MANAGING ANTERIOR/ MEDIAL TIBIAL STRESS SYNDROME or ‘SHIN SPLINTS'
The following advice is what I recommend through personal experience of having ‘shin splints’ as well as through treating and working with people who are effected by them. The tips below summarise what I have found effective in treatment.
I know this is the first thing you are always told but its common sense, stop doing whatever causes the pain. Rest until you are pain free running/ walking again. Often you will find that the pain eases as you continue running. However, the pain will get noticeably worse after the session or when you begin your next session. Rest could take one day or 2 weeks, it really depends on the person, how they manage their recovery and the degree of severity of the shin splints.
2. ALTERNATE ACTIVITY
If you do not want to miss training sessions some run sessions can be reasonably well replicated in water. Try Aqua-running, its impact free and can help with improving strength and run technique. Cycling and swimming can also help you maintain your fitness whilst resting from impact.
Get freezer bags, cover them in a thin towel and apply straight onto the areas of pain. Apply the covered ice for 20mins. Remove for 1-2 hours and apply again for another 20mins. Repeat this icing up to 3 times per day during the acute phase. On your return to training, ice application is most effective immediately after a training session! Standing in cold water such as a river is ideal for reducing inflammation, as the water is continuously moving and your body never gets to heat the water around the leg. The water does need to be cold though less than 15OC! Ice massage has also been found to be very effective.
Before a session get some oil/ moisturiser and rub the muscles of the lower leg vigorously. Massage in and around the problem areas this is to warm up the tissues pre-exercise. Do the same after a session! 5mins is all it takes and it helps! Again ice massage post session can be used here.
5. STRETCH AND STRENGTHEN
Stretch the muscles of the lower leg. This includes the calf muscles, the Anterior Tibialis (muscle at the front of the lower leg), and the Peroneals (muscles at the side of the lower leg). These muscles can be tricky to stretch (see images at bottom of page). A Foam Roller is one of the best tools you can use for self massage and stretching. Pre exercise use more dynamic stretches, such as ankle drives. Post session more static stretches should be used.
Strengthen muscles of the lower leg, and ankle through stability exercises (see images at bottom of page). I also encourage Barefoot running, however, this must be performed on suitable surface free of stones/ glass etc. Barefoot running should be implemented into all running programmes. It is introduced lightly, e.g. 5 mins of easy running, or by performing running drills and strides barefoot. You can eventually perform your whole run session barefoot, but only when the bones and muscles of the lower leg, ankle and foot have strong enough to support the mechanics of running.
Mobilise the bones in your feet. This can be done by; walking barefoot, rolling your foot on a tennis-ball, and by self massage.
6. FOOT WEAR
Be cautious when buying new runners (even if they are the same brand and model), introduce them gradually, alternating them with your older runners, allowing your body to adapt to the new restrictions and support of the footwear. I have run in most brands, and currently have 6 pairs of runners which I use. My preference is with Nike Frees 5.0s. These runners replicate barefoot running, but care needs to be taken when you begin running in them, there is little to no cushion and support, so you MUST build strength, mobility, and proper running mechanics in order to use them. Most people will have their own preference regarding the runners they use, but if you are a regular runner (+3days per week) then I would suggest having 2 sets of runners on the go.
Orthotics. I am not against the use of Orthotics, however I strongly believe that you should do everything possible to avoid having to get them, i.e. Treat the injury, Strengthen, Stretch, Mobilise, and build proper movement mechanics. Orthotics work, but they should be thought of as a supplement and the source of the problem tackled first. If you do buy them, then make sure you get them made properly from a specialist who is aware of the demands of your lifestyle. Be prepared to pay.
7. SURFACES Shin splints can be caused for a number of reasons, most notably a change in; footwear, mechanics, mileage for walking and/ or running, and activity type. A change in the surface you would normally run/ walk on also plays a huge role. Similar to coping with your footwear, introduce different running surfaces gradually, this includes, running on road to trail to field to track as well as the gradient of the surface. I have had many marathons runners highlight the effect of road camber on their running pains.
To conclude....Shin Splints are very common in people who are involved in repetitively high impact activities. They are totally manageable within a training programme, chances are your friend or training partner will have experienced them at some stage. Everyone is different when it comes to the recovery time...and this is obviously dependent on how you deal with them. You’ll get to know the symptoms over time making it easier for you to cope with and avoid any interference in your training programme. I hope these tips for prevention and treatment help you stay exercising and training injury free!
2. Peroneals, Anterior Tibialis
3. Peroneals, Anterior Tibialis, mobility of the foot/ ankle
4. Gastrocnemius, Soleus
5. Hamstrings, Gastroc, Soleus, muscle groups of the posterior spine
6. ‘Ankle drives’ dynamic stretch or strengthening exercise
7. 1 leg stability exercise/ single leg squat
Lynne Algar MSc Exercise Physiology
BSc Sport and Exercise Sciences