Shin Splints: Read all about it

Ned

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Shin Splints: Read all about it - updated

'Shin Splints' is an umbrella term for many different conditions.

I read so many posts on here about the problem, so as a sufferer myself, I thought I'd share my knowledge in the hopes that you are able to prevent serious damage like I unfortunately have.

You can read here about the possible causes of 'shin splints'
I will post a follow-up of diagnosis and possible treatments.

The pain initially may be caused by only one defect, but by continual training without corrective measures/treatment you risk what is medically known as a ‘continuum of injury’, perhaps causing irreparable damage.
Why exactly, anatomically, this happens (the etiology) is not yet agreed upon by the research or clinical communities, because the causes can be so vast. It might be that you’ve never run before in your life and all of a sudden do 6 miles a day and your body is going through a drastic change, or that you’ve ran all your life, and simply changed running shoes to 3mm thicker.

Some conditions you may come across which are common to the term ‘shin splints’ are:

• MTSS (Medial Tibial Stress Syndrome)
• Compartment Syndrome
• DOMS (delayed-onset muscle soreness). The muscle pain is caused by a sudden onset or increase in training. Someone not used to training may experience minor pain during and after exercise.
• Stress Fractures

MTSS - Medial Tibial Stress Syndrome
Recent studies report up to a 35 percent incidence of MTSS in actively training military recruits and 13 percent in civilian runners. The Etiologies (the causes) of this conditions can range from:

1. Varus/valgus foot position and Flat-footedness
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2. Over/excessive foot pronation: This means the muscles in your foot, attached to your shin are stretched, and stretched muscles cannot become stronger and prevents nourishment from reaching nerve and muscle cells.
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3. Weakness in the plantar flexors: Reported to be the cause in ~60% of cases. Increase of over 30% of initial training mileage within short time periods can over-load the muscles causing damage. Initial Lower fitness = earlier onset of fatigue = more stress transmitted to bone = continuum of injury, possibly bone damage
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4. Incorrect/insufficient stretches, causing tearing or/and inflammation of the soleus muscle.

5. Periostitis: Caused by inflammation of the periosteum, a layer of connective tissue that surrounds bone. May occur from additional stress placed on muscles, such as running on hard surfaces, using incorrect footwear or poor foot support.

6. Bone Damage: When a sustained, new or over normal amounts of stress is placed on a bone, it adapts by beginning a remodeling process, thus increasing metabolic activity. Osteoclasts begin to remove old bone matrix, creating tunnels in the bone. Osteoblasts then fill the tunnels with new bone. If the stress is sustained too long, during the time between removing old bone and then filling the tunnels with new bone, the bone cannot handle the continued loading and microfissures result. If the bone stress continues, stress fractures may result.



Compartment Syndrome.

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A tough tissued called a fascia surrounds the different muscle groups. This fascia is a small compartment that holds the muscles, blood vessels and nerves. It has limited flexibility so if the muscle swells beyond the fascia's ability to stretch it puts pressure is felt on the nerves and blood vessels in the small space. If swelling continues blood flow to the muscles will decrease, nerves get compressed and it can cause numbness or tingling in the feet and lower legs. Compartment syndrome is caused when increased tissue pressure within this closed fascial space results in tissue ischemia. The earliest symptom is pain resulting only during exercise. The pain will increase with training and reduce dramatically immediately after exercise. If untreated, can cause muscle death, liver failure and extreme chronic fatigue. As many as 45% of all cases of Compartment Syndrome are caused by tibial fractures, so if you have CS, it may be the result of a continuum of injury stemming from one or more conditions listed above.


There are two types of compartment syndrome; Chronic and Acute.

Chronic Compartment Syndrome is a recurrent syndrome that occurs with exercise or work. CS was previously thought to be an atypical form of shin splints. This syndrome is usually observed in athletes training for endurance. Often, it occurs bilaterally and the pain it causes may be reproducible at a specific exercise distance or time interval. For example, most long-distance runners reproducibly experience the onset of pain within 15 minutes of initiating their run. Athletes may not be able to play through the severe pain. However, runners may be able to continue running with a modified flatfoot strike. Symptoms tend to subside within 1 hour after the activity, and are minimal during normal daily activities but return when activity is resumed.

Acute Compartment Syndrome
This variation may occur after another injury. For example, a bruise in your leg which has caused swelling or related symptoms from MTSS such as bone fracture. The inflammation in one area affects the surrounding muscles and also causes them to swell. Without a steady supply of oxygen and nutrients, nerve and muscle cells begin to die within hours. Unless the pressure is relieved quickly, this can cause permanent disability or death. If you have an injury which should not be causing pain in the anterior compartment or posterior leg, seek medical advice.



Treatment

For occasional pain in the shin:

• Reduce workload – Decrease distance and increase rest periods, allow your body to adjust to the training and strengthen.

• Check you gear – Proper running shoes should give adequate foot support and encourage normal posture. Not an area to skimp on! Don’t run in your everyday trainers, and try seeking out a professional running shop/expert.

• Apply R.I.C.E. treatment – Rest, Ice, Compression, Elevation.

• Seek massage therapy – Your local Gym, University, Doctors or hospital will be able to give you information on a local sport massage therapist. You can instruct them to work on the specific area of pain. This will help reduce swelling, break-up any scar tissue/blood pooling in the area and encourage a much faster recovery.

• Purchase some insoles for everyday wear – Whilst foot posture and bio-metrics when walking and running are completely different, it is important to have both in working order. If you have a valgus or over-pronated foot (see above) then increase heel and arch support (Airplus Mens Gel Arch supports are ideal)
• Or try a general sports insole, try Sorbothane or yoursole. Shop around for best prices.

• Take anti-inflammatory drugs – Non-steroidal are recommended, Ibuprofen and aspirin etc.

• Check your route – Athletes have reported that mere changes in their daily jogging route have caused shin splints, most usually from running on harder surfaces, or hills. With pain, NEVER run on concrete or tarmac. If your route takes you through a street, simply walk. Similarly if your route takes you down hills I suggest you walk, running down hill causes massive strain on the affected muscles. If you run on a treadmill, set the incline to at least 3%.

• Exercise & stretch the Plantar Flexors – You may think exercising the foot and ankle is redundant, but in actual-fact it is arguably more important to strengthen those muscles, especially if you are experiencing shin pain. See the post below for a good range of foot exercises.




For regular pain in the shin:

• All of the above – Those are things you can do yourself easily enough. But also:

• Goto your GP – He will refer you to a hospital with podiatrist. You will probably then follow the standard procedure…

• Scans – Initially to check for obvious fractures of the bone, you will need an X-Ray. They however do not show hair-line fractures so I would recommend instead an MRI scan, though the most prevalent scan for shin splints is a Triple Phase Bone scan. Its always best to attempt to persuade your consultant to do these straight away, since waiting lists are often 4+ weeks and usually PRMC’s are trying to stick to dead-lines. Usually if you explain this, they’ll treat you with priority.

• Physiotherapy – For muscular/tissue damage the physio can use ultra-sound (Rue JH, Armstrong D, Frassica F, et. al. The effect of pulsed ultrasound in the treatment of tibial stress fractures. Orthopedics 27:1192, 2004), micro vibrations that will stimulate the healing process. Your physiotherapist can also identify any physical weakness and suggest improvements.

• Orthoses – Your consultant or physiotherapist may recommend orthotics. These are custom fit devices that are specifically cut to correct your personal foot defects and promote healthy body posture. These are used by individuals with disabilities mainly, but additionally by military personnel world-wide as a preventative measure for the symptoms above. If you have been provided with orthoses I would suggest that he keeps that to yourself when it comes to the medical entrance examination. I have heard of some people being rejected for military service if they wear orthoses... If it does arise at medical, explain how you encourage foot posture exercises and reinforce that the orthoses are there in part to teach good foot posture, then you should be able to pass the medical without question.

• Surgery – Seen as a last resort treatment, surgery can take a few different forms. I’m no expert on this subject, but I believe surgery can be performed to relieve ‘shin-splints’. Cutting of the fascia surrounding the afflicted muscle is the common procedure for Compartment Syndrome.
• MTSS and the other symptoms of ‘shin splints’ can be slightly more difficult to treat with surgery, and results vary dramatically. Since it’s a complex subject I had to do a little reading before making notes. I found that surgery for chronic, refractory cases of MTSS is an option although results are variable at best. Performing a release of the fascial attachments to the posteromedial tibial margin has had reported success rates of 29 to 86 percent. However, a recent study reported that only 41 percent of athletes returned to pre-surgery levels of participation (Yates B, Allen MJ, Barnes MR. Outcome of surgical treatment of medial tibial stress syndrome. J Bone Joint Surg 85-A(10):1974-1980, 2003). It is thought that this is due to: biopsies; only 4 cases with periostitis; 2/3 with bone injury; 1/3 with injury to the medial attachment of the soleus fascia )Michael RH & Holder LE. The soleus syndrome: A cause of medial tibial stress (shin splints). Am J Sports Med. 1985;13:87-94.). So here it’s quite apparent that some conditions of ‘shin splints’ cannot be treated with surgery.
 

Ned

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Exercises – A preventative measure and treatment for ‘shin splints’

Courtesy of http://foothealth.about.com

Seated Ankle Dorsiflexion and Calf Stretch
Exercise 1: Sit on the floor with your knees straight. Loop a rope or towel around the front of your foot and gently pull back. Move your foot up toward your shin (dorsiflexion) and hold for 10 seconds. Then move your foot down toward the floor (plantarflexion). Keep your legs flat on the floor, motion should only be at your ankle joints. Start with 3 sets of 10 exercises and then increase to 3 sets of 30 exercises.
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Once you have mastered the stretch, now it is time to strengthen by using a resistance band. Perform the same movements, but loop a resistance band around the front of your foot and the other end of the band around a table or chair leg. Do 3 sets of 10 exercises and then increase to 3 sets of 30 exercises.

Bent Knee Ankle Dorsiflexion and Calf Stretch
Exercise 2: Sit on a bench or table with your knees bent and your legs hanging off the side. Bend your foot up toward your shin (dorsiflexion) and hold for 10 seconds, then lower your foot by pointing your toes back toward the floor (plantarflexion). Start with 3 sets of 10 exercises and then increase to 3 sets of 30 exercises. Do this 3 times per day.
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Once you have mastered the stretch, move on to the strengthening exercise. Keep the same position as before, but now you want to add a weight to your foot. Raise and lower your foot with motion only at the ankle joint. Try not to have any motion at your knees. Start with 3 sets of 10 exercises and then increase to 3 sets of 30 exercises.

Toe Walking - Stretching and Strengthening
Exercise 3: Begin by standing in place and rising up onto your toes with your heels off of the floor. Try to hold the position for 10 seconds and slowly lower your heels back to the floor. Start with 3 sets of 10 exercises and then increase to 3 sets of 30 exercises. Do this 3 times per day.
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Once you have mastered standing in one place, start walking on your toes. Start with your toes pointed straight ahead, walk about 25 yards. Next, point your toes inward and walk 25 yards. Finish by pointing your toes outward and walk 25 yards. Remember to keep your heels off of the floor. Start with 3 sets of 10 exercises and then increase to 3 sets of 30 exercises. After you have mastered walking on your toes, you can progress to high-impact exercises like jogging or skipping. Be sure to do them on soft grass.


Heel Walking - Stretching and Strengthening
Exercise 4: Begin by standing in place and lifting the front of your foot off of the floor and keeping your heels on the floor. Try to hold the position for 10 seconds and then slowly lower the front of your foot back to the floor. Start with 3 sets of 10 exercises and then increase to 3 sets of 30 exercises.
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Once you have mastered standing in one place, start walking on your heels. Start with your toes pointed straight ahead, walk about 25 yards. Next, point your toes inward and walk 25 yards. Finish by pointing your toes outward and walk 25 yards. Remember to keep the front of your foot off of the floor. Start with 3 sets of 10 exercises and then increase to 3 sets of 30 exercises. Do this 3 times per day.After you have mastered walking on your heels, you can progress to high-impact exercises like jogging or skipping. Be sure to do these exercises on soft grass.
 

Ned

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Standing Ankle Dorisflexion Stretch

Exercise 5: Stand facing a wall, keep your knee straight and your heel on the floor and place the front, bottom part of your foot against the wall. You will feel a stretch in your calf muscles. You could also use an inclined platform for this stretch. Start with 3 sets of 10 exercises and then increase to 3 sets of 30 exercises
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Straight Knee Calf Wall Stretch

Exercise 6: Stand facing a wall with your body square to the wall. Outstretch your arms and hands and lean against the wall. Keep one knee straight with your heel and foot firmly on the floor and gently lean forward until you feel a pull in the back of your leg (calf). When your knee is staight, this stretches the gastrocnemius (superficial calf muscle). Start with 3 sets of 10 exercises and then increase to 3 sets of 30 exercises
WallCalfStretch2.jpg





Bent Knee Calf Wall Stretch
Exercise 7: Stand facing a wall with your body square to the wall. Outstretch your arms and hands and lean against the wall. Keep one knee bent with your heel and foot firmly on the floor and gently lean forward until you feel a pull in the back of your leg (calf). When your knee is bent, this stretches the soleus (deep calf muscle). Start with 3 sets of 10 exercises and then increase to 3 sets of 30 exercises.




Wall Toe Raises - Strengthening
Exercise 8: Stand with your back against a wall, keep your heels on the floor and raise the front of your foot up (dorsiflexion) toward the front of your lower leg (shin). Hold that position for 10 seconds and then lower your foot back down so that it almost touches the floor, then begin the next exercise. Start with 3 sets of 10 exercises and then increase to 3 sets of 30 exercises. Do this 3 times per day.
WallToeRaise.jpg

Once you have mastered doing the exercise with both feet at the same time, start to do the exercise one leg at a time. Another variation to try is to do quick up and downs of the foot. Remember to keep your heel firmly planted on the floor. Start with 3 sets of 10 exercises and then increase to 3 sets of 30 exercises.


Foot Step Holds - Strengthening
Exercise 9: Stand comfortably with your feet shoulder width apart. Take a normal sized step forward with one leg and let your heel touch the floor, but before the front, bottom part of your foot touches the floor you need to stop. Do not let the front part of your foot hit the floor. Step back so your feet are side by side and shoulder width apart like when you started. This exercise helps strengthen the muscles in the front of your lower legs. Start with 3 sets of 10 exercises and then increase to 3 sets of 30 exercises.
StepHoldDF3.jpg

Once you have mastered a normal size step, take a much larger step forward. If that become easy, you can progress to using a step stool. You stand with both feet on the step stool and with one foot you step down off the stool, your heel should touch the floor, but you should stop before the front of your foot touches the floor. Start with 3 sets of 10 exercises and then increase to 3 sets of 30 exercises
 

SamForrest

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Quality post mate. Always good to see it talk about the actual cause and types of lower leg problems. Rather than just 'shin splints'
 

Ned

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Ned’s Top 10 Tips:
1. Support the arch to control excessive pronation. Use orthotic insoles, or good insoles with lots of arch/heel support.
2. Train endurance of the plantar flexors while maintaining dorsiflexion range of motion (See useful website I have found: here) or above. You can do these anytime of the day, but reccomend at least 3 sets, 3 times a day. The good thing is, most of these can be done at work/school etc. I'm happily sat in the office doing them right now.
3. Encourage cross training into your weekly workout schedule. Swimming, rowing, get a good variety to work the different muscles.
4. R.I.C.E – Probably many of you know this already. Rest, Ice, Compression, Elevation. Always have at least 1 or 2 days rest in a week, especially after running. Use ice immediately after exercise on the areas affected by pain, but importantly, remember to elevate the affected limb above heart level. This is essential for good blood flow to the area. Anything will work, ice cubes directly massaged into the area, ice pack covered with a towel, my personal favorite is a gel wine cooler, slips right over your leg. Careful not to get frost-bite. Compression, tape the foot only. If using other methods of compression do not leave for more than one hour. Submerge legs into warm water after to allow blood flow to return. Someone mentioned having two buckets with hot/cold water and switching between the two, that is fine but you need to elevate your leg while treating it with ice.
5. Do the 10 jump test; jump repeatedly whilst balancing on one leg on a rest day. If pain occours within the 10 jumps REST, allow the tibia sufficient rest to break the chronic bone remodeling response and allow a return to normal bone homeostasis.
6. Take Non-steroidal anti-inflammatory drugs, usually abbreviated to NSAIDs or NAIDs. Ibuprofen and aspirin are fine, ask your chemist.
7. Seek physiotherapy and rest. A lot of trainees I have met with these problems cannot afford periods prolonged rest, but it will take LONGER to recover if you seriously injure yourself. A physiotherapist can help to teach you stretches, give treatment such as shock/ultra sound, and advise you of any areas of weakness.
8. Don’t tape the lower leg. Taping the arch of the foot will have a much greater impact on leg pain.
9.NEVER just try to ‘run off’ pain in the knee, shin or leg.
10. NO DOT attempt a self diagnosis. Go to your GP!
 

JDMSAM

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one of the best posts ive read in a long time, aprrectiate it mate
 

Qwerty123

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Awesome post Ned, already copied and saved this information for future reference....(hopefully wont need it, but the strength & prevention excercises can be done now.)

Thanks for taking the time to post!
 

Ned

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Seen a lot of posts coming up again in the Common Training Injuries section regarding shin splints, so hopefully this will introduce those poor souls with some knowledge on the subject.
Best regards.
 

Qwerty123

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Awesome post Ned, already copied and saved this information for future reference....(hopefully wont need it, but the strength & prevention exercises can be done now.)

Thanks for taking the time to post!

Alas, I did need it.:flushed: "Bump" for a quality thread.:blink1:
 

G

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Thanks for a decent thread & thanks for bump, needed something like this today! :applaus:
 

bruce2007

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Would like to see this thread stickied if possible. Best thread on the most common injury on here. Excellent posting :shakehands::applaus:
 

ROBERTS

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Just printed this post off for future ref and pre stretches, is a good post :biggrin:
 

Ned

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Thanks for the feedback gents.

Fustratingly since the forums switched over some of the punctuation has gone awal, and I'm not able to change it. I'm very glad this is helping some of you though.

18 months later and its still lingering about!
 

Stoo2k

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Just had a good read of this also. Some things to discuss with my physio on thursday.
Has anyone cranked up the incline on the treadmill and noticed a difference? I will be doing this on wednesday and post the results.
:rock:
 

X-Guard

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i think the key is just to not run on hard surfaces, so go in the woods or something
 

Kentish

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i think the key is just to not run on hard surfaces, so go in the woods or something

Disagree. Quite a few people have their shin splints, or shin pain at the least, resolved by going to a running shop and getting a gait analysis, which involves them recording the way you heel strike, and diagnosing a pair of trainers to prevent you pronating.

When running through woods, it is often uneven, and so every heel strike lands in different positions, not even like it should, thus causing problems.
 

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