toes toward your knee. This can be done with a resistance band or by hanging some sort of weight (1-2 soup cans in a plastic shopping bag works) from your foot.
- Posterior Tibialis: Stand pigeon-toed (with your toes pointing inwards each other). Using your calves raise up on your toes and return the heels slowly back down to the floor.
- Stretch. Standard calf stretches work fine. Google will enable you to find them easily.
I stated that often Shin Splints result from some sort of imbalance in the muscles of the lower leg. In my opinion a heel-strike running form can be a major contributing factor to this imbalance. An alternative approach to getting rid of Shin Splints is to change how you run – and get away from heel striking altogether. This opens a completely different set of options and actions the runner needs to take to resolve the problem. I’ve read stories of people changing only how their foot strikes the ground and their Shin Splints have improved. Others have pursued formally the structured programs in this genre: Pose Method, Chi Running or Evolution Running. The overall goal is to adopt a form that is less stressful on the body. These forms challenge the concept that we need to use muscles to propel us forward and rather we can rely on falling forward to propel us. Then running becomes a continuous series of stopping us from falling to the ground. We’re “simply” catching ourselves when we fall and picking up (not pushing off) the trailing foot that is left behind. I won’t go into the differences between these forms here. The forums are replete with discussions about why someone believes one is better than the other; and vice versa.
This second approach becomes much more of a re-engineering of the running style. As they say, old habits can be hard to break. It takes a good amount of mental commitment to pursue this. It can be frustrating and rewarding. There are many stories of not only Shin Splints being resolved, but Plantar Fasciitis, Achilles Tendonitis, knee pain, etc. Some people call it a fad. I think it’s an acknowledgement that running, like virtually every other sport, has a right way to do it and a wrong way. And almost always the right way must be studied and practiced and learned, just like one does for soccer and golf and skiing and baseball and and football and…………………..
Jim
