Wednesday, June 21, 2006

Prevent and Treat Shin Splints

Prevent and Treat Shin Splints

Any runner or athlete engaging in repetitive impact activities is in danger of developing shin splints, that awful pain in the front lower leg that, if left untreated, can disrupt your training for months. If you’ve ever experienced them, you certainly don’t ever want to again. And if you’ve never experienced them, trust me, you’re not missing out on anything pleasant.

The fancy name for shin splints is "medial tibial stress syndrome," which makes the diagnosis sound much more self-absorbed than is truly the case. But, doctors, trainers, and therapists have an innate motivation to feel smarter and more desirable than the rest of the world, so they like to attach complex terminology to every condition. It also helps to make others feel inadequate and worthless. Regardless, you can treat yourself, and we can start by breaking down the daunting label of "medial tibial stress syndrome" word by word.

The term medial simply means "inner," while tibial refers to the tibia, which is your shin bone. We all know what stress and syndrome mean. In other words, medial tibial stress syndrome is a condition in which the inner portion of your shin bone is stressed excessively. I know - we should have just stuck with the term shin splints.

Regardless of terminology, it’s important to know that a number of muscles attach to the inner portion of you shin bone. And when they’re overworked, they develop microscopic (or larger) tears that result in swelling and pain. In some cases, the outer lining of the bone itself becomes damaged and inflamed, and this can become excruciatingly painful to the touch, during walking or jogging, or when accidentally banging your leg into the side of the bed frame.

The key to treating shin splints, or preventing them in the first place, is to discover why these poor muscles are being overworked. In some cases, you may just need to ease back on running or impact activities. You may simply need more variety in your program, a change of shoes or terrain, or technique modifications. Sometimes, however, the problem is more profound and involves wicked muscle imbalances, foot alignment problems, flexibility issues, or leg length discrepancies. These issues, of course, may require more sophisticated treatment regimens and, sometimes, outrageous out-of-pocket expenses.

No matter the cause, there are options that can be useful for anyone treating their very own case of shin splints, or to prevent any initial occurrence. These will be laid out for you shortly. Nevertheless, it’s a wise idea to visit your doctor if your shin splints are interfering with your workout program, causing severe pain, or destroying your very semblance of a normal, peaceful life. It can happen - I’ve seen it. Don’t be a victim. Instead, follow these guidelines:

1. Proper Shoe Fit. Everyone’s feet are slightly different, and since this is no longer the 1970’s, we can’t all wear our Converse All-Stars and hope for the best. Nowadays, there are specific shoe designs for specific feet, and you should visit a qualified outfitter to determine the precise fit for yours. Most individuals that experience shin splints, however, usually have an arch that’s crashing down like a turn-of-the-century tech stock with every step, and they need some solid, built-in arch support. In some cases, the individual in question may also need a separate insert with an additional arch and rearfoot support to control excess "crashing."
This is key. During walking and running, everyone’s foot goes through a stage where the arch drops (pronation), allowing the foot to absorb shock, and a stage where the arch returns to normal (supination), allowing you to “push off” forcefully into your next stride. In some cases, the arch remains “down” too long or the pronation phase is excessive (a big-time fallen arch, so to speak). That’s where the problem arises. When your arch falls excessively with every step, it severely stresses the muscles that pull your arch back up. The muscles, in turn, become stretched and strained, and have to produce extra force to realign your foot. Over time, they wear down and become inflamed.

Where are these alleged muscles? Well, as you might have guessed, they attach on the inner portion of your shin bone. And just like that, you’ve discovered the origin of shin splints, my friend. But the point of this discussion, of course, is to find shoes that prevent excess pronation or a proper shoe insert that does the same. However, I can’t tell you which shoes are right for you without first seeing your feet. So send me pictures of them, and be sure to attach large, unmarked bills. Thanks!

2. Stretching. Like finding the proper shoe, specific stretching can prevent your arch from falling excessively, which will have the welcome effect of unloading those overworked muscles that attach to your shin bone. The main culprit is the gastroc-soleus complex, better known as your calf muscles. Tightness here, especially in the region of the achilles tendon, forces the foot to compensate for a lack of motion by slamming its arch straight down, a sure ticket to mental and physical anguish, not to mention shin splints.

Stretching this region is simple. You’ve probably tried the stretch with your hands up against a wall, one leg back, leaning forward, stretching the calf of the back leg. It’s a fine stretch, but only if it’s done correctly. And by correctly, I mean that you need to emphasize keeping your arch up, not letting it fall as you stretch. You do this by rotating your heel inward, which will raise the arch (by the way, perform these stretches barefooted). In addition, keep the region below the first toe (the first “ball” of the foot) in contact with the ground. Doing this as you stretch will focus the “pull” on the calf muscles, not the arch.

To emphasize the achilles tendon region, bend your knee slightly as you perform this stretch, but be sure to keep your heel flat on the ground and, of course, keep the arch up. A final stretch is one of my favorites, naturally because it involves the squat. To perform it, simply squat down as far as possible, keeping your heels flat (and keep your weight back on the heels), your arch up, and your knees aligned over the middle toe (not crashing inwards). Hold the bottom position for 30 seconds. Sound easy? Try it. It’s amazing to see how difficult it can be for people to keep their heels flat and attain a deep squat. This also makes it a great flexibility test.

Another stretch, to add variety, is a forward lunge performed in the same manner as the squat stretch. Try each of these for the 30 seconds apiece, three times each, prior to running and impact activities.

3. Strengthening. The key to strengthening the muscles that support the arch is to not necessarily work them directly, but to perform running-specific exercises in the proper alignment. Remember, these muscles aren’t necessarily weak, they’re simply overworked. And if you’re alignment is poor during exercise, they become overworked quite quickly.

Like the stretches described previously, all of the following exercises should be performed in the “arch-up” position and preferably barefooted. You’ll be challenging this “arch-up” position by imposing your body weight on the foot. For example, you could perform a squat or lunge exercise for repeated reps (15-20 reps, three sets) while preventing your arch from falling, which would be quite natural during these maneuvers. Also, keep your hips level, your back straight, and your knees aligned over the second or third toe. Keep your weight back on your heels. These make for excellent coordination exercises.

Start at a manageable level of depth. If you can’t maintain the arch-up position, you’re going too deep. As you improve, squat or lunge deeper, try a single leg stance while maintaining proper alignment, move on to one-leg squats, and finally to two- and one-leg hops and diagonal jumps. This improved alignment, coordination, and strength between all muscles of the lower extremity will eventually translate to improved running technique and reduction of adverse forces.

4. Training Variety. Running the same tired street, at the same speed, in the same direction, will eventually lead to repetitive stress and possible injury. Mix it up by exercising on varied terrain, such as grass, pavement, and track surfaces. Surfaces that are either too hard and unforgiving, or too soft and unsupportive, can lead to shin splints. Find a happy medium.

You also may need to take up different activities entirely. The body loves variety. Try some non-impact exercises, such as biking, swimming, or one of those funky elliptical machines. If that’s too big a change, at least cross-train with exercises that aren’t so repetitive, such as playing basketball or performing agility drills.

5. Ice. Ice is nature’s finest anti-inflammatory. But you don’t have to wait until you see flames shooting from your shin bones before you use it. The healthiest athletes have prevention down to a science, and prevention in this case is as simple as icing after every run or bout of impact activity, whether you’re in pain or not. This also underscores the main objective of any article involving injury management - get in the habit of prevention, and they’ll be no premature end to your exercising career.

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