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Shin Splints

Runners have probably complained of “shin splints” since Phidippides ran the 26 miles from Marathon to Athens. Of course, we don’t know if his shins hurt after that, because he died of exhaustion within hours of his arrival. Nevertheless, exercise related lower leg pain (ERLLP for the acronym loving, medical-literature readers) is a significant risk of training. Despite its high incidence in physically active people, relatively little is concretely known about its treatment.

ERLLP, or medial tibial stress syndrome (MTSS, another fun acronym) is thought to be caused by excessive tibial loading (overtraining) over a period of time. In a normal tibia (the shin bone of the leg), as in any other bone of the body, bone is absorbed and reformed constantly. As long as bone is resorbed at the same level that new bone is being created, everybody is happy. In the case of MTSS, bone is being resorbed faster than bone can be created at the cellular level. Simply put, the bone cannot withstand the continuous stress placed on it by training, and it starts to break down – causing pain and limiting running mileage and speed.

What causes shin splints? and furthermore… How can you treat it?

As with all lower extremity injuries in runners, there is no one good answer. Excessive pronation (where the foot rolls toward the arch as the runner goes through the gait cycle) has been examined by many researchers. Although earlier studies showed significant correlation between pronation and MTSS, more recent articles have questioned that relationship. Foot orthotics coupled with ice have been shown to lessen pain and improve function. Another mode of treatment is stretching, as described in my article on treating plantar fasciitis. The thought is that stretching the gastroc/soleus muscle complex (calf) gives some relief to the tissue around the medial tibia, as that tissue is the only soft tissue attachment along the bone.  But if your pain lasts a significant period of time (6 months or more), some studies show that you may need to halt training altogether, cross train with a low impact activity (such as walking, swimming, or using an arm bike), and wait until walking is no longer painful before returning to running.

Unfortunately, when it comes to “shin splints,” there is no silver bullet that fixes it all. The following exercises will help strengthen the muscles around your tibia, allowing them to absorb more shock and reduce the amount of stress place on the tibia. With proper training that includes cross training, the correct shoes for your gait, and a good stretching routine, shin pain can be something runners leave in their dust.

Shin Splint Exercises

The Alphabet ExerciseThe Alphabet 

1) Sit in any chair with plenty of room in front of you to raise your leg

2) Lift one leg in front of you

3) Pretend you’re writing the alphabet with your big toe on an imaginary blackboard

4) Proceed through the entire alphabet

5) Repeat with the other leg

6) Do two sets on each leg

toe raisesToe Raises 

1) Stand with your back against the wall and your feet about shoulder width apart

2) Place your heels about one foot’s length away from the wall

3) While keeping your heels firmly planted, slowly raise your toes off the ground as far as you can

4) Slowly lower your toes back to the ground

5) Repeat this motion slowly 12 times

6) Repeat the motion quickly 12 times

7) Do 2 sets slow and 2 sets rapidly

walking toe raiseHeel walking 

1) Stand with your toes raised in the air

2) Walk backward on your heels while holding your toes in the air

3) Continue this motion for 20-30 yards

4) Walk forward on your heels with your toes in the air for 20-30 yards

Written by

Laura Alexander O’Connor, MPT, has been a physical therapist since 2003. A St. Louis native, born and raised, she has worked in outpatient orthopedic clinics with a variety of patients, including many runners. She presented at the 2004 National Athletic Trainers Association National Convention, was published in the Journal of Athletic Training in 2005, and has participated in clinical research at both Washington University and Saint Louis University.

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