SHIN SPLINTS. Read, digest and understand.

Discussion in 'Stickies/Frequently Asked Questions' started by Rover, Sep 8, 2016.

  1. Rover

    Rover Moderator

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    So what are shin splints?

    Shin splints is actually a bit of a misnomer and should really be referred to as "exercise-induced leg pain", as I will explain. The most common type of exercise-induced leg pain is medial tibial (shin bone) stress syndrome (MTSS) which doesn't exactly role off the tongue, but is a more accurate term. The other two main types are a stress fracture or compartment syndrome.

    MTSS occurs when the muscle that inserts just behind the shin starts to pull away from the bone. There is a sheath around the bone called the periosteum, and this can get inflamed as a result of the pulling away, and cause pain. If this inflammation of the periosteum persists, because someone continues to run without attempting to treat it, then it may go on to cause a stress fracture. A stress fracture is not like a traumatic fracture that occurs suddenly. It is a continuum. So it may start with a worsening of the inflammation around the periosteum, and then slowly go into the bone itself.

    The good thing about this is if it is caught early enough, it is possible to prevent a full-blown stress fracture. And this is definitely something you want, because a stress fracture can mean being put in a boot and no running for around 12 weeks.

    Compartment syndrome literally means that the different muscles that make up the calf – which are split into compartments – get too big for the muscle sheath they are in and can cause quite severe pressure pain.

    What causes it?

    All three types of exercise-induced leg pain come under the category of "overuse injuries" (which are the most common types of running injury) as opposed to trauma. Biomechanics (how our movement is controlled in relation to our joints and muscles), training or the environment (running surface and footwear), or a combination of all these, can make someone vulnerable to developing an overuse injury.

    MTSS results from a repetitive overload and the pelvis, and all the joints from the hip down to the foot may potentially contribute to the onset of symptoms.

    One of the most common causes of MTSS is excessive or poorly controlled pronation (flattening of the foot). Pronation is a normal movement that occurs in the foot to help with shock absorption. Efficiency during running relies on achieving the right amount of pronation and supination. Things like fatigue, tight calves and gluteal (bottom muscle) activation can have an effect on the control of the foot as it hits the floor. Footwear and the surface that you are running on are also important factors.

    Most patients that come in with MTSS describe an increase in their training volume/intensity or new footwear leading up to their symptoms. As a stress fracture can occur with untreated MTSS, many of the causes are the same.

    Compartment syndrome is often related to a sudden change in training or load and can also occur with tight calves. The pain from compartment syndrome is not something you can run through and patients will describe their calves as feeling hard, and a sense of pressure building up in them.

    How do I treat it?

    There are effectively three different types of exercise-induced leg pain, and each has quite different treatment.

    MTSS, which is probably the most common, would involve:

    • Correct training errors – this may relate to volume/intensity or lack of recovery

    • Checking footwear is appropriate

    • Correcting biomechanical problems – the pelvis and all of the joints in the leg have the potential to contribute to MTSS and each patient will present slightly differently and will need to be thoroughly examined.

    Some patients may need to be referred to a podiatrist. Correcting timing and control issues with certain muscles groups, and restoring appropriate flexibility to the joints and muscles of the lower limb may also be part of the treatment.

    Clearly because exercise-induced leg pain is a type of overuse injury, there is usually some need to temporarily alter training. With the right treatment, your time away from running will be kept to a minimum and you will be advised to cross-train to maintain as much of your fitness as possible. We want to get you back running as soon as possible!

    Being injured is always tough, but with the correct treatment you will learn more about yourself and what type of training is best for you. Shin splints isn't a good term because it is too simplistic, and does not convey the serious problems that lurk behind it.

    • Rebecca Christenson is a physiotherapist at Pure Sports Medicine. To get in touch, please visit www.puresportsmed.com or follow her on @rebchristenson


    May I also suggest reading the linked thread as regards post by @The guide

    http://www.royalmarines.uk/threads/injuries-in-training-and-the-drop-out-time-effects.93264/
     
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  2. Ted

    Ted New Member

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    Hi, great thread. I am currently suffering with lower leg pain (skin splints).

    It happened last Wednesday halfway through 8 mile run. I have my pjft coming up in a few weeks and I am worried that wo won't be able to complete due to injury. Should I go and see if I have stress fractures or am I being over dramatic?

    Cheers ted
     
  3. Ted

    Ted New Member

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    (Shin splints) my apologies
     
  4. Rover

    Rover Moderator

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    Better to be safe than sorry.

    Perhaps best to get it checked rather than aggravate the injury and fail your PJFT.
     
  5. Stiglitz

    Stiglitz New Member

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    Wish I had this info before I fractured my tibea. Paid an arm and a leg in professional physio's to sort it out and have me on a strict rehabilitation program, took me six months to fix properly.

    Nice post mate.
     
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  6. old-lynx-mech

    old-lynx-mech Active Member

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    @Ted
    The diagnosis can be a bit hit and mis. An MRI scan gives the detail and full extent. x-ray is not so good unless there is a big fracture to be seen. Worth seeing a good physio as a 1st off though
     
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  7. wackojacko544

    wackojacko544 Member

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    I'm just looking for some advice. I tried to do my treadmill run today and about half way into the 1st run might left shin/calf was a lot of pain, I carried on running and completed the first run. Tried the 2nd one but at about 0.6km I was in agony so I had to stop. My shins and calf's have felt a bit achy over the last couple of months to be honest and last couple of sessioms a little bit more. I've called my GP to get an appointment but I'm going to have to ring again tomorrow to try and get one for tomorrow. Just so I know if I have it or not and how to deal with it. But what worries me is I'm hopefully sussposed to get a call from capita today or tomorrow regarding an date for a face to face medical, but if I do get it I'm not sure what to do. I'm just in a bit of a very frustrating limbo.

    Sorry about the long post but any advice would be greatly appreciated.
     
  8. AD777

    AD777 Guest

    Rest up and stay off it until it gets seen to. Chances are it'll just be a minor setback and nothing to worry about. Pain and little injuries are inevitable. Whilst waiting to hear what's going on with it you could crack on with your body weight excercises.
     
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  9. wackojacko544

    wackojacko544 Member

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    Yeah, only problem is that I do fintan circuits which involves quite a bit of running. I'm also worried that my treadmill running might get affected as it was going well.
     
  10. john lewis

    john lewis Well-Known Member

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    Lay off the fintans for a little bit, get on the bike and in the pool until the pain goes then build up again steadily. Some quality rowing circuits on here which would be a good Fintan replacement. RICE
     
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  11. C30

    C30 Member

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    Good advice above. It is a good idea to get it checked out but the only solution really is to rest up and strengthen, and that is more than likely what you will be told by a physio / GP. Make sure you have decent running shoes and insoles if you need them, and don't do too much too quick.
     
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  12. wackojacko544

    wackojacko544 Member

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    Yeah, going to add another session or 2 in the pool. Might have to try the bikes in the gym along with the rower.

    Yeah, I'm going to rest up but I want to make sure it is shin splints from the GP before I start worrying.
     
  13. wackojacko544

    wackojacko544 Member

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    Also when you say rest up does that mean no running so I can still swim, weight session, rowing, gainers. It's just without my runs and circuits my programme doesn't feel like much.
     
  14. john lewis

    john lewis Well-Known Member

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    Yeah mate just make sure it's low impact so not jump squatting etc
     
  15. wackojacko544

    wackojacko544 Member

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    Thanks, so nothing that involves impacts if that makes sense, like burpees. So swim, cycle, row and non impact body weight such as gainers.
     
  16. wackojacko544

    wackojacko544 Member

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    Went to a physio today and he confirmed that I had shin splints, luckily I've got them before they got worst and there quite mild. I've been told to lay off running this week and I've been given stretches to do until next Monday where I'm having another appointment to see how I've got on. I'm also getting a deep tissue massage as I did today because he said my calfs were tight which could be a reason I've got them in the first place.

    I'm just wondering if anyone else has had experience like this and can give me any other advice I could do to help. Also I'm in the medical process at the moment so do I need to let anyone know or not, and if I can't run for a week or 2 (hopefully not much longer) if this will affect my cardio/runs massively such as my PJFT as I was doing well with it. Thanks in advance and sorry about the lengthy post.
     
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  17. C

    C Resigned account

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    Compression Socks - wear to bed and/or post run (I particularly like CEP, pricey but they've got a genuine history making medical compression wear and going on the quality of them vs other compression gear I've used in the past they're worth it)

    Ice wellies - Stole this one from Arny01, fill wellies with ice and water from the hose sit in said wells as often as possible - sam principle as ice packs but gives better coverage to control inflammation better

    Gait analysis - Work out why this happened to stop it reoccurring my problem was with weak glutes and wrong shoes

    SMR/Massage/Mobility - Make sure you don't have tight calves/hamstrings/soles of feet etc.

    Keep your fitness up with rowing/cycling/swimming, can still do circuits without running, my running progress stalled due to not getting any mileage in the legs but my overall CV fitness rocketed through vast amounts of rowing and lots of circuits, made the return a lot easier gave me a good platform to build on
     
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  18. A350-800

    A350-800 Member

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    Hello mate sorry to hear you are going through this, I posted some exercises that really helped me at the bottom of this thread :)

    http://www.royalmarines.uk/threads/unknown-injury-lower-leg.96233/#post-593682

    The recommendations above from 'c' are excellent; I found particular relief from self massage and also by booking myself into a calf massage, sometimes it's a bit of a challenge to get deep into the post tib and tib anterior by yourself even with a tennis ball. You could ask someone else to help you at home if you want but I found I didn't need to after the calf massage :) as 'c' suggested working out the root cause of your issue (often a biomechanical issue such as weakness of post tib/overpronation/relative lack of flexibility) as well as treating the symptoms with the ice wellies works brilliantly :) I hope you manage to get yourself back soon :)
     
  19. A350-800

    A350-800 Member

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    Here are some from the other thread last week

    I found these exercises very helpful, but I recommend you introduce it gradually to strengthen your posterior muscles as I got a bit over excited and made things worse :L

    The posterior tibialis stretch:



    Posterior tibialis eccentric strengthening exercises:








    Using a tennis ball on the inside of your shins and doing gentle soleous is and gastroc stretches are helpful too :)
     
  20. C30

    C30 Member

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    It is your choice whether you mention it or not. I would say that because they are 'mild' and will be cleared up in a few weeks, that there is no necessity to mention it, but the ball is in your court. If they were severe you would have to mention it.
     
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