Shin splints; some advice on avoiding them and getting rid of them

By Judith Cooper, Sport and Remedial Massage Therapist

I see a lot of runners complaining of shin splints; many of them are relatively new to running or have recently increased the level of their training. In many cases, if caught early on, this condition responds well to treatment and need not become a chronic problem.

Shin splints are also known as “medial tibial stress syndrome” which simply means that stress has caused an injury around the medial (inside) part of the tibia. The exact location of the pain varies from individual to individual, but generally, this is what to look out for:

• Pain or tenderness on the inside or front part of the lower leg
• Pain may ease after a short spell of running (although with some types of shin splints it can get worse!)
• Pain felt when toes are extended
• Pain felt on weight bearing
• Pain felt if inside of shin is pressed

The other injury commonly associated with the tibia is the stress fracture. Generally, the pain of a stress fracture is more constant than that of shin splints and does not go away when the muscles are warmed up and flexible. There is often more significant pain and swelling with a stress fracture. In any event, if the pain in your shins does not go away after 2-3 weeks of correct treatment then go and see a physiotherapist or qualified sports massage therapist.

So, what has happened and why? The precise detail will vary from individual to individual, but the basics are:

• The soleus muscle (lies underneath the big calf muscle at the back) attaches to the back of the tibia. If it becomes tight and short, it can pull on its attachment to the tibia, irritating the periosteum (tissue covering the bone) and causing inflammation and pain. When running, the soleus has to flex and pull many times, aggravating the problem.
• Tightness in the muscles at the back of the lower leg (calf) will put strain on the muscles at the front of the lower leg which work to lift the foot upwards and control foot plant. This can lead to the tearing of fibres particularly where they attach to the bone.

How can these things happen?

• Sudden onset of training without gradual build up.
• Sudden significant increase in training without gradual build up.
• Excessive running on hard surfaces.
• Sudden introduction of hill work or increase in hill work.
• Inappropriate or old footwear offering inadequate support.
• Overpronation (foot rolling in) causes muscles of the lower leg and foot to overwork as they try and stabilize the foot. Continual overuse can cause them to tear where they attach to the tibia.
• Toe running (landing without proper heel contact) also stresses the lower leg muscles
• Beginners are more likely to get them simply because their bodies are not used to the work, which is why is so important to build up gradually.

What to do if you develop shin splints?

• If the pain is severe then stop running. Follow RICE principles; Rest, Ice, Compression, Elevation. Ice the affected area for about 8 minutes every two hours or whenever you can until the inflammation subsides (normally within 48 hours). Anti-inflammatories can help but should not be relied upon or used simply to mask the pain. Rehabilitate the injury gradually. Do not rush back to running but rather build back slowly with some cross training. Get some treatment; sports massage will greatly help the muscles to increase in flexibility, speeding recovery and making re-injury less likely.
• If the pain is mild then reduce your training and avoid hills and hard surfaces. Remember concrete is 6 x harsher than asphalt and asphalt is 6 x harsher than packed dirt. Follow RICE principles, get some treatment and monitor the situation carefully

What preventative measures are there?

• Improve flexibility and length in the affected muscles by regular stretching and deep massage, particularly of the gastrocnemius and soleus muscles. A physio or sports massage therapist can help if you are unsure of suitable stretches.
• Avoid overtraining and incorporate rest into your training regime.
• Warm up thoroughly before running and just as importantly, warm down. Warming down reduces blood pooling after exercise and has been shown to be of great benefit to the healing process.
• Cool your legs down after training; hose them down with cold water or put some ice on them. This will reduce inflammation and consequently the build up of inflexible scar tissue.
• Check your footwear. Is is suitable for the work you are doing. Does it support your foot? Is it old and tired? Go to a reputable supplier where you will be able to ask for advice.
• How are your foot mechanics? Do your shoes wear unevenly? Perhaps you are overpronating and would benefit from shoe inserts or orthotics to help?

Many injuries associated with running are easily treated and easily avoided. Regular massage keeps soft tissues in optimum condition making injury less likely. For more information, contact Judith or check out the Sports Massage Association (SMA) website www.thesma.org

Judith Cooper is a member of the Sports Massage Association (www.thesma.org) and has a clinic at John Honey Physiotherapy in Macclesfield, 01625 500777. You can contact her direct on 07932 794420.