Also known as Medial Tibial Stress Syndrome (MTSS), shin splints is a catch all term, it is the universal "my shin hurts" term. But the pain could be lots of things, muscular irritation, compartment syndrome, stress fracture, or sometimes the actual periosteum of the (perisoteum is a thin connective tissue that is the most outside covering of a bone) of the tibia. How do you know what's contributing? Read on my friend!
The number one reason for shin splints to arise from the musculoskeletal abyss is usually/always too much, too fast.
I also want to say that shin splints are pretty normal, and manageable. Easing into walking, aerobics, running, whatever your flavor of exercise is, will mitigate the ouch.
Reasons why shin splints arise:
- A too large increase in mileage, speed, or terrain change for walkers/runners.
- Any scenario where you are increasing the demand of shock absorbing and work in foreleg muscles, will stir up this super unpleasant sensation.
First, I just want to remind all of us, myself included, that the body likes a little prep. The body will respond to stress and get stronger. The smart way to train is to gradually increase that stress over time to let your body get a little inflammation, rebuild tissues, and get back at it!
On the front end of my weight loss journey (30 down, 20 pounds to go), I weighed 183 pounds, at 5'2". And one day, after a stirring talk with my buddy Angie, I jumped on my weight loss train with gusto, toot toot! I remember my first run after being pretty patchy with exercise for about 7-8 months. It was intense/terrible/uncomfy. Shins a'fire! My caveman crazy brain over rode my physical therapist brain, and a walk with intervals, or just a walk the first time out would have been a great call.
Please ease into your program! But if you got a little wild and crazy read below, and we will talk about bone structure, anatomy, and some strategy to make shins go right!
Let's get all sciencey about shins.
Boney anatomy and bone irritation:
Boney anatomy and bone irritation:
Shins have two boney maroneys. Then tibia on the inside, and the fibula on the outside. They articulate at the foot with the talus.
How does the bone get irritated? The tibia flexes back just a wee bit as we strike the ground with our foot. When we train too much, too fast the bone tissue gets broken down faster than it can be rebuilt. It's akin to you cleaning up after one 2 year old pretty good. But if you had to keep up with a room full of 2 year olds and they had popsicles and several bins of toys, you could clean up a bit but you would never clear the room, and every person in the room would have sticky hands. Same idea with bone stimulation, and bone building.
Weight bearing, cyclical, repetitive exercise stimulates bone growth, but the growth needs time to happen. You pull the trigger on bone building when you do more than your normal level of activity. That tells your bone to start building up that area of bone, and it triggers bone building cells called osteoblasts to make stronger bone. This tissue turn around usually takes about 6 weeks. Longer in those with healing issues, and maybe even shorter for others. This process of rebuilding tissues after stress is called Wolff's law, a link is provided if you want to delve another layer deep into the theory and physiology. If the stress of the new activity is too great, the bone cannot remodel fast enough to recover from the stimulating inflammation, and irritation of the outer layer of bone (called the periosteum) occurs. If you keep training hard, this inflamed periosteum may start to fail and a stress fracture may happen.
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It would be rare to have JUST boney inflammation without a mad tendon or muscle too. And why is that muscle mad? Usually a weakness or tightness SOMEWHERES in the biomechanical chain. Or maybe you kept going when you were pretty fatigued.
Muscular anatomy:
Many muscles that attached to the lower leg are also movers and shakers of the foot. They contract to decelerate and accelerate your body and maintain your balance as your foot strikes the ground while walking or running. Dorsiflexors live on the front outside of your shins, and pull your toes up and plantarflexors point your toes, and live on the back side of your calf.
Academics divide the bottom of foot into four layers of foot muscles, ligaments and tendons because there is so many important structures there. Lots of tiny muscles here flexing, extending toes, spreading toes!
Most dorsiflexors and plantorflexors also do other jobs, like pulling the foot in or out, flex or extend toes! Muscles work in concert with each other during the running cycle, turning on and off as needed. Also rotation happens at the foot causing pronation and supination of the foot. Just throwing out this info to illustrate how complicated the anatomy and function of our glorious lower legs and feet really is, and why getting shin pain if your go out to hard is so easy to bake up.
I found great images of muscles on a massage therapy sight, and encourage you to visit this link http://medicfrom.com/publicpress/Massage/Basic_Clinical_Massage_15.html. Scroll like a champ down to the foreleg pics and just 'preciate all the LAYERS of muscles and tendons that surround the leg and foot!
Overuse and irritation in these muscles may be the source of your shin pain. And treating the muscles will aid your recovery. If your foot is slapping the ground as you walk or run it could mean weakness and tightness in the calf is making it hard for you to pull up your toes. MAYBE an old ankle sprain may have left you with decreased range of motion into pointing or flexing that wasn't really called out as a problem until you started walking or running. All of these issues may not be part of your story but even a mild asymmetry in core, hips, knees, or ankles can cause big problems if your are progressing into running. Even mild injuries from the past, if not addressed or rehabbed may have left a small mark in your symmetry.
Most of these issues are totally addressable and the comments above are not a full list of causal reasons for shin splits, just keep in mind asymmetries and weaknesses even from years and years ago CAN be improved. I am talking to you "I have always had weak ankles" people. Your body is strong and if you have never TRIED to strengthen a weakness, please don't assign yourself a label! (Last two sentences....a physical therapy rant!)
Academics divide the bottom of foot into four layers of foot muscles, ligaments and tendons because there is so many important structures there. Lots of tiny muscles here flexing, extending toes, spreading toes!
Most dorsiflexors and plantorflexors also do other jobs, like pulling the foot in or out, flex or extend toes! Muscles work in concert with each other during the running cycle, turning on and off as needed. Also rotation happens at the foot causing pronation and supination of the foot. Just throwing out this info to illustrate how complicated the anatomy and function of our glorious lower legs and feet really is, and why getting shin pain if your go out to hard is so easy to bake up.
I found great images of muscles on a massage therapy sight, and encourage you to visit this link http://medicfrom.com/publicpress/Massage/Basic_Clinical_Massage_15.html. Scroll like a champ down to the foreleg pics and just 'preciate all the LAYERS of muscles and tendons that surround the leg and foot!
Overuse and irritation in these muscles may be the source of your shin pain. And treating the muscles will aid your recovery. If your foot is slapping the ground as you walk or run it could mean weakness and tightness in the calf is making it hard for you to pull up your toes. MAYBE an old ankle sprain may have left you with decreased range of motion into pointing or flexing that wasn't really called out as a problem until you started walking or running. All of these issues may not be part of your story but even a mild asymmetry in core, hips, knees, or ankles can cause big problems if your are progressing into running. Even mild injuries from the past, if not addressed or rehabbed may have left a small mark in your symmetry.
Most of these issues are totally addressable and the comments above are not a full list of causal reasons for shin splits, just keep in mind asymmetries and weaknesses even from years and years ago CAN be improved. I am talking to you "I have always had weak ankles" people. Your body is strong and if you have never TRIED to strengthen a weakness, please don't assign yourself a label! (Last two sentences....a physical therapy rant!)
What to do?
So with front of the shin pain, most likely caused by a jump up in training, here are some recommendations.
1. Just be aware of other shin ouch sources and make sure this isn't your kind of pain:
- Stress fracture: stress fractures require the attention of a physician and imaging to rule it in, and will require rest from running to recover and heal it. Women typically are more vulnerable to this injury, and it may be characterized by pain lasting after a run, an ache along the tibia or fibula, painful to touch along the bone. It is a weakened spot of bone that cracks a bit from repetitive stress. A stress fracture can also happen in the bones of the foot.
- Compartment syndrome: so think of your leg as a container. When you exercise blood flow increases to your legs as the muscles demand fuel. Sometimes the swelling or flow of blood causes pain because the container fills up and is not relieved of this fluid shift fast enough. The lower leg is divided by fascial compartments, and a compartment may get too full pressing on blood vessels and nerves and due to it not being real stretchy. Muscle groups are covered in connective tissue that can trap the blood flow and cause pain, pins and needles, redness, and can be serious. If the pressure in the compartment is high, tissues actually cannot get blood flow and tissue death can occur. Totally not fear mongering here! It is rare but possible source of shin pain with exercise. Compartment syndrome in the lower leg is much more common in trauma situations (fracture, crushing type injury, gun shot wound) where there is a lot of damage and the swelling response is significant in a short amount of time.
- Check out the links for the above issues to allow you to explore the above issues deeper.
- WHEN EVER IN DOUBT, stop, collaborate and listen, but also see a physician.
2. Self Massage and stretch: Roll out the affected muscles with a can, tennis ball, golf ball, or foam roller. And do some good stretches! Never stretch cold by the way! Check out this video I made for Cathy, the author behind the Good Year series, who went out too hard at the beginning of her program and has had some shin splint issues. Always remember, when addressing a really mad muscle, you may get more muscular relaxation or tissue softening with a gentle approach.
VIDEO! Disclaimer: It's long! 13 minutes worth, and I am talking to Cathy, and I was going to remake it for public use cause I don't LOVE my outfit, but as this is my Portland launch month who knows when free time will arise again!
3. Ice: the magic elixir! 10-15 minutes at a time with a towel or other barrier to protect the skin several times (4-6) will help reduce pain and swelling. Always check your sensation and skin make sure that you are not "burning" your self with the ice. A good safe way to ice is to let the tissue come back to normal temp before reapplying more ice.
4. Rest: Definitely give the running or walking a rest. Bike, swim, and let the inflammation go down. When walking no longer reproduces pain, start back with a gentle walk, and reassess before you jump right back into running.
5. Elevate: elevating your feet above your heart will help to mechanically tilt the swelling away from your shins and back towards your heart.
6. Address muscular imbalances: Is one of your gastrocnemius (calf) muscles tighter than the other? Is one hip stronger than the other? Is your core getting tired out as you walk or run and then your form degrades? There may be something in your biomechanical chain (pelvis, core, hip, knee, ankle, and any of the stuff that attaches to these arts) breaking down a bit for you, and seeing a medical or fitness professional might help you get there! Or sign up with me and we will figure out your imbalances!
7. Give yourself time to build up. SO remember all the muscles that just make up your foreleg and foot? And how your core, hips and all kinds of other factors affect your walking and running gait?
The study listed below followed collegiate athletes and monitored those who got the MTSS. Those with less than 5 years of athletic experience, orthotics, and a prior history of stress fracture or MTSS were most likely to get MTSS. Through my therapy eyes, I would say anyone with orthotics is already predisposed due to someone in there course of life saw a motion that needed to be controlled by an orthotic. And I also want to highlight the years of experience and maybe throw out that the larger base of strength in hips, pelvis, buns, calfs, quads the less likely you will have glaring asymmetries or weaknesses. This month we are kicking off a strengthening program for Cathy, so check it out if you are interested in a nice base strengthening program.
Med Sci Sports Exerc. 2009 Mar;41(3):490-6. doi: 10.1249/MSS.0b013e31818b98e6.
8. TLC. Establishing a relationship with any of the take-care-of-your-body professionals. Rolfers, massage therapist, acupuncturist, etc may be necessary to help you stay as fit a s a fiddle! Maybe even a physical therapist?
Summary:
- Start slow! Slower than you think.
- Address tight and sore and weak muscles!
- REST, ICE, ELEVATE!
- Make sure it's not something else that needs the help of a medical professional! (Pain that does not go away when you stop exercising, numbness, tingling, loss of feeling or strength in the shin muscles)
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