The New York City marathon is one of top 10 marathons held in the US every year. In preparation many aspiring runners and competitors had to scale-up their training. From personal experience, with an increase in training frequency comes an increased risk of injury.
I spend a lot of time talking to other runners in the marathon community and one of the most common complaints I hear about is the appearance or re-appearance of the dreaded ‘shin splints’.
This condition is the source of a lot of frustration and mystery in the running community. With many runners experiencing shin splints without fully understanding the mechanisms and causes behind it. As a result, the condition persists and efforts to treat the problem are often not successful. This article is going to help explain shin splints; everything from its most common presentation to its causes, from its aggravating factors to the most effective self-treatment. Armed with this information, when the next marathon finally rolls around, you should be ready and shin splints free.
What Are Shin Splints?
When runners tell me that they have shin splints, they are referring to pain in the front of their lower legs most often brought on by long distance running. Shin splints normally appear as a direct result of either significantly increasing your training frequency (such as gearing up your preparation for a competition and choosing to run an extra 5 miles a day), or returning to training after an extended period of inactivity (like taking a few months off running because of an injury).
Typically shin splints are felt as a dull ache along the shin bone. At first the pain might not be particularly noticeable or debilitating, but continuing to run with shin splints can cause the pain to become increasingly severe. If the condition becomes severe you might have to stop running altogether.
For runners it can often be difficult to determine the underlying cause of shin splints. Understanding the basic anatomy of the affected area and biomechanical issues can help you identify the most likely culprits and treat the problem effectively.
Anatomy of a Shin Splint
As a long distance runner, your lower body takes a pretty severe beating on a regular basis. Pounding the asphalt mile after mile places a lot of stress on the muscles and connective tissues of the lower leg. The lower leg is made up of the tibia (shin bone) and fibula (small bone on the outside of the shin bone) and lots of ligaments, tendons and muscles. The more obvious muscles that make up the calf; Gastrocnemius and Soleus sit in the back of the leg.
The less obvious are the Anterior and Posterior Tibialis, and many other smaller muscles that connect the foot, shin and ankle at the front and back of the leg. These muscles form a complex network of connections around the lower leg.
Medial Tibial Stress Syndrome or MTSS is the most common medical diagnosis for shin splints. MTSS is an overuse or repetitive stress injury of the muscles, tendons, bone and surrounding tissues around the shin. It can be brought on by a number of factors ranging from training errors to biomechanical factors.
Weakness, damage or stress to any one of the lower leg muscles can cause the entire shin to ache. However overuse of the Tibialis Posterior muscle and tendon is the primary cause of pain for most runners.
The tibia is also covered in a layer of connective tissue known as Periosteum, and increasing the pressure exerted on it while running can cause it to become inflamed, resulting in radiating ache over the entire shin.
The main contributors of MTSS
- Overuse of the muscles and Tendinopathy or degenerative changes in the tendon.
- Periositis – inflammation of the Periosteum (connective tissue covering the bone).
- Excessive stress on the tibia and in extreme cases can also be stress fracture.
Identifying the contributing factors for your specific case of shin splints will help to develop a self-treatment plan to effectively treat the problem.
Though there are a number of causes, it comes down to the fact that the body can’t keep up with the wear and tear of running. Basically the repair can’t keep pace with the wear and tear on the body.
Primary Cause of Shin Splints
Returning to running after a period of inactivity or increasing your training frequency too quickly is one of the leading causes of shin splints. To prevent this from happening you should immediately reduce your training frequency and build back up gradually over a period of weeks.
Long distance running doesn’t guarantee that you are going to get shin splints, but doubling your running distance overnight can definitely increase the changes of getting it. So make sure you steadily increase your training intensity and frequency. If you start noticing shin splints take a week off and reduce your distance until you get stronger and build back up.
Core And Hip Weakness
Weak core and glutes are a major risk factor for getting running injuries. Without a strong base the extension can’t work properly. Too many runners spend most of their time exercising the leg muscles without working on building a strong base with good core stability and hip strength.
Poor Foot Mechanics
Weakness of the foot muscles combined with lack of ankle and big toe flexibility can often result in over pronation or “flat feet”. Running with a collapsed arch can cause uneven distribution of stress on the lower leg often resulting in running injuries.
Self Treatment For Shin Splints
1. Since this an overuse injury, need to back off on running. The tissue is not able to handle the load being placed on it. Backing off on your running and running on softer surfaces (track field) might be better. On the non-running days, spend time doing more high intensity strength training…pushing the anaerobic system. You might be surprised but running will improve too.
2. Deep tissue or myofascial release work on the lower leg. Rolling on a foam roller, you can also use a wine bottle or lacrosse ball to roll on the lower leg.
3. If you have a hand held massager, can use it to massage the muscles along the lower leg.
Use Restore herbal oil, it’s good for pain and helping the tissue heal
After massage follow with heat or warm water soak+epsom salt+baking soda
No ice at all. Stop Using Ice For Healing Injuries
4. Make sure your ankle joint, calf or achilles tendon isn’t stiff – Ankle flexibility exercise
5. Make sure you have adequate big toe flexibility – lack of big toe flexibility is going to affect your ability to roll over your foot when walking or running. Check out this Big toe stretching exercise
6. Open up the hip – put your back foot up against the couch so you can stretch the quads and the shin muscles too. This is a great hip flexor stretch.
7. The core, glutes and foot muscle have to be strengthened for long term success.
If these treatments don’t offer a permanent relief from shin splints, it’s possible that you’re suffering from stress fractures along the shin bone. This is most likely caused by high impact caused by long distance running combined with other underlying conditions, such as weak muscles in the core and leg, poor diet, reduced bone density and menstrual problems. It’s essential that you go to your physician and stop training immediately if your shin splints don’t improve after resting for two weeks.
Other Causes Of Shin Splints
There are a few other causes of shin splints and these conditions can get worst if you continue to train – so in short, if it keeps hurting, stop running.
- A disc bulge in the lumbar spine (low back) with nerve compression can refer pain down the leg to the shin. Low back joints and ligaments can also refer pain down the leg.
- Pain on the front and upper part of the shin could be referral pain from a patellofemoral joint (anterior knee pain)
- Anterior Compartment Syndrome – is lateral or outside shin pain due to a swelling of one of the 4 muscle (tibialis anterior, extensor halluces longus, extensor digitorum longus and peroneus tertius) in the anterior compartment of the lower leg. Swelling caused by an injury or overuse can result in pain, numbness, tingling and possible tissue death due to ischemia. This is a serious condition and needs medical attention.
All of these conditions require immediate medical attention. Fortunately these conditions are not as common and shin splints can be treated by rest, reducing training frequency, Physical Therapy and possibly investing in a new pair of running shoes. Shin splints no longer need to impact your training or competition – so see you at the next New York City marathon!
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