If Only I Knew...
How to Avoid Shin Splints
By Marie-Catherine Bruno, BScPT, Cped(C).
As the winter is slowly going away, most of you will start running again. Unfortunately it will take a while before you can actually run your favourite trail (unless you have had a very dry winter), so you will probably end up running on the road a little bit. No need to say that this is really hard on your body, especially on your legs. Therefore, let’s talk about shin splints, runners’ most feared injury!
First of all, what is a shin splint? It is a generic term to describe an inflammation of either a muscle (the tibialis), a tendon or of the bone’s outer membrane (perioste) in your lower leg. The most common one is an inflammation of the tibia due to a constant pull from a certain muscle (the tibialis posterior), that is attached all along the tibia. Shin splints affect mostly runners, but it is not rare to see overweight people dealing with them as well.
It is a gradual onset of pain, usually starting after running for a while (anywhere from 10-15 minutes, sometimes up to 45 minutes when very minor). The pain will be dull, or like an ache. It can be anywhere along your tibia, or sometimes around the inside of your ankle, just behind the ankle bone. The pain usually goes away when you stop running, but if you press hard on the painful area, you can reproduce the pain, even at rest. It takes a few days to go away, but the minute you go back for a run, it will come back. When really inflamed though, it can even hurt when walking.
There is a multitude of possible causes to shin splints. The key to healing such an injury is to first of all find out what the cause is; only then can you receive the appropriate treatment. I will only concentrate on the most common ones, but keep in mind that you can still have shin splints even if none of the mentioned causes applies to you.
- Falling arch (also mistakenly called flat foot). Do your feet seem to be flat? If so, do a quick test: lift up your foot, and look if you see an arch. Then put it down on the ground, and gradually put all your weight on that leg. Is the arch still there or is your foot now flat on the ground? If the arch is still there, and as pronounced as it was up in the air, move down to the next cause! If on the other hand your arch seems to have flattened out (like 60% of the population), you have what we call pronated feet, meaning that the muscles and ligaments that should hold up your arch are not strong enough to do their job, and therefore your foot looks flat when you put weight on it. This condition needs to be treated with either orthotics (the easy way!), or by getting on a specific strengthening and stretching program (see your physical therapist). If you do not treat it, it changes the whole alignment of your body and creates abnormal wear and tear in your joints in the long run (ankles, knees and hips). In the short run? You will probably develop shin splints from your tibialis posterior (one of the muscles holding up your arch), that constantly pulls on the bone (the tibia) on which it is attached, because constantly stretched.
- Old or unapropriate shoes. When you are running, you increase the load on your joints by up to 80%. Therefore, your body has to do a lot of shock absorption. Your shoes should act as good shock absorbers. Take a look at them: do you see creases on the side walls of the sole? If so, you should buy new ones. It means that you have a flat (!), and they cannot absorb much anymore, no matter how new the top still looks. Also, look at the sole and note what part of the heel is worn. It should be near the center, but a little bit more on the outer side. If you are wearing out the center or the inner part, you do not have the appropriate shoe for your foot. Shoes are designed for different types of feet: some of them are for pronators (pronated feet), some are for a normal, neutral foot, and a minority of shoes correct supination (the opposite of pronation). If you don’t have the appropriate one, you are creating a new problem! So make sure you buy your shoes in a specialised shop - no saving money here okay? (because quite frankly, the money you will save on a good bargain will be reinvested in anti-inflammatory drugs and physical therapy!).
- Running with spike shoes. If you do a lot of track work outs and use spikes, you have to lift up the front of your foot higher in order to clear the ground. This requires a lot of work from the tibialis anterior, another leg muscle. Overworking that muscle will result in a tendonitis of that muscle. Advice: start with only one of those workouts a week, for about a month. Then slowly progress to two, and then maybe three. But avoid running with spikes more than 3 times a week. Also, do your warm up and cool down with regular running shoes.
- Working on a hard surface and/or being overweight. The harder the surface, the most your body has to absorb when you are walking. So you have to wear good shoes to work if you work on concrete floors (a thick absorbing sole). The ideal is a pair of walking shoes, or even running shoes (but watch out for going over you ankle with those, as they are much higher and don’t have much lateral stability). You work on a hard surface and you are overweight? Please invest in good shoes, because not only you are prone to develop shin splints, you are also eating up your joints. Your body was not designed to take extra weight, so please compensate.
- Running on banked surfaces. As you may have noticed, the streets are slightly banked on the sides so that the water can evacuate the center of the road faster. If you always run on the same side of the road, you are putting a lot of stress on your ankle, and therefore pulling some of muscles in your leg. Running on indoor tracks (banked curves) also has the same effect. Advice: change direction once in a while, if not life threatening of course! Try to run on bike paths instead of along the road as they are flater.
The most important part of the treatment is to eliminate the cause. So you first have to figure out what caused it in the first time (and running itself cannot be blamed!). If you cannot find anything in the above list, see a specialist. Then work on getting rid of the cause (buy new shoes, get orthotics, lose weight, change your running route…). This alone will take care of most of the problem, but you will still need some anti-inflammatory treatment to speed up the healing process. For some people, medications and ice alone will do the work, but for more acute and stubborn ones, you will probably need to see a physical therapist.
Then go back to your training program, but be wise and go progressively. As you get better, you can increase the length of your runs and the frequency. Now enjoy running painfree!