TRAINING RELATED LOWER LEG & FOOT PAIN
(Shin splint pain causes and prevention)
John Fiore, PT
Sapphire Physical Therapy
As the darkness of winter gives way to endless evenings and the greening of the surrounding hills, the time is right to increase your running mileage. The spring and summer running calendar is full of great events to test your legs and enjoy the running community. Along with longer runs, races, and shorter recovery periods comes the increased risk of injuries.
Lower leg and foot injuries comprise the majority of running related injuries. Common knowledge and anecdotal advice columns and websites share a few common misperceptions. I often read that getting rid of worn out shoes, inserting custom orthotics, and avoiding off-camber training surfaces are all that is required to avoid injury. While it is true that foot ware, foot support, and training techniques play a role in pain-free running, the key to injury treatment and prevention is in addressing the intrinsic causes rather than the obvious symptoms. Below is a sample of actual statements (both correct and incorrect). You will notice the limitation in quick-fix, external, short-term solutions.
SHIN SPLINTS (fact or fiction):
I developed shin splints because I increased my mileage too rapidly.
Fact & Fiction: Yes, increasing your mileage greater than the standard 10% rule may increase your injury risk, but balanced lower leg, foot, and ankle strength and mobility will decrease the impact of increased mileage.
If I don’t heel strike I won’t get shin splints.
Fiction: While heel striking places increased stress through the lower leg, knee, and hip, forefoot striking places increased stress through the plantar aspect of the foot and metatarsals.
If I stretch more, my shin splints will go away.
Fiction: While stretching is one component of injury treatment, shin splint inflammation and pain are a manifestation of force through the lower leg musculature (tibialis posterior, tibialis anterior, soleus) which exceeds she tensile strength of the connective tissue between the muscle and the tibia bone.
I can’t run anymore because I get shin splints.
Fiction: Proper treatment of an injury through treatment of the underlying cause rather than the pain symptoms will result in a long-term solution and return to full activity. The underlying cause will likely take work and discipline on your part and the assistance of your coach or physical therapist.
If I get orthotics my shin splints will go away.
Fact & Fiction: If an orthotic provides relief, then the solution is likely weakness of the intrinsic foot musculature. An orthotic alone will provide short-term symptom relief only until the foot accommodates to the now ever present orthotic.
My worn out shoes caused my shin splints.
Fact & Fiction: Running shoes wear out long before the shoe appears trashed. The experts at Runners Edge can help you select the shoe appropriate for your running needs and goals. Any drastic change in your running shoe type (i.e. Gel or air mid sole to 4 mm drop shoe) requires foot conditioning to decrease subsequent soreness. Find a shoe that works and stick with it. Gradually break in both your shoe and your body to the shoe if you are moving toward a negative heel shoe.
Effective treatment of shin splints include off season preparation and cross training, evaluation and treatment of underlying hip, glut, lower leg, and intrinsic foot muscular weakness. Modalities such as deep tissue massage, ice and interferential current, and Kinesiotape application will expedite your recovery from shin splints as you work with your physical therapist on the underlying cause of your shin splint symptoms.
See our website (www.sapphirept.com) for our monthly specials and more on how physical therapy can effectively treat the underlying causes of your running injury. Happy trails!
John Fiore, PT