Running Injuries – The Big Five Series – Shin Splints

Definition

Inflammation of the muscle attachments and interosseous   membranes to the tibia (shin bone) on the inside of the front of the lower leg. Note: “shin splints” is a very widely used phrase and can refer to several lower leg injuries. The focus of this description is specifically on the inflammation described above.

Symptoms

• Pain or tenderness along the inside of the shin, usually about halfway down the shin. Pain and tenderness may extend to the knee
• Pain on palpation of the shin
• Pain is most severe at the start of a run, but may disappear during a run, as the muscles loosen up. This is different to a stress fracture, where there is pain during weight bearing activities (walking, stair-climbing)

Causes

• Inflexible calf muscles and tight
• Achilles tendons – place more stress on to the muscle attachments
• Overpronation (feet rotate too far inward on impact) excessive running on hard surfaces, such as concrete pavements
• Incorrect or worn shoes
• Overtraining, or a rapid increase in training load or intensity
• Beginner runners are more susceptible to this problem for a variety of reasons, but most commonly due to the fact that the leg muscles have not been stressed in such a way before they started running.

Shin Splint – Treatment Methods

Self-treatment

• Stop running, especially in the case of severe pain, if pain is mild, then reduce training load and intensity, and avoid downhill running and running on cambered surfaces
• Take a course (5 – 7 days) of non-steroidal anti-inflammatory drugs(ibuprofen/voltaren/cataflam/mobic) available from your general practitioner or pharmacist
• Apply ice to the shin area – for 10 minutes every 2 hours, in order to reduce the inflammation
• Self-massage, using arnica oil or an anti-inflammatory gel, to the muscle only (along the inside of the shin).
• Stretching of the gastrocnemius and soleus muscles. Hold for 30 secs. Relax slowly. Repeat to opposite side. Repeat stretch 2 – 3 times per day.
• Remember to stretch well before running
• Return to running gradually
• Full recovery is usually between two to four weeks

Medical treatment

• Physiotherapy, if injury doesn’t respond to self-treatment in 2 to 3 weeks
• Orthotist or podiatrist for custom-made orthotics to control overpronation
• Orthopaedic surgeon – if injury does not respond to physiotherapy treatment, a bone scan, diagnostic ultrasound or X-ray may be necessary to check for a stress fracture.

Alternative exercises

• swimming, pool running, cycling (in low gear) “spinning”
• avoid any weight-bearing exercises

Preventative measures

• Stretching of the gastrocnemius and soleus muscles. Hold each stretch for  30 seconds, relax slowly.
• Repeat stretches 2 – 3 times per day. Remember to stretch well before running.

Strengthening of foot and calf muscles

1. Place a weight around the foot, and move your foot up and down from the ankle, with no movement in the rest of the leg. Or use a partner to grasp the foot and provide manual resistance.
2. Band exercises. Anchor one end of an exercise band (e.g; inner tubing of bicycle) to a heavy object, such as the leg of a couch. Loop the other end around the foot. Move the foot up, down, and from side to side against the band’s resistance to exercise different muscle groups.

• Correct shoes, specifically motion-control shoes and orthotics to correct overpronation
• Always apply ice after running
• Run on soft surfaces
• Avoid overstriding, which places more stress onto the shins
• Gradual progression of training programme
• Incorporate rest into training programme