Shin splints prevention and treatment

Shin pain

If you’re a runner who has suffered from shin splints you’ll know just why this injury, more than any other, strikes fear into my running heart. Whatever you call it or the exact cause, shin soreness, MTSS (Medial Tibial Stress Syndrome) or Soleus Syndrome is bad news for any runner and personally I wouldn’t wish the scourge of shin pain on anyone. That dull ache that becomes a nasty pain down the inside of your shin will stop you running, so it’s definitely something to be on the look-out for and guard against. With the recent trend towards minimalist shoes and barefoot running, there’s never been a better time to give some thought to monitoring and looking after the condition of your deep lower compartment calf muscles and feet to prevent shin splints and shin pain.

Detection and prevention – catch shin splints early

It’s a good idea to develop a regime of detection, preventative maintenance and if you do slip over the edge and start getting painful shin splints, techniques to help release and manage tightness that no amount of stretching is going to fix.  This article contains much of what I’ve learned about managing my shin pain over the course of a number of years. Thankfully I don’t have to over do the management of my shins anymore, these days it’s just keeping a watchful eye on the condition of my calves and feet to ensure that I catch the problem before it manifests into pain. Improvements in running technique, stronger feet and calves and generally being smarter about backing off as needed have all  helped me get on top of the shin splints issue.

If your pain is acute and you can’t run you should seek advice and treatment from a qualified physical therapist or sports medicine professional.

What causes shin splints?

Running Injury EquationYou could write a thesis on the potential causes of shin pain but I’m not going to do that here. However, I will make the point that prevention not only involves having a good maintenance regime, but if you’ve had chronic shin soreness then it’s likely your running form is making a big contribution to the problem. No amount of therapy can cure what is caused by how you run, it will remain a re-occurring and vicious cycle until you address the root cause of the problem. As I’ve written about in a previous article, running technique tends to be the injury multiplier in a complex equation that includes changes in: shoes, surfaces, volume and intensity.

The key technical issue that contributes to putting stress, twisting and excessive movement through the knees, ankles and feet is running with inactive or weak buttock muscles. When your glutes are not doing their job your thighs will collapse and rotate inwards causing twisting down the lower leg. All of this over stretches and strains the soleus and deep compartment muscles in the lower calf. Do this enough and you’ll have yourself some sore shins or a range of other overuse running injuries. There are detailed strategies for correcting running technique to avoid injuries in my book Running Technique.

Detecting shin splint before they stop you running

You can take steps to detect soreness before it actually manifests into shin pain that stops you running. It’s the nature of overuse type injuries to sneak up on you, and the reason is that it takes some time for muscles and connective tissue to tighten, harden up, go stringy, ropey and horrible. So unless you’re getting a regular massage, there’s a good chance you might miss the process occurring before its too late. The simplest and fastest way to check-out the health of your calves and deep compartment muscles is to give them a quick rub when you’re having a shower. It takes about 30 seconds to check both sides. If you do find any hard, tight or sore areas then it’s time to jump into some self massage and therapy to loosen things up before the problem becomes acutely painful.

Regular preventative and treatment measures

A range of different strategies can provide really good results and help keep you on top of the shin pain problem. I’ve included descriptions and photos of a few things that I do on a regular basis to keep my lower calves and shins in good condition.

Using a ball to massage and stretch under the feet

One of the simplest and most effective things you can do is to stretch your feet and roll them over a ball on a regular basis. A couple of different types are handy, I use a firm but slightly springy training baseball for stretching and standing on – especially through the arch, forefoot and close to the heel. In addition, rolling your foot over a golf ball (not standing) is good for going a bit deeper and seeking out nasty tight spots. The first time I tried these steps I was amazed at the instant relaxation and relief through the whole lower calf area, much more effective than stretching. Why? The deep compartment muscles all end up attaching under the foot via strong tendons that when you give them a stretch help relax the whole muscle.

Pressure point and superficial massage

Using pressure point techniques to loosen up the deep compartment of the lower calf is also a great preventative and treatment option for sore shins. The trick is to loosen up the superficial muscles and fascia a bit first, either with some self massage or using a massage stick. Often the stick alone, if you worry away at your muscles for a bit, will bring up some sore spots to the surface, if this happens, run easy for a couple of days until things feel good again.

Once the superficial muscles are loose then you can kneel on a cushion or low surface and put your thumbs into any tight areas you can feel as you push through the gastrocnemius (back of the big calf muscles). Have a bit of a feel around and hold for 5 to 10 seconds or until the muscle begins to relax. Keep searching around the middle to top of your calf until you’ve released the tightness.

Don’t go crazy here, the idea is to use firm pressure, but not punch a hole through the back of your leg. If firm pressure is not helping release tightness, then seek professional advice as you could do damage if you go too hard without knowing what you’re doing.

Eccentric stretching and lower calf raises

This is a potential prevention and treatment option, although if you’re really sore I’d avoid this until the inflammation settles and you’re not in pain. Stand on a gutter edge or step on your forefoot (either barefoot or in flexible shoes). Bend your knee and flex up gently and in control and then lower slowly under control. You want to resist on the way down to stretch and strengthen the muscles. Don’t drop down too far or fast, just below the horizontal.

Barefoot jogging on grass

A single lap jogging on grass at the end of a training session with a neutral to forefoot contact, will allow an eccentric stretch to develop. Again this is something to avoid if you are already sore and have acute inflammation. A slow lap jogging is really a dynamic stretching and strengthening regime for the lower calves and feet. Your feet and ankles are put through a wider range of motion than with the support of shoes. Do less or avoid this if you feel any discomfort.

Dry needling

It took me a while to become a convert to needling as a treatment option for injuries, but for hard to massage, stretch and heal places needling is worth a shot. Inserting needles along the inside of the shin into the soleus all the way up the calf is good stuff and then when they have done their magic, roll over and get your therapist to put a couple through the back of the calf down through the superficial muscles into the muscles of the deep compartment. It sounds gross and painful, but it works for me. It does less damage (and hurts less) than trying to smash down through superficial muscle and usually you can run the next day. I find that in the days after treatment the muscles really loosen up. If you’ve tried everything else without success then needling could be the circuit breaker you  need to unwind the tightness and get back into some gentle running again. You’ll need to see a qualified professional, make sure they use sterile disposable needles.

Conclusion

In summary, a range of strategies can be used by runners to prevent, manage and treat shin splints. As with all things running, there’s rarely one magic solution to a problem, so attacking shin pain from all sides will make sure you have covered all the bases in managing this insidious injury. What do you think? Do these ideas work for you? Please let me know if you’ve got other handy tips for preventing and managing shin pain.

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2 Responses to Shin splints prevention and treatment

  1. Missy October 24, 2011 at 6:35 am #

    Thanks for the article– I have found a lot of benefit from the techniques you have described here. I especially second the dry needling for the pesky ones. Also, a good professional can often find areas you didn’t know existed. :)

    The opposing bent knee could be a decent alternative for the calf when one doesn’t have a massage stick handy (i.e., quick incognito session at work :)). Rub the calf along the knee with short strokes to move the muscle (vs moving along the skin).

    Similarly, the heel of the opposing foot for the anterior to lateral part of the lower leg works well. I find this one works best sitting on the floor with the leg being worked on fully extended. Again, short strokes to move the muscle vs. along the skin will prevent “massage burn” (I learned the hard way).

    Cheers,
    Missy

    • Brian October 24, 2011 at 6:57 am #

      Hi Missy, thanks for chipping in with those suggestions. Agree one of the benefits of paying for a massage is for the discovery value of those annoying injuries that you don’t yet know existed! Brian