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Shin Splints

But what is a shin splint exactly? Well depending on who you ask and where you look, you can get one of two answers usually, both of them being right to some degree. The first train of thought when it comes to shin splints is that it is a combination of muscle weakness and imbalances that cause them to tug at their insertion point and irritate the periosteum (nerve-rich, thin membrane enveloping the entire bone). The other train of thought is that it's a boney reaction to stress (but not a stress fracture).  The pain is a reaction to the bending of the tibia during running. Which may account for the age and sex differences between people who do and do not report shin splints.

Treating both of these causes is similar luckily and on the surface simple: reduce the load to your lower leg and strength the supporting structures of your foot, calf, and ankle. What has been found to reduce the load to your leg is to increase your stride frequency by about 10% (bringing it close to 180 steps per minute or more) will decrease the load on your due to less time in being in contact with the ground. When you run, you place about 5-6 times your body weight on your leg with each step. A change in shoes may be needed, not in the way you think. You would want to switch to shoes with a thinner sole and even consider running on a harder surface. A softer surface and running shoe actually increases the stiffness in your leg when running and the goal of treatment is to unload your leg while allowing to continue to run. The last big step is to increase the strength of the muscles in your leg. The reason for this is because, as muscles get stronger and or larger, the bones that they have to attach to get stronger as well.

If things do get more serious, it's important to look at other treatment options. One change could be orthotics. Orthotics have a lot of potential to improve the mechanics of your foot and ankle. But, with a lot of medical products, there is a lot of variabilities both in cost and effectiveness. Be sure to talk to a professional about what may be right for you.

The last thing I want for you is for you to have to miss the activity that you love. So my general recommendations for this issue are to start with myofascial release. This can be done with a foam roller, or even easier with a tennis ball. Dr. Sankey has a great video on how to do it here. This is going to do several things, it will relax the tissue, reduce the pain and bring in good blood flow to the area.

Next, you need to look at getting stronger. You can start with simple calf raises. They could be done flat on the ground, at the gym, on a curb, one-legged or two. The main objective is to simply raise your heel off the ground. I will usually have a patient do them three different ways. First with your feet in neutral, next with your feet externally rotated and lastly with your feet internally rotated. For all of these, 10-12 reps are enough, just make sure you do it for 3 sets. Video. The other major strengthening exercise is the short foot exercise. It trains all of the small, intrinsic muscles of the foot and calf and in my opinion, it is one of the single hardest exercises you can do. These muscles are hard to consciously activate, but once you learn how to, the exercise becomes much easier. Simply begin with your barefoot flat on the ground. Now, without curling your toes, attempt to raise your arch and make it higher. It sounds really easy, but it can be frustrating at first, check out the video here. Do this for 10-12 reps. The great thing about this exercise is that once you get good at it, you can add in other exercises, like trying to maintain a short foot posture while you do a lunge for example. In addition to these exercises, consider some weightlifting or strength training for the hips and legs in general.

With any nagging injury, it is Important to seek medical help if you're not getting better. There may be additional issues that may be preventing you from healing. 


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