RW member Shattered Shins tried almost everything under the sun to overcome chronic shin splints. Here's her account of what worked for her - and what didn't. (This is not an official RW article, but she has been emailing this account to other needy RW members for some time!)
I'm female, born 4.4.63
I was first told never to run when I was 17 and suffering from constant bruising on the shins with extreme shin splints. So long as I never pushed myself speedwise – nor went above 15 miles per week - I was able to cope. But things fell apart big style in October 2001 when, aged 38, I started training for the Flora London Marathon after a seven-year lay-off with virtually no exercise at all.
The shin splints came back with a vengeance – but I was able to cope with them by taping them up with mini-magnets over the worst areas. At one stage I had over 27ft of elastoplast wrapped round my legs!
But then I started to get a real tightening down the outside of my thighs. It wasn't bad – but I knew something was wrong. This was misdiagnosed by one physio as ITB trouble. Gently kicking a beach ball to my daughter one day with my right foot resulted in a tear in a quad muscle in the left leg, which over the next 3 months healed and retore several times. I started getting really sharp, needle-like pains all over the quads in my left leg. I went to a physio who didn't have a clue what was wrong, but to hide this told me it was a 'nutritional' problem. Having taken several weeks off running I started up again – this time with the shin splints no longer under control because I was limping so much.
The quad problem got to the stage where I couldn't walk. I was suffering desperate pulling in the groin on the left leg with strong pains and the left leg collapsing. However, I kept running, as after a bit the muscles loosened off enough for me to run with a limp.
When it got to the stage where I couldn't walk at all, I went back to a physio I'd seen eight years previously – who knew from my description what was wrong. He said when he saw my legs that 'you don't get odd-shaped legs like that without there being a bio-mechanical reason'. After several weeks, with sports massage, physio treatment and constant remedial exercises, the quads regained their 'balance' and the signs and symptoms disappeared – although they'll come back almost instantly if I miss a day's exercises.
The root of the problem lay in the knee joints not having full extension. This stopped the vastus medialis quad muscle working properly, so it was wasted and over-powered by the other quad muscles which had torn when they'd been under a high workload. However, I also have an extreme Q-angle in the hips – which means that the quads are in the wrong position to start with.
Once I'd done the remedial exercises for two weeks, the shin splints got much better and for the first time ever I could run up hills.
But I still had one desperately sore area of shin splints, which felt more like a bone twist than anything. As my physio couldn't help, I went to see a specialist running doctor and another physio – who both wrongly diagnosed overpronation as the cause.
Then I went to an osteopath – who correctly identified all sorts of muscle problems (a result of having finished the FLM!) and treated them. Then I saw a podiatrist who via video gait analysis showed me that the muscles over the tibia were under tension in exactly the place where the pain was. He said I had unequal leg lengths – probably the result of an unequal but wide Q-angle – and a really unusual gait in that my feet cross over each other when I land! He made me orthotics which so far have worked.
I do get crippling knee pain from time to time, which can completely stop me running and tends to be related to loss of full knee extension. That's sometimes brought on when I've missed a couple of days' remedial exercises – and sometimes when I've stupidly done leg extension exercises in the gym (these are now banned!). The physio sorts this knee bursa instantly with interferential treatment and ultrasound.
A chiropractor I saw recently to try to sort out a back problem said that my pelvis was twisted and that the orthotics had the lift under the wrong leg – and this was confirmed by another podiatrist who was treating my daughter and said that I didn't have unequal leg length but did have a twisted pelvis! Disconcerting!! As the orthotics seem to be working, I'm disregarding these latest bits of advice – but in reaching this far I've gained so much experience of leg problems that I thought I'd put them down into this document so that anyone else can possibly benefit from them before going on the rounds of 'specialists'.
Sorting out the quad imbalance and tight knees got rid of 20 years of extreme shin splint suffering, knee pain, patella tracking problems, tight overdeveloped calf muscles and Achilles tendon pain. It's changed the shape of my legs radically. It also enabled me to run up easy hills for the first time ever. Orthotics and a heel lift sorted out the residual shin pain / stress fracture problems – and now I can run (well okay, jog) for almost as long as I want. I do still need occasional physio treatment to sort out my knee bursa – but apart from that all I have is mild inflammation along the tibia. That's a vast improvement on what it's been like over the last 20 years.
On the physiological side, I now think I know why I have so many problems with my quad and leg muscles: I generate excessive lactic acid because I have an anaerobic energy system (which is designed for sprinters and fast twitch muscles) but my muscles are slow twitch (endurance ones). The muscles are crying out for the oxygen which my body doesn't deliver. Huge lactic acid accumulates and eventually the muscles seize up.
It's just a shame that to get this far I've had to see – in the last six months – three physios, one specialist running doctor, one osteopath, one chiropractor, one sports masseur, two podiatrists. Of these only one physio and one podiatrist were any good – although the osteopath wasn't bad.
The one thing I have learnt is that if you're told to rest the injury, that alone will simply enable it to recover to the stage where it was before you did the exercise that caused the injury in the first place – so you'll be forever experiencing problems once you reach a certain stage in your training. I therefore resist 'rest' unless I know what the injury is and what caused it, which seems to be something that the more inept (but rich!) sports injury professionals don't bother about.
Quad Imbalances (specifically - wasted vastus medialis) and associated problems
Signs and symptoms
a) Signs / Associated (indirect) Injuries
- Odd-shaped legs – the quads bulge to the outside of the leg and the inside of the leg isn't muscled – and indeed may be 'flabby'. The calf muscles may be unusually well developed and tight.
- Muscle tears – if quad imbalance is excessive and training is intensive – then the outside muscles are so overloaded that small tears may arise in the quads. Also, there may be 'tightness' in the groin, where some of the quad attachments are.
- Chronic shin splints – even if the runner hasn't suddenly increased training, but just gets them when doing a consistently high weekly mileage
- Collapsing knee – when walking slowly and/or on elliptical trainer
- 'Runners Knee' where the patella tracks in the wrong place – caused by – the quads pulling it out of alignment. May be associated with knee bursa – formed as a protective mechanism.
- Inflamed Achilles tendon(s) / tight calf muscles (can also be caused by many other reasons)
- Quad muscles under tension when they should be flaccid. Lie flat – face down on a hard (carpeted) surface. Roll yourself from side to side with max bodyweight over the thighs. You'll feel one / some of the muscles under tension – it can hurt!. Similarly, lie flat on your back and have someone feel your thighs (!). Again, they'll feel a rigid muscle. If the quads aren't under load, they shouldn't be tight, but the muscle imbalance will make them so. Even after remedial exercises you may be stuck with this. As for you, the muscles will never have a 'normal' position (ie if you get them 'normal', then they are actually in the wrong place for your natural skeletal frame)
- Knee Bursa – if the quads are imbalanced then the bursa in the knee (in mine on the outside of the knee) will get inflamed as a protective mechanism – to prevent further injury to the knee. This can be an absolutely devastating, grating 'bone on bone' pain which completely stops running but disappears when walking, but can also be felt climbing stairs or walking depending on just how bad it is. May also be painful on forward lunges.
- Sporadic intense sharp needle pain in the thigh lasting a microsecond but very painful – esp. when stopping suddenly – eg from walk to halt / changing direction / just walking. Could happen anywhere within the thigh but typically will occur most frequently in consistent locations.
- Hip / Groin strain / pulling sensation – as the anchor points for the quad muscles are being pulled in the wrong direction – can be completely disabling. Whilst walking is almost impossible, running may be possible – after a painful hop / skip / jump for the first 500 metres – followed by mild limping throughout. The muscles seem to warm up in running whilst in walking they don't.
- Inability to run hills could be total – no matter how mild the gradient - or just find it hard
- Unusually high rate of perceived exertion – could be combined with high heart rate / excessive sweating. This is because the muscles are having to work harder than they should – because they're in the 'wrong' position for the exercise concerned. Usually most noted on the bike / elliptical trainer – where foot position is 'forced' by the pedals / footplate.
- Inability to run fast without suffering injuries again because the leg muscles are /gait is completely inefficient - and speed shows up the problem most.
- Biomechanical – eg the bones are unusually shaped – hence the muscles can't help but be in the wrong position. Very common in females due to wider hips (Q-Angle)
- Twisted pelvis – due to injury / or naturally occurring. This can result in knee injuries or a twisting shin (shin splints / stress fractures) due to differential loading and may also show itself as (3)
- Real or Apparent Leg length discrepancies Apparent discrepancy could be due to twisted pelvis &/or unequal Q-angles. This will also affect one leg more than the other.
- Knee joint not having full extension if it can't extend properly – due to 1,2,3 above or any other reason – eg past injury / operation or just general tightness – then it can't trigger the vastus medialis – which will therefore be 'wasted'. Test for this – sit on the floor – legs straight in front of you – reclining back slightly against a hard back rest. Have someone press down firmly on quads just above the knee and at the same time they try to lift your toes so that the heel comes off the ground. Should come up by a couple of cms. If it is locked on the ground – or barely rises at all - the knee isn't extending properly – and will need 'unlocking' via interferential treatment by a physio ( one session) followed by a regular – once a day without fail – series of alternate leg rises ( see on) to keep it mobile. If you miss a day a week on a regular basis or two consecutive days you may need to go back to the physio for 'unlocking' again, as once mobility is lost – the exercises alone won't get it back – they can only keep it.
If you're really lucky you'll have a combination of the above – or even all of them!
REMEDIAL TREATMENT / EXERCISES
1. Knee Extension
If you 'fail' the above 'knee extension test', you'll need to visit a physio to loosen off both knees so that you can then perform these exercises everyday to retain full knee mobility. The hardest thing is to keep doing these exercises even when the problem appears to have been cured – but if you do stop – even briefly – the knee rapidly loses full mobility and even a couple of mm's is a lot when you're running long distances. After you've relapsed a few times – and had to shell out to see the physio again – you'll realise that it really does make more sense to do the exercises every day, forever!
All of following (1a-1d) are performed without any break at all between exercises. If you find this hard to begin with – grit your teeth and do it anyway – it soon gets easier.
MOST IMPORTANT:- Keep the leg being worked completely locked straight, pushing the heel forwards and down – throughout.
1a) Alternate Single Leg Raises
Lie flat on back. Lift right leg (straightened) til you feel the pull behind the knee. Lower. Repeat for a total of 10 times, fast.
Repeat with left leg.
Repeat with right leg for 9 times. Left leg for 9 times, right leg for 8 times etc down to 0.
Go straight on to 1b)
1b) Lie flat on back – raise straight right leg (heels forward and down) – hold for 30 seconds. Repeat with left leg. Repeat with right leg for 20 seconds, repeat with left leg for 20 seconds – repeat with right leg for 10 seconds, repeat with left leg for 10 seconds.
GO straight on to 1c)
1c) Sit up on floor – body 90 degrees to legs – hands either side of knee being worked ( sitting against a wall may be easier). Lift right leg straight up in front of you 'til you feel the pull again. Lower, and repeat for a total of 10 lifts. Repeat with left leg. Repeat with right / left leg for 9, 8,7, etc down to 0.
Go straight on to 1d)
1d) Same position as 1c) but lift straightened right leg and hold for 15 seconds. Repeat with left leg. Then right leg for 10 secs, left leg for 10 secs right leg for 5 secs etc.
Once this becomes easy – and it will – you could do these exercises uses light wrist weights (or a 4 season mountaineering boot) around your ankle – but Do NOT compromise the straightening of the leg as you do so, better not to use weights than use them but bend the knee.
Exercises 1a)-d) are the absolute priority – they tale c 11 minutes max once you get used to them – and Have to be performed everyday - first thing in the morning – and also in the evening before you exercise if your job involves lots of sitting.
2. Short arcs – helpful additional exercise to help with knee extension / quad imbalance
Perform 'short arcs' – using a rolled up towel behind the knee – sitting upright – legs out in front of you – straighten the leg 10 times each side – concentrating on the vm muscle as you do so. See
http://www.peakrun.com/articles/97_1.htm for full details.
3. '30 degree' knee extensions – (a substitute for quad strengthening on the leg extension machine)
Using a wall pulley with the suspension point for a broad soft strap passing behind the knee joint at an angle of approx 30 degrees above the knee. A strong elastic 'theramed' style band suspended from a door handle and passing behind the knee joint can be used instead. Completely take the weight off the inactive leg – (maybe rest the toe on the ground for balance) – bend the active leg at the knee and straighten against the resistance – taking care that the action does not come from the hips. Work up to 3 sets of 15 per leg at a resistance of up to at least 24lbs or so.
This exercise targets the Vastus Medialis – and should be used instead of Leg Extensions. Leg Extensions are really seriously bad news for quad imbalances involving the vastus medialis – since the vast majority of the action actually strengthens the already over dominant outside quad muscles. The vm muscle only gets triggered in the last 10% of the movement range – but the legs shouldn't be loaded when straight out anyway – as this risks knee injury. There may be well intentioned urging from many people (including fitness instructors) for sufferers of runners knee in particular to 'strengthen the quads as they protect the knee' – but if the inherent imbalance of the quads is the cause of the problem – all that will happen is that you'll exacerbate this imbalance. Don't do leg extensions!!! Don't do ANY leg strengthening exercise (eg that includes leg presses) which involves your foot being in anything other than direct 'normal' contact with the ground or a bench.
4. Stand from sit
Sitting on a hard straight backed eg kitchen chair, simply stand up and sit down 10 times – on one leg keeping the other off the ground. Repeat for the other leg – and build up to a total of 3 sets of 15 per leg. Sounds easy ? If the VM is really weak, this exercise will be hard !!! You may need to rest the inactive foot on the ground lightly. You can also adjust how hard this exercise is by how far away the active foot is from the chair – experiment a bit.
5. Step ups
Up and down onto a step bench - or bottom step of staircase – 3x15 per leg – progressing to carrying weights as you get stronger. Then progress to step up at the end of the bench – off to the side – up -off to the front – up and down behind – 20 times per leg – (changing the end of the bench!) and then do this carrying weights – it's the best leg strengthening replacement for leg extensions and leg presses
6. Side steps
Standing sideways to a step, keeping the leg nearest to the step stationary on top of it throughout and the toes and heel parallel to the inner edge of the step - or with the toes slightly turned away from the straight edge , step up and back down – keeping the lower foot immediately to the side of the upper foot – and quite far away from it – and being controlled throughout ( not collapsing onto it). Land heel first. 3 sets 15 per leg – carry weights to increase the difficulty.
7. Forward lunges
If these are hard – start off by stepping forward onto a step – reducing the load on the quads. Then progress to the floor. 3 sets of 15 per leg – then progress to carrying weights.
8. Wobble Board
5 minutes with both feet astride of centre – rocking forwards and backwards and side to side – try to minimise the time that the board's edge touches the ground. Then progress to doing this on one leg – keeping the foot central.
Using 2 legs together, build up to 3 sets 15, then introduce light weights.
I find squats really hard – because my muscles can't work out the movement – so I stand with the rear leg (foot) supported on a chair behind me – the front leg well in front and do them that way. Just as hard – if not harder.
10. Squats on trampet
If you've got a trampet available, these also help – build up to 3 sets of 15 per leg, single leg at a time.
11. Hip adduction / abduction / extension
The only way I know to do these is in a gym – although with an elastic theramed band – I guess you could tie it round the bottom of eg a sofa and do them. I find these exercises hard enough anyway and have never perfected the technique – so can't describe it here !
12. Tennis Ball stretches – invaluable for loosening off tight Achilles / calf muscles.
These are the best ever exercises for lower leg problems – including tight calf muscles / Achilles tendon injuries. TIP :- Use as hard a tennis ball as possible.
13. Hamstring stretches
The most effective one I've found is lying on your back - bend the knee of the leg to be stretched – clasp your hands behind the calf muscle and straighten the knee / leg slowly. Hold for 30 secs. Do this after every exercise session – without fail – as the hamstring needs to be stretched to help prevent knee problems . UPDATE….see Hartmann's site at end of doc for an even better technique
14 Psoas Muscle Stretches.
It's really hard to work out if your psoas muscle is imbalanced – it lies deep within the pelvic cavity and due to various sensitive organs which overlie it – it isn't the sort of muscle to be prodded about by the inexperienced! If it is imbalanced – your pelvis could be twisted and this will load your quads / knee / shins in one leg differently to the other leg. The best method of stretching the psoas muscle that I've found is to kneel on one knee – and with the other leg at 90 degrees in front of you – foot on the floor – rock forward til you feel deep tension within the thigh muscles – keeping your back / knee / hip in a straight alignment.
Check this out as well.
15. Freezing Cold baths (more tolerable with a hot shower on your head)
Do this after every run if badly affected by lactic acid – but def after every hard work out
16. Hot baths with Epsom Salts
NOT after exercise – but helps dispel lactic acid – especially good after a sports massage
17. The best routine for stretching ever
After spending close to £500 on physio / osteopaths / sports massage etc etc – I still suffered from constantly seized muscles – and walked with a stick / used a hot water bottle at night even in a heat wave. Hip pain in particular was dire.
Then early in June I found this site from Paula Radcliffe's physio which advocated a completely different stretching technique – using ropes – and holding the stretch for just 2-3 secs repeated 12 times.
After just 2 days of the exercises I was 98% pain free – able to walk normallys and stop using the hot water bottle. The change its made to the quality of my life in indescribable
18. Cross training is invaluable
Rower – works the hamstrings – bike the quads –
I hope that some of these exercises help you with whatever your problem is.