Shin pain / shin splints

I started suffering shin pain after a hill run in unsuitable trainers about July/August. Never had any bother with it before then. Been running 10-ish years, usually at least 20+ miles a week, 3+ runs. Do more when I'm training for marathons and ultras, which I run fairly slowly - 4:15 marathon.

The shin pain initally came on very quickly during the run as a burning sensation on the insides of my shins/calves, more like the burning you get in your calves from running up hills or stairs. Since then it's come and gone but not settled down completely, despite a couple of physio visits, a couple of sports massages, regular icing, lots of foam rolling of calves and shins and everything else, tennis ball rolling of soles of feet, new trainers (new but the same model I'd been running in for years with no problems - it was another brand that caused the flare-up) and a whole month off running.

Now I'm not sure what to do. It's not as bad as it was a couple of months ago, but it doesn't really seem to be improving any more. Running on the flat is okay but down hills is sore. Uphills is no bother.

I've been taking it slowly since I started back with just slow runs of 2-5 miles, I foam roll and self massage before and after, I ice after runs and I finish off showers with a blast of cold water on my shins. I don't take anti-inflammatories but would if it was recommended.

When running, it usually starts to hurt within a couple of miles and continues to hurt for an hour or so after. A dull ache that feels bone deep rather than a pulled muscle sort of feel. Walking isn't sore but crouching down on tiptoes produces moderate discomfort. It feels tight, so I've been crouching to stretch it quite a bit, which I don't know is the right thing to do or not.

Gait analysis shows that I have hypermobile ankles and while I definitely don't pronate in the usual fashion (my shoes have very definite 'neutral' sole wear), my ankles do sort of bounce in then out again more than most peoples, which my physio and shoe fitter both say will be stressing the inner shin muscles more than usual. I'm wondering if anti-pronation shoes would help to prevent that and if they'd be worth trying. My physio and fitter both said anti pronation shoes wouldn't help but I'm still pondering over it...

I'm also wondering if some type of minimal/barefoot shoe would be worth trying out as while concentrating on my gait and trying to feel what's happening in my legs and feet, I noticed that I seem to be almost trying to midfoot strike to minimise the pain. Which isn't easy in normal cushioned shoes...

Any ideas/advice would be welcome 

rwd

I really sympathise because you seem to be doing all the right things.  Changing shoes/ getting stability ones for the floppy ankles seems drastic given there were no prior problems.

I suffered in the Spring, and still have to be careful, and what worked for me was

(1) concentrating on lifting my feet off the ground more quickly - strangely it reduces heal strike (i.e. think of the lift, and the landing takes care of itself)

(2) more difficult now it's cold, but I would soak the shins in a cold bath (kneeling) for a good 5 minutes after a run - more than just a blast of cold water. The kneel stretch is good, too.

(3) mueller shin guards for compression

(4) Youtube "toe tapping shin splints".  Don't laugh, it works...sit with knees at 90deg and lift foot from heal and tap; carry on until exhaustion. 

(5) acupuncture

Good luck

Hi

I think shin splints are caused by an argument between the muscle and the fascia around it, about what size your leg should be. The toe tapping is not load bearing so can't encourage muscle growth, so my guess is it releases the fascia.....?

Toe-tapping works the tibialis anterior muscle on the front of your shin (which controls the dorsiflexion of your foot I think). It attaches to the top of the tibia so your pain could be caused by periostitis of the tight anterior muscle. I think toe-tapping strengthens it as well as stretches but I'm not sure.

Torchbearer - After some googling and head scratching over long words I don't know the meaning of, I finally found some pictures. I appear to have posterior problems, not anterior. Annoyingly, most descriptions/treatments seem to mention arch support as it's almost always caused by flat feet, which I definitely do not have...

Am going for weekly deep tissue massages to sort out a chronic neck/back/shoulder problem, and am getting the guy to spend a bit of time on my shins as well. He also said it was weird I had it but didn't have flat feet, but seems to think a few weeks of painful manipulation will sort it out. I'm not so sure...

Teknik - I don't understand what you mean by 'an argument... about what size your leg should be'. Sorry, my dumb! Could you perhaps elaborate for me please?

Ah, right. Thanks Teknik, I get it now. Sort of...

My physios both say everything is tight in my lower legs but I don't know what they use to measure that as I'm not 'stiff' at all and usually score off the charts in any measured flexibility test. My t'ai chi teacher has commented a couple of times on how 'relaxed' my ankles are. I don't really understand how muscles can be too tight without it in some way restricting flexibility.

I haven't been to my GP about this yet as any exercise related injury gets the standard response of rest it for 3-6 months and take a shedload of ibuprofen. Then come back after that if it isn't any better. At which point they usually just try to feed you stronger drugs.

In the past when I had a mystery groin/abdominal problem that was causing acute hip bursitis, my doc told me it was something to do with my hamstring and just said rest it for a month. That's how I ended up at the physio and sports masseur I'm seeing now. All in one hour I got examined, diagnosed correctly with a strained psoas, massaged in the right spot so hard I nearly cried, then a week later it was gone completely and three weeks later I ran a marathon pain and symptom free.

I hadn't thought of an x-ray or MRI as my physio reckons a stress fracture is very unlikely. Though I suppose I may have to go along to my doctor and pretend to take ibuprofen for 6 months in order to get a referral to a specialist, just to rule it out!

runs-with-dogs. I've got a problem with tibialis posterior myself at the moment. Thought it was a stress reaction in my medial malleolus (inner anke bone) to start with. Had a week of no running before I realised it was the muscle & tendon, not the bone. I've had some very painful massage, which helped; I've run for up to an hour with some discomfort but not actual pain and I'm intending an 11.5 mile run tomorrow. I've also realised I have slightly tender Achilles' tendons - sore when I pinch them gently, but otherwise okay. And I have a 50-miler to run on 2nd February, and need to get my mileage back up for that.

I'm presently trying eccentric calf-muscle loading exercises - after warming up on the exercise bike, I'm standing on a step, raising up on both legs, then standing on just one leg and slowly lowering the heel to below the level of the step. The idea is to do three sets of 15 reps of lowering with a straight leg and the same with a bent knee (to exercise soleus), twice a day. I'm starting off with 10 reps with my leg facing forwards, then 10 with toes-out and ten with toes-in then 10 with bent knee, on each leg. A study found excellent results in 15 athletes who did these exercises for 12 weeks, with 15 reps straight leg and 15 reps bent leg, three sets, twice a day [the toes-in and toes-out is my own addition based on previous advice from a physio], starting just using their own body weight, but building up to do the exercises while wearing weights, and then using weight machines for extra resistance.

In the study, the healthy leg was used for the return to "on the toes" but since I have the slight tenderness in both Achilles' tendons (although the posterior tibialis problem only on the left leg) I'm using both legs for that, and doing the exercises on ecah leg in turn.

One interesting thing in the study was that although only eccentric loading was used on the bad legs, both the eccentric and concentric (contracting) strength of the leg improved to match the strength of the good leg. Also, after the 12-week period, the athletes were able to maintain normal training so long as they performed the excercises twice a week. Reference: Alfredson et al (1998): American Journal of Sports Medicine. 26(3), 360-366

Jeez, you're just seven weeks away from a 50 miler? Do you think you'll be okay for it or are you considering a possible DNS? I've got a 33 miler in March and a 53 miler in April but they're far enough away that I'm not quite panicking about it yet...

I guess I'll have a good shot at the calf exercises too - sounds like they work. But I'm still puzzled as to how. I have massive calves already and when I do the toe tapping exercise my tibialis muscle pops out from my shin about an inch. I'd have assumed that the calf/toe exercises would be to strengthen weak bits but I can't see how that's the case here. Perhaps more releasing of fascia maybe...?

Thanks for the help. Hope you're okay for your 50 miler

I'm really hoping to run that 50-miler (and the LDWA 30-mile challenge two weeks before), because otherwise I'm not going to manage my intended "5 x 50 for 2013". Thanksfully I'd been keeping up my fitness reasonably since NDW50, running a decent B2B about every third weekend, with a couple of 20-mile trail races and Beachy Head marathon, so having had a week off and a couple of weeks light running shouldn't have done too much harm to my fitness level - let's see how I go tomorrow and during the next week. If I can manage a B2B of say 22+10 next weekend I should be okay. At least it's Thames Trot in February, not one of the really hilly ones!