When my friends at Women’s Running asked me to write this article, I got a faint shiver down my spine for shin splints are a nemesis I know well. When I took up running again, after a long absence, it was the first injury I got, and the resulting frustration is what kick started my journey into understanding running injuries.
Anyone who’s ever had shin splints (also known as medial tibial stress syndrome) will be familiar with that deep, sickening pain on the lower third of your shin, towards the inside of the bone. In the early stages of the condition, pain is felt at the beginning of exercise and then subsides during the training session. If the condition progresses, pain is felt in less intense activities and can also be present at rest. If touching the area, it is best to clear the vicinity of all young children, as it is often exquisitely painful and can lead to an incontrollable outburst of expletives!
Like many running injuries, shin splints are classed as an overuse injury. The two main theories as to what causes the pain to manifest in this area implicates the surrounding soft tissues and the bone itself. The soft tissue theory suggests that tightness, weakness, or excessive movement at the ankle causes traction or tugging at the site of their origin on the shin, leading to an irritation of the bone. The alternative explanation implicates the tibia itself. With this hypothesis suggesting that the problem arises via micro-trauma to the bone at its skinniest point. This is due to repeated bending or bowing of the bone on initial impact with the ground. If you want to get your nerd on and explore these theories in a bit more depth, check out this article on my blog.
So let’s get down to business…how do you treat shin splints?
Prevention is always the best medicine when it comes to running injuries. Shin splints are similar to most running injuries, in that the most effective way to prevent them is to respect the laws of adaptation. This means, firstly, listening to your body. If you are feeling pain when running, it’s because your brain has decided that a particular area of your body needs protecting. Usually, but not always, this is because too much stress, or load, is being accumulated in the painful area, and you are not leaving enough time in between stresses to allow the tissues to adapt and get stronger. So the key to injury prevention is gradual, patient loading.
Now, if you’ve gone past the prevention phase and are in the painful phase, the next sections will be helpful for you.
2) Pain relief.
Ice – Ice works really nicely as an analgesic. And research suggests that crushed ice is the most effective form. Rough guidelines of 10 minutes every two hours, if needed, are adequate (remember to wrap ice in a damp towel to prevent ice burns).
Pain medication – Always consult your GP or pharmacist before taking any medication.
3) Decrease the load on the sensitive area.
Intuitively, if you continue to stress the already over-stressed area, it will prevent healing or de-sensitisation. Decreasing the load can be as simple as resting, cross-training, such as pool running or, my favourite option, running re-education.
4) Running re-education.
The goal of running re-education is to assess an individual’s running style, and see if subtle changes to their biomechanics can shift the load from the painful area, without jeopardising their performance, or creating an environment for another injury elsewhere in the body. So, in the case of shin splints, we are trying to reduce the stress on the lower third of the shin. Here’s a few of my favourite options.
Increase cadence – The best way to do this is via a metronome. Generally, I go for 5%-10% more than your current cadence and see what happens. You can always gradually increase it from there and reassess the ‘experiment’.
Change the direction of the ground reaction force. Any change in the direction of the ground reaction force, to a more backwards and downwards force, will decrease the load in the front of the shin and may be enough to keep running without pain. To cue this, I often video my runners and freeze the frame of them running when their swing leg is at its highest. I ask them to imagine bringing their foot backwards and down in a backwards tick type motion.
Encourage the patient to ‘run up tall’. I often use the ‘helium balloon attached to the crown of the head’ cue or get them to imagine their spines like a slinky toy, wanting to open it up. This cue helps decrease an anterior pelvic tilt, or a forward lean from the waist.
Other techniques that may help with this condition include off-the-shelf orthotics, taping or running barefoot or in minimalist footwear. This type of footwear tends to shift the load from the shin and knee, more to the foot and ankle, probably by subconsciously increasing cadence and landing closer to your centre of mass.
If you want to know more about treating shin splints and pick up a few extra running techniques, check out this article on my blog.
I hope this article gives you a few ideas and helps put you on the path to beating shin splints. Remember, I literally feel your pain on this one. As always, you can let me know how you’re getting on and get involved in the conversation via twitter: @londonrunningpt or via my Facebook page.