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What are shin splints and how can I avoid them?

Shin splints is a "catch all" term for pain located primarily on the front of a runner's shin. Tight calf muscles and tight Achilles Tendons can increase the likelihood of developing shin splints. Stretching the calves and Achilles are very important for preventing shin splints. Increasing weekly mileage too quickly can also lead to an increased incidence of shin splints. Be sure to follow the 10% rule of running by keeping the increase in weekly mileage to 10% per week. Running on softer surfaces like dirt, gravel, grass or a track can reduce the risk of developing shin splints. Developing the muscles in the shin, ankle and foot can also help prevent shin splints. A few exercises include, heel walking or walking across a room keeping toes lifted; towel curls, place the heel on the end of a hand towel and using the toes curl the towel underneath the foot; alphabets, trace the alphabet in the air with the foot; and marbles, pick up marbles on the floor with the toes and place the marbles in a cup. Finally if you have developed shin splints, an ice cup massage is an excellent way to treat the injury. Fill a small paper cup with water and put it in the freezer. Once frozen, tear down the sides of the cup and rub the ice cup over the affected area. Five minutes of ice massage on the affected area after a run will go a long way in preventing shin splints from flaring up and sidelining a runner.

Shin splints are normally caused by muscle imbalances between anterior tibialis and calve muscles (soleus and gastrocnemius) - such as tight calves and a weak anterior tibialis. Flat feet - often the leading cause of shin splints, this condition causes the anterior tibialis to become overstretched, weakened and inflamed. Try non-weight bearing activity such as swimming, upper body ergometer and bicycling. Do light exercise to including foam rolling of the calves, IT band, quadriceps and Piriformis. Flexibility should follow, statically stretching the calves, and hip flexors. In addition, you should work on strengthening the anterior tibialis through resisted dorsiflexion and single-leg balance exercises.

This is a potentially complex problem with relatively simple treatments that can be challenging for athletes of all types. The medical term is Medial Tibial Stress Syndrome and it encompasses everything on the continuum from shin splints, to bone stress reaction (think of it as pre-stress fracture), to stress fracture. A variety of biomechanical forces can be at work here, but essentially it all comes down to too much, too soon. You push your lower leg muscles into doing something they are not ready to do.

First, you notice a muscle ache along the shin bone (most often on the inside) that lasts longer or is more intense than regular pains after running. Later, this begins to be something that causes you to shorten or change your route. It is often associated with increasing mileage or advancing hills (especially downhill) too quickly. 

Treatment is relative rest from running, but not necessarily rest from exercise. Cross-training is great and you really need to strengthen all the leg muscles, but especially those of the lower leg. These are the muscles that are responsible for ankle motion and some toe movements. Don’t forget stretching, a loose muscle functions better. Ibuprofen in the early stages is helpful. Ice massage is a great technique that can help with swelling and prevent scar tissue formation. When the pain has improved, a gradual increase of mileage and hills is essential to prevent re-injury. A good rule of thumb is only increasing weekly mileage by 10% each week.

There are a variety of braces and compression sleeves developed to help with shin splints. Taping has also been used. The idea is that compression will support the muscles and prevent some of the strain where they attach to the bone. Individually, some people have improvement with them, but there is no scientific evidence out there that they do anything. Arch supports may provide more support, especially in heel pronators or people with flat feet.

The most important thing with shin splints is DON’T IGNORE THEM! This is an injury that lies somewhere on a continuum. By pushing through shin splints you can push yourself right into a stress fracture. Stress fractures can be more difficult to heal than regular, traumatic fractures. This can translate into months without running.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.