Shin Splints…

One of the most common injuries that are experienced in Track and Cross-Country is know as shin splints.  I’m currently suffering from them.  My first race of the season is only 5 weeks away and my workouts are always curtailed.  I seem only able to do less than half of the workouts and maybe not complete any races?  After just 200m I feel barely able to walk, and I’ve spoken with my local GP who told me that I would never be able to be a runner because of the difficulties that I experienced with shin splints.  My school friend Tom had a promising career in professional football cut short because of shin splints too.

Anyway, I’ve decided that I’m not going to be beaten and to look more into the subject as there’s not much I could readily find out there:

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 become irritated, resulting in a razor-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 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.  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, as it was for me in high school.

 

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 mens.  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 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 such as I-B Propfin should be taken one hour before starting practice.  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. 

                                                            Taping of the arch.

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.
·        Tapping the arch.
·        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 on every team. 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.

Shoe Features

Below are features of a shoe for an overpronator, the more common runner type for shin splints recipients.

  • Rigid plastic collar that wraps around the shoe heel for support and to control excess pronation.
  • A firm shoe with lots of supports.
  • A rear-heel area made of solid rubber.
  • Dual density midsole with the firmer material on the inside edge.  This construction is easy to spot since the midsole will usually come in different colors.
  • A “board-lasted”shoe.  To tell if a shoe is board-lasted, pull out the insole, the extra strip of material that is inside the shoe.  If there is no stitching between the inside and bottom of the shoe it is board lasted.

 

A firm shoe with lots of support preventing excessive motion is needed for those who overpronate.  Something to keep in mind is that the more cushioned the shoe the less stability the shoe will have.

For the underpronator motion of the foot is limited.  The type of shoe needed would be one that is flexible.  It should be a cushioned shoe with a soft midsole.

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.  I have my athletes jog easy for a few minutes, spend a couple of minutes stretching, more running (up to a mile), return for more extensive stretching and drills followed by build-up sprints.  When doing an interval workout, jogging between repetitions will help eliminate the tightening up of the leg muscles.

Several minutes of easy running followed by more stretching should be performed after every workout.

Special attention should be paid to proper mechanics including running with the toes straight ahead, landing slightly on the outside of the heels first, and then after flattening out the foot, roll off of the toes.

Stretching Exercises

  • Kneeling position, the runner points his toes out behind and gently sits back on heels pressing the tops of the feet towards the ground.
  • Standing arm’s length from the wall, place hands on wall, keep feet and knees straight, lean forward as far as possible.
  • Standing with feet flat, bend knees forward as far as possible keeping heels on floor.

 

Because research shows that your muscles are more elastic after they’

ve been warmed up, stretching should take place after a good warm-up as well as at the end of the workout.

Strengthening Exercises

  • With a partner hold down the others feet which are flat on the ground.  With resistance on their toes, have them lift their toes up.
  • Sitting with left ankle on right knee, apply pressure to inside of foot (near large toe) with hand, and turn foot up and in, using leg muscles.
  • Same position as above, apply pressure to outside of foot (near small toe) with hand, and turn foot down and out using leg muscles.
  • Same position as above, apply pressure to top of foot (near toes) with hand, and lift foot using leg muscles.  Repeat with right ankle on the left knee.
  • Sitting on a table or chair attach a weight (a bucket filled with rocks works well) around the foot.  Without bending your knee move the foot up and down from the ankle.
  • Anchor one end of an elastic band to the leg of a table or sofa.  Stretch the band, and then loop it around the end of the foot.  Move the foot up and down and side to side against the bands resistance.
  • Draw each letter of the alphabet with the big toe of each foot in the air.
  • While standing erect raise up and down onto your toes several times.  If that is too easy you can make it more challenging by performing the same exercise while standing on a step and allow your calves to stretch over the edge of the step.
  • In a sitting position lower and raise the feet with the heels on the ground as high and quickly as possible for 60 seconds.  I have athletes do this exercise during the school day while sitting at their desk.
  • Walking down steep hills.
  • Walking on toes.
  • Walking on heels.
  • Walking with feet turned inward and outward.
  • With socks off, gather up a towel that is flat on the floor, using only the toes.
  • Pick up marbles using the toes.
  • Off-season training.  One of the most effective ways to eliminate shin splints is to do some type of running in the off season.  An increase in mileage should never exceed more than 10% per week.

 

Prevention in summary:

  • Proper Shoes
  • Warming up and cooling down.
  • Stretching
  • Strengthening exercises
  • Proper running mechanics

 

Summary

Don’

t let shin splints get the best of you.  In almost all cases shin splints can be treated or better yet avoided through preventative measures.  Much of the information in this report came from a great variety of sources, but I would like to especially acknowledge Runners World Publications for many articles in which I used as resources.

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