Shin Splints

(Distilled knowledge from the internet and books)

Sources
What are they
Sore Shins
Shin Splints
Symptoms of shin splints
Causes of Shins Splints
Biomechanical factors
Overloading, and Overuse shin muscles
Muscle Imbalance
Initial Treatment
Relieve the Pain
Rest – Prevent further damage
Ice – Reduce the inflammation
Compress – Support the muscle
Elevation
Prevent Further Injury
Stretching and Massage
Consult a Doctor or Sports injury clinic
Identify the cause of the Shin Splints
Maintain Fitness
Prevention
Footwear
Running shops
Before Training Stretching Exercises
Strengthening
Running style
Other treatments
Summary
Symptoms
Causes
Initial Treatment
Prevention
Pronation

Sources

[wikipedia][sportsinjuryclinic][BUPA][thestretchinghandbook][Watfxc.com][Marathon training for Dummies][Running start to finish][Runners world complete book of running]

What are they

Sore Shins

The most common causes of shin pain are:
General shin soreness, shin splints, and stress fractures.

General shin soreness can be simply a problem with overusing or stretching the shin muscle, which is often overcome by following the RICE principle;
Rest after the shin become sore – avoid walking about for the rest of the day or even the next day
Ice the shin after the run by applying for example a bag of ice wrapped in a towel to the shin
Compress the shin afterwards with an elasticated long sock or elasticated bandage
Elevate the shin.

This will cure most shin soreness within a couple of days. If the pain persists or recurs with further running then further action is required. Afterwards sore shins, the next most common problem is the shin splint.

Shin Splints

Shin splint is a general term used to refer to a recurring painful condition in the shins, or to a pain at the front of the lower leg. It's often used to describe the pain caused by inflammation of the thin layer of tissue that covers the bone (a condition called Medial Tibia Stress Syndrome (MTSS) (Tibia is the bone that runs from your knee to your ankle), by tiny fractures on the surface of the bone, and nerve irritations. The most common type that is experienced involves the tearing away of the muscle tissue that attaches to the front of the lower leg

There is confusion from the term Shin Splints and medical professionals may try to avoid using it.

True shin splints symptoms occur at the front inside of the shin bone and can arise from a number of causes. This includes stress put on the bone during weight-bearing activities such as running, dancing, aerobics, gymnastics, football and hockey jumping or sprinting, and may be very slow to heal.

Symptoms of shin splints

The pain associated with shin splints is a result of fatigue and trauma to the muscle's tendons where they attach themselves to the tibia.

In an effort to keep the foot, ankle and lower leg stable, the muscles exert a great force on the tibia. This excessive force can result in the tendons being partially torn away from the bone. This can cause the following symptoms:
  • (Razor sharp) Pain, tenderness, or aching over the inside lower half of the shin
  • Pain at the start of exercise which often eases as the session continues, but aches afterwards
  • Pain often returns after activity and may be at its worse the next morning.
  • Sometimes some swelling.
  • Lumps and bumps may be felt when feeling the inside of the shin bone.
  • Pain when the toes or foot are bent downwards.
  • A redness over the inside of the shin (not always present).

  • Shin splint pain tends to reduce within an exercise session, and can ache afterwards. If the pain increases with exercise then the shin should be investigated further – you could be suffering from a stress fracture or Chronic Compartment Syndrome.

    Causes of Shins Splints

    Knowing the cause of a problem can help to get rid of it.

    Shin splints occur when you put too much stress and strain on your shin bone. This happens when there is repetitive impact on your shin bone during weight-bearing sports or activities. There are main 3 causes of shins splints;
  • Biomechanical Factors
  • Overloading and Overuse
  • Muscle Imbalance

  • Biomechanical factors

    This is how the body moves and reacts with itself. When you consider any sport-induced injury it might be an idea to look at the whole body to find the cause of the problem. The following can contribute to Shin Splints and one or all of these can be the cause or recurring shin pains.
  • Over Pronation is a major cause
  • Poor running style such as excessive leaning forward
  • Landing on the balls of your feet (fore foot striking)
  • Landing too far back on the heels causing the foot to flap down at the front
  • Running with your feet pointing too far in or out
  • Decreased Flexibility of the ankle joint
  • Overloading, and Overuse shin muscles

    Running itself doesn’t cause shin splints. The shock force of repeated landings and change of direction can cause the problem. When the muscles and tendons become fatigued and overloaded, they lose their ability to adequately absorb the damaging shock force. The muscles can be overloaded and overused from the following:
  • Starting running (novice runners)
  • Increasing the running intensity too quickly, (speed, Distance, number of training sessions)
  • Exercising on, or just starting to run on hard surfaces (Concrete is worst)
  • Exercising on uneven ground
  • Returning to an exercise program to soon after injury
  • Increases in, or excess up or downhill running
  • Running in worn down shoes
  • Muscle Imbalance

    If the calf muscle is stronger then the shin muscles (in relative terms) then shin muscle has to work proportionally harder. This leads to the shin muscle fatiguing and the becoming overloaded.

    Tight Achilles or calf muscles can cause shin splints in a similar way, the tight calf muscles can cause an overstretch in the shin muscles, overstretched muscles can become weakened and inflamed.

    Initial Treatment

    In many cases one is able to continue training with a mild case of shin splints. Time off from running may be required in severe cases. Once you have identified that you have shin splints you will want to repair the damage and get back to fitness as soon as you can.

    What you can do. Some of these ideas depend on the severity of the shin splints.
  • Relieve the pain
  • Prevent further damage
  • Stretching and Massage
  • Consult a sports injury expert
  • Identify the cause of the shin splints
  • Maintain your fitness

  • Relieve the Pain

    Follow the “RICE” principles – Rest, Ice, Compress and Elevate immediately after the run. Pain relief may be taken in Anti-inflammatory medication or Anti-Inflammatory Gel may also be necessary (Such as over the counter medicines like Ibuprofen). If you have seen a doctor about your symptoms, they may also prescribe anti-inflammatory medication. RICE should be followed for 2 to 3 days depending on the severity of the symptoms.

    Rest – Prevent further damage

    Remove the cause of the problem until you are mended. In this case this is running, so Rest until your shins feel OK. This can take a few days to a week, a month or more. The longer you leave the treatments of shin splints the longer the recovery will take. Like any injury, resting the affected part allows the injury to heal. While you are recovering, don't do activities that cause pain. You can resume running gradually once your shins are no longer painful. This rest will relieve the injury but won’t necessarily cure it. You can keep high fitness levels cross training with other sports, such as swimming or cycling. You might be able to continue running while you are recovering.

    Ice – Reduce the inflammation

    Like all injuries, applying ice or cold therapy in the early stages can reduce pain and inflammation. A cold compress is typically described as a bag of ice or frozen peas wrapped in a tea towel and placed on the affected area. You can also use ‘freezer packs’ for camping and picnics. Plastic cups filled with water can be used or putting the lower leg in a bath of cold (or iced) water. Don’t apply ice directly to the skin though. Apply the ice for about 20 minutes every couple of hours to ease the pain. A cold wet flannel can reduce mild inflammation.

    Compress – Support the muscle

    Bandaging around the shin muscle, or taping that area allows the shin to rest at removes the pressure from the muscle. Compression socks, sleeves or elasticated bandages can be used. Recurring shin splints can be compressed like this to allow a runner to continue running. Taping at the top of the shin and at the ankle can have a similar effect. If you are compressing the legs, make sure you still have blood going to the toes – if they go purple it is far to tight!

    Elevation

    When I read all about shin splints, all the guides gave a variation of the RICE principle. I can understand Rest, Ice and Compress; however when it comes to Elevation the guides become very vague…. What I read suggests that when you are in the pain relief stage of recover you should Elevate your shin above your heart. Hmmm, so after an evening run and I got the pain from shin splints I have to raise my shin above my heart for the rest of the evening? This will make sitting watching the TV awkward, eating dinner nearly impossible (Imagine teaching your kids manners – ‘don’t put your elbows on the table’ type of thing – and their response will be ‘but dad has his foot on the table’)

    Prevent Further Injury

    OK, you have recovered from a dose of shin splints (is dose the right word? I don’t know), but then next time you run the problem recurs. So to prevent further injuries you need to analyse what caused the problem in the first place. If the shin splint is a one off occurrence and recovers this is good. If the shin splints are a regular part of your running life, a running diary might be a good idea. Note the runs that you do, hills, distance, speed and so on and then mark clearly where you get shin splints – there might be a pattern that gives a clue to the cause. Also mark down any strength training you are doing. A paper diary is good but there also computer based diaries as well (or a simple spreadsheet).

    Stretching and Massage

    Tight calves cause a muscular imbalance where the shin muscles become overstretched and weakened. Inflexible shin muscles will get aggravated more easily. 30 seconds to 5 minutes of stretching can increase the flexibility of both sets of muscles.

    A friction massage using the thumbs may prove to be beneficial. Firmly rub the affected area from the bottom of the leg upward.

    After the initial 24 hours, some heat treatment and deep tissue massage can speed up the healing process of the muscles and tendons. However, avoid the inflamed periostium close to the bone.

    Consult a Doctor or Sports injury clinic

    Recurring shin splints should be checked by a doctor or clinician who will investigate the shin, lower leg and ankle to confirm the diagnosis if shin splints.

    They can provide a range of treatments and advice to help relieve pain and promote healing. They can help devise a graduated training programme to promote recovery and help you return to your usual sports activities. As a last resort an operation may be offered

    Identify the cause of the Shin Splints

    You can repair the damage caused to your shins however unless you identify what caused the damage in the first place the next time you run you are likely to return with shin splints again.

    Here are some factors that cause shin splints, this is easier for a regular runner who suddenly starts suffering from shin splints than for a new runner:
  • Have you changed your running shoes recently (up to 2 months ago, depending on the miles you run)
  • Are your running shoes old and worn
  • Did you get ‘gait analysis’ and other techniques by specialist running shop staff when you changed your running shoes
  • Do you Over pronate? There are a few tests for this – read the last section of this for more details.
  • Have you changed your running surface (grass to tarmac for example) or do you run on hard surfaces (tarmac, or concrete)
  • Have you suddenly increased the distance you run by more than 10% a week (apart from one off races)
  • Have you increased the amount of hill running.
  • Do you have a rest day or 2 in a weekly running schedule
  • Have you increased or started weight training your legs
  • If you do weight training on your calf muscles, do you match this with weight training for your shins. Weights should be done on opposite muscles

  • Identifying which of these is the root cause can be tricky and more than 1 thing can be combined to cause shin splints.

    For a new runner the first thing I would consider looking at the running shoes you are wearing. As a new runner it can be tricky to get the ideal shoe. Then consider if you have run hard or are easing into running.

    Maintain Fitness

    Recovering from shin splints can take a week, a month or more to be fully recovered. The first principle of treatment is to stop doing whatever caused the injury, this however doesn’t mean you can be inactive for the next month or more. While you are resting from running you can maintain your cardiovascular systems (heart, blood systems and lungs) with other exercises. The common alternative exercises are swimming and cycling. These are not as intense as running however they do keep your lungs and heart working. Running in water is another option, this is where you wear some floatation device, go to the deep bit of a pool – where you can’t touch the bottom and do the motion of running (you don’t have to move about the pool). These 3 exercises are less intense than running so you will want to exercise for longer to maintain your fitness. If the shin splints are milder treadmill running can be used with no incline. The smooth belt provides a good surface for the foot to land on and the flat running removes stretching due to downhill running. Non of these recovery exercises should put stress on your shins and if you can find another that you enjoy then go for that. For a new runner, after saying all this about resting and recovering, continuing with a running programme can help. Running can strengthen the leg muscles since it will strengthen the leg muscles. Having said that, though you might want to keep running through the recovery process, it will take longer though and you can ease the pain you might suffer. Some recoveries might take a very long time and an absence from running for say a year, might not be acceptable.

    Prevention

    The best way to deal with shin splints, and any injury is to prevent them happening in the first place. I have mentioned a few factors that can cause shin splints above, and I think it is obvious that reducing these factors can prevent an injury. However if you take that to an extreme, it will mean no running – and that is the last thing you want to do. There are some things you can do that will help. These are some of the factors: Biomechanical factors - Over pronation or supination in the foot - Poor running style - Landing on the balls or toes of your feet (fore foot striking) - Running with your feet pointing in or out - Decreased Flexibility of the ankle joint Overloading, and Overuse shin muscles - Increasing the running intensity too quickly (Distance, number of training sessions) - Exercising on hard surfaces - Exercising on uneven ground - Returning to an exercise program to soon after injury - Increases in up or downhill running Muscle Imbalance - Calf muscle is stronger than the shin - Tight calves

    Footwear

    The way your foot lands makes a huge impact on your injuries, and this has been given 3 categories – Over Pronation, Neutral and Supination. Overpronators are more prone to Shin splints. Footwear or inserts have been designed to adjust the foot landing and reduce injuries. A specialist running shop will be able to advise on a range of suitable trainers and running shoes, as well as analysing your running style. As trainers age the cushioning breaks down, with most lasting about 500 miles. Here a running log is useful to record how many miles a pair has traveled and when to change them. It is amazing how quickly the miles add up. 500 miles is 10 miles a week for a year, or a 3 mile run every other day. If your trainers are getting old consider a new pair. Heavy landing runners can wear down the cushioning quicker than lighter footed runners New trainers (a month or 2) might not be suitable and have slowly aggravated the shins. In which case a trip to a running shop might be necessary if there are no other obvious reasons for your shin splints.

    Running shops

    Specialist running shops know what they are talking about. If you go along and ask for a pair of trainers they will hopefully put you on a treadmill to look at you run. However the more information you give them the better they are at their job. If you go along with your old pair to show them, and explain any injuries they have a better chance to get the right pair for your feet.

    Before Training

    When you first wake up your muscles are cold, and as you become more mobile during the day your muscles warm up and lengthen. After you have exercised your muscles are longer again, they then shrink back to where they were in the morning as you slow down and sleep. This is normal, and the change can be 10% or more during a day. If you hit cold muscles with a full on work out without letting them lengthen slowly you are likely to exaggerate any imbalances between calf and shin muscle. For this reason a good warm up is important. Warm up should consist of gentle running, a little stretching, slightly more intense running, a rest and then the work out. At the end of a run just stopping is not so good either. The toxins created from the run are still there in your muscles; the muscles are still loose and lengthened. The toxins can cause a pain in the legs following the run (lactic acid build up) and that can cause a limp, which creates an imbalance with your muscles. A warm down is the opposite of a warm up. You can do the following to reduce the risk of shin splints: - The shins can be warmed (for example warm towels or a wheat bag) to loosen the area. - An elasticated bandage or taping the ankle, shins and arch of the foot can be used to protect the shin. - Massage the area before exercise - Stretch the calf muscles - Anti-inflammatory over the counter medicine can be taken (Ibuprofen)

    Stretching Exercises

    Stretching exercises can loosen stiff muscles. Stiff muscles can cause muscle imbalances between the calf and the shin. Stretching the calf and thigh muscles before running can reduce the pain of shin splints, however a thorough stretching routine should come after a training session. After training the muscles are looser and the stretches have more effect. There are 2 types of stretches, stationary and dynamic stretches. Stationary stretches are where the limbs are manipulated or moved to pull the muscle. The position is held for a time and then limbs return to their starting positions. Short stretches are held for a count of 5, and deep stretches are held for a count of 30. Never do these stretches with a bounce (for example touching your toes – bobbing down and up quickly) the stretch is to be in a controlled fashion. Dynamic stretches occur as you are moving such as an exaggerated move as you walk. This produces excess stress on the muscle and the idea is that with this excess movement the muscle will become more capable of the normal stresses. Here are some stationary stretches that might help: Shin stretches - Kneel down both knees on the floor, legs parallel and feet touching under your bum), gently sit backwards gently stretching the shin - When you are sitting at a desk (in work for example), bend the legs under the seat and the toes pointing into the floor, and the feet vertical. The feet are under the kept in position and the legs moved forward to stretch the shin muscles Calf Stretches - Stand an arm length from a wall, feet shoulder width apart. Keeping the heels of the feet on the floor, gently lean forward to stretch the calf muscles. This stretch can be modified by moving further away from the wall, or by stretching one calf at a time by lifting the other foot of the ground. - Stand with the feet shoulder width apart. Keep the heels of your feet on the ground, bend the knees forward and so that you torso is lowering straight down towards your feet. - On a stair balance on the balls of your feet with the heel hanging over the edge of the step or ledge, gently lower your heels to perform the stretch Upper leg stretching of the quads and hamstrings should also be undertaken. All the parts of the body are connected and a tight hamstring can impact on the shins. Touching your toes with your knee straight is a good example of hamstring stretch and sitting with straight legs and bending to move your chest towards the knee is a good example of a quad stretch.

    Strengthening

    Strengthening and conditioning the muscles of the lower leg will can help to prevent shin splints. There are a number of specific strengthening exercises you can do for these muscles. Running cross country benefits from stronger lower leg muscles. Sitting exercises, repeat these repetitions 10 to 15 times, rest and do 3 sets.: - Place, and keep the feet flat on the floor, lift the toes. Put some weight on the toes to increase the strengthening - Place the feet flat on the floor and raise the heel, hold for a count of 1 and lower - Place the feet flat on the floor and raise the ball of the foot, hold for a count of 1 and lower - Put the foot in the air and draw out the letters of the alphabet with the big toe of each foot - Sit on a high chair or table and feet dangling in the air, suspend a weight from your foot and raise and lower this weight with the foot - Use a resistance band (elastic band) held at one end (round the leg of some furniture), sit on the floor and stretch the band round a foot, Move the foot forwards and backwards and side to side against the bands resistance Standing Exercises: - Raise yourself up and down onto your toes (tip toes). Make this harder by holding weights in your hands or in a backpack - Raise yourself up and down onto your toes (tip toes). Make this harder by doing this while standing on a step and letting your heel lower down under the step to stretch the calf - Walking down steep hills. - Walking on toes. - Walking on heels. - Walking with feet turned inward and outward. - With socks off, gather up a towel that is flat on the floor, using only the toes. - Pick up marbles using the toes.

    Running style

    How you actually run can (surprisingly) affect how your body moves and this can have an effect on injuries. However actually changing the way you run is quite a drastic step and curing one problem might create another (the body is a series of linked mechanisms so change one movement and they all change). If you can, run on a treadmill with a mirror in front of you to analyse your running style. Look at how each part of your body moves as you run, the treadmill speed should be set at a normal outside running speed. If not perhaps there are shop windows you can look in as your run past - Head – there should be no excessive movement (wobbling) however Paula Radcliffe is well known for her wobbling head style. Oh, head up as well, - Mouth should be smiling all the way – this is fun after all. - Shoulders should gently roll with the arm movement - Arms and hands should move forwards and backwards and not out to the side (you are wanting to move forwards after all), the thumb moves from brushing your hip and as far across your chest on the up stroke as the nipples. Arms crossing the chest haunches your shoulders and creates a more stressed running style - Hands should be relaxed - Chest points forwards - Hips roll with the legs movement but no excess movement - Knees move forwards and backwards in a straight line and don’t touch as you run - Feet move in a straight line and not out to the sides - Toes point straight ahead or slightly outwards - Stride length should be easy and not over long, shorter strides are OK - Silent running, if you can hear your feet pounding on the pavement then you are landing hard which can send shocks up your legs - Your running style should be smooth and “With style” - Try to land your feet under you rather than in front of the body or behind the body (to prevent landing on the heels excessively or too much on the toes) Where the foot lands can affect your shins, for example, hitting the ground with the toes, balls of your feet or heels first. The further forward on your feet that you land the quicker your running style but the more stress you place on your calf muscles and under uses your hamstrings. Heel striking is best for reducing shocks up your legs.

    Other treatments

    - Cross country runners tend to tape just above the ankle and just below the knee with sports tape to prevent movement of bones, and to prevent painful shin splints. - Don't suddenly change your training regime. As a rule of thumb with running, distances should not increase by more than 10% per week. For example, if you complete a total of 10 miles one week, do not increase above 11 miles the next week. This helps to ensure the muscles are not overworked. - For runners, try to avoid always running on hard pavements as they provide no shock absorption. Try running some of the time on tarmac, grass or even sand to reduce the shock passed through the legs. Treadmill training for a while can help. - Uneven running surfaces can be avoided - Eat a diet rich in vitamins and minerals, and make sure you eat enough calcium-rich foods such as dairy products. These are important for keeping your bones strong and healthy. - Maintain a running log to track progression This will make it easier to identify when and why problems occur.

    Summary

    Symptoms

    Shin splints, simply put are a recurring pain in the shin. The pain reduces during exercise and returns afterwards.

    Causes

    Shin splints are caused be the shin muscle being overworked. This can be caused by your running such as foot pronation, running style, landing on the balls of your feet or toes, feet pointing in or out They can be caused by overloading the shin muscles such as increasing your running intensity too quickly, exercising on hard surfaces or uneven ground, excessive downhill running and worn down trainers. Finally they can be caused by muscle imbalances where the calf muscles are stronger than the shin (in relative terms) of the calf is less flexible. To a lesser extent the other leg muscles play a part here.

    Initial Treatment

    After a run where you suffer from shin splints, relieve the pain by RICE (Rest, Ice, Compression and maybe Elevation) and take an anti-inflammatory drug if required. Then prevent further damage by working out what caused them in the first place, a running diary might be a good idea for this Since one of the causes can be tight muscles, stretching the leg muscles can help, stretch before, half way through and after runs. Identify the cause of the shin splints. What have you changed in your running recently? Something changes to make you injured so identify what it was to cause the initial injury. First place to look is often running shoes, then the terrain you are running over and the distances. Maintain your fitness with another sport while you are resting from running and if the shin splints keep happening consult a specialist .

    Prevention

    Get your gait analysed next time you are getting your running shoes to identify your running style and remember that it can change over time, and consider changing your trainers if you haven’t for a while Have a good look in a mirror as you run to check your running style and identify any odd bits with your running Decrease your running intensity a bit and increase slowly. Avoid hard running surfaces and too much uneven ground and lots of hills for a while Strengthen your shin and calf muscles Before you run do a good warm up routine and warm down afterwards, followed by stretching.

    Pronation

    Pronation is the way the foot rolls after it hits the ground. If it rolls inwards too much this is Over Pronation, if it rolls outwards it is called supination or under pronation. When the foot lands it twists and rolls and pushes of to propel you forward, this twisting twists the tibia slightly and this twists the calf muscles. Too much of this twisting can tighten the calf muscle and create problems with the shin but also since the leg is connected, this twisting also affects the knees and hips. Too much twisting can cause a shin fracture of the tibia. Females are more likely to suffer from shin splints in this way because their hips are wider than mens, the feet strike the ground at a greater angle and causes more over pronation. Running shoes are designed to reduce the effects of Over Pronation or Supination (under pronation) Looking at the back of your feet can give you an indication of your feet, the picture below shows supinated feet on the left and over pronating feet on the right.

    This is also linked to your foots arch, and this can be tested with a wet test. Wet your feet, stand normally, then step away and check your footprints. If you leave an impression of your whole foot, arch and all, you have flat feet (1)(supination likely). If what shows up is mostly ball and heel (2)(pronation likely), your arches are high. If your footprint shows something in between the two extremes (3), with a moderate amount of arch, you’re blessed with a normal foot that shouldn’t cause you any problems.