Shin Splints Can Be Avoided

Commonly runners are sidelined or limited by the presentation of leg pain during and often after runs. The pain is usually located at the sides of the "shin" bone and can be debilitating, even limiting the ability to walk. Over the years, this has been a problem that I sometimes have encountered in my running. Since I love running (and don't like not running), I have researched over the years some ways to limit the presentation of shin splints while training for a race, or in my case a marathon. I will discuss some ways that we can "run smart" and limit the injuries that have been commonly classified as shin splints.

What is a shin splint?
A shin splint can be located on the medial (inside) or lateral (outside) of the lower leg below the knee. Medial shin splints are commonly inflammation of the muscle attachment to the shin bone (tibia) and hurts as from pressure to the muscle just inside the bone. Lateral shin splints are commonly inflammation to the tendon (posterior peroneal tendon) and adjacent tissues in the front of the outer lower leg. In either case, the pain can present during a run, immediately following the run or sometimes the next day.

What causes shin splints?
The exact cause of shin splints are not known, but usually it is related to rapid increase in running or jumping (or sometimes walking fast), changes in shoegear, or pronation (flattening of the foot). Some secondary causes may be balance problems (leaning to one side during a run), poor training technique (progressing too fast, poor running technique or surfaces), leg length problems or even injury.

What I have learned...
1) Using correct shoes.

Since commonly over pronation (excessive flattening of the foot) or over supination
(increased arch height - rolling out) can cause stress to the muscles or tendons in the area and create shin splints, a quality exercise or running shoe will help improve and prevent these symptoms. In choosing a shoe, price is not the most important, but cheap priced shoes are usually cheap shoes. Get a quality shoe, designed for the exercise you are doing (running shoe for running or walking, basketball shoe for basketball, etc.).

2) Training smart.

As you run or train, Run Smart! Let me explain…

If you are running on a track, understand that always running the same direction on the track will work muscles differently than switching directions. One of the possible causes for shin splints is working muscles at different rates, therefore switching directions regularly will work all muscle of the legs equally and reduce the chances for shin splints.

If you are running on a road, most roads in most locations throughout the country are canted (or tilted to improve water runoff). Therefore, running against traffic always will cause supination of the left foot and pronation of the right foot. With supination, you will work the lateral (outside) muscles of the leg more than the medial (inside) muscles of the leg. Pronation does the opposite. By switching sides periodically, you will again work all muscles equally and prevent the presentation of shin splint symptoms.

Lastly, in running smart, the speed of training should be carefully controlled. Start slow and progress slowly to the amount of running you desire. Give the leg muscles time to get strengthened before forcing them into harder regimen. The speed of progress will require understanding of how much running you have done and where you should start. Cross training (elliptical or bike) can also help even the muscle strength as you progress.

In all these aspects of running smart, it should be understood that shin splints are caused by overusing a muscle group and creating an injury. By adjusting the training to reduce this overuse, you will have a more enjoyable run.

3) Evaluation for possible "gait" abnormalities.

“Gait” abnormalities are best described as running or walking abnormalities. Do you have a leg length problem? Do you over pronate or over supinate? Do you have imbalance issues, back problems, knee problems, or other reasons to overwork a muscle group that may cause your shin spints?

Let me discuss some of these running issues:

Leg length abnormalities (left leg longer/shorter than right) can be a large problem when running. The APMA has found that running produces 4-5 times your body weight through your feet. If one leg is shorter, the body is designed to adjust…you will pronate the shorter foot to make it longer and supinate the longer foot to make it shorter. This will lead to overworking the muscles and cause leg pain and possibly shin splints. A simple adjustment to your shoes (or orthotics) will alleviate this problem and produce continued running without pain.

Imbalance issues, often caused by weakness of ligaments (like chronic ankle spraining) or ear problems. One of my patients is deaf in one ear and runs lopsided (towards the deaf side) and has issues with shin splints. With a simple orthotic, a custom item to replace a shoe insert in your running shoes that maintains your foot in neutral position and helps the foot function as it should, his shin splints have been eliminated.

Pronation or supination is also a form of imbalance of the feet and can cause overuse of some muscles and may also lead to shin splints. Orthotics are the answer here also.

By being evaluated for your running, your “gait” abnormalities can be evaluated and often adjusted to help you return to running without the pain.



Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com

Running On A Trip

Most runners have a favorite route, or even a favorite run. Whatever the distance, most runners will also agree that running outside is easier than on a treadmill. This makes running on a trip more difficult, especially when training for a marathon. If traveling on a weekend, this may even raise greater difficulty to make long runs and consistent training. Many people have this difficulty, but are required to run on a trip. What are your options.

Recently, a friend and more experienced runner Dr Marybeth Crane of Grapevine, Texas helped me find an answer. In fact, I can say she provided an inspiration for me on my current trip to Pittsburgh, PA. In my training regimen, I was scheduled to run 16 miles today. Knowing that the travel would make this more difficult (based on Dr Crane's experience), I ran the long run on Wednesday prior to traveling. Running at home, on my regular routes is much easier and allows me to stay on track.

Today I did run a 6 mile pace run, which allowed me to continue to stay on my training regimen while traveling. Other options would include cross-training or even a shorter run in the morning and a second run in the evening. I was very happy with my 6 mile run, and glad that I ran the longer run back in Utah.

Thank you Dr Crane for helping me stay on track in my training...

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com

Cross-Training With An Elliptical

One of the big concerns with running at greater frequency and greater distances is injury, often called "repetitive stress injuries", such as muscle strains, sprains or stress fractures. Many of these injuries don't just limit continued activity, but completely stop the exercise for a period of recovery. With my current goals for the year of running, injury is not an option.

With this information in mind, I have continued to run (including a most recent 16 mile night) and am heavily training for an upcoming marathon. What are my other options for staying fit, working the muscles and reducing possible injuries? Swimming, although a good exercise utilizes different muscles and different motions than running. It is a good activity for cross-training, but will have minimal benefit for my running. Biking adds greater leg strength and greater aerobic benefits, but still is not a perfect match for running. A newer exercise modality, the elliptical, is a similar modality and has been shown to be valuable with cross-training for runners.

So, over the years I have been able to cross-train with the benefits of an elliptical trainer. I have also recognized a higher aerobic benefit in a shorter period of time. In my current exercise regimen, I am utilizing the elliptical as an additional activity for the day or an alternate when I have less time to exercise that day. Although use of an elliptical will not prepare me for a marathon, it is a good adjunct and should be considered especially by those that commonly get stress fractures or other stress injuries. I will keep you informed at how it works for me...

Dr Brandt R Gibson
Mountain West Foot & Ankle Institute
36 North 1100 East, Suite B
American Fork, UT 84003
801-756-0765
www.UtahFootDoc.com