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The sorry state of shin splints
As we gear up for the 2014 spring 10K, fun run and marathon season, there is a common running injury that should be discussed.
Shin splints is a well-known, catch-all term used to describe pain at the front or lower inside edge of the tibia (shin bone).
The term doesn’t discriminate the different possible tissue problems occurring.
More properly known as medial tibial stress syndrome (MTSS), this condition occurs during physical activity and results from too much force being placed on your tibia and connective tissues that attach your muscles to the bone.
MTSS is common in runners and in those who participate in activities with sudden stops and starts or jumps, such as basketball and soccer. The overloading is usually a result of improper form when exercising, wearing worn out or improper athletic shoes or more frequently, ‘too much training, too soon’.
Sometimes a contributing factor can be the surface of the ground. The slant of the road (called ‘camber’), hill-work or changing the type of surface (going from hard asphalt to soft grass/sand, or vice versa) can also generate extra loading on these tissues.
The pain may be caused by an irritation of the periosteum (the sheath covering) of the tibia, inflammation of the tendinous connection from the muscle to the bone, the muscle itself, but this injury may overlap with other conditions that include increased pressure inside the compartment sheath surrounding the muscle, or stress fractures in the bone itself.
Most cases of this injury resolve with rest, a decrease in training distance or speed or a change of training method (switching from running to water running, while tissues heal). In rare cases, surgery may be necessary to treat complications from tibial stress syndrome.
MTSS due to an irritation or inflammation of the sheath or connective tissue can cause a dull aching pain on the front or inside lower part of the leg. The pain may increase when you move your legs, climb stairs, or walk. The pain typically goes away with rest and may be worse when you first wake up in the morning. If the area of pain is localized (small area), tender when you press on it and doesn’t subside much, there may be a stress fracture.
A compartment syndrome is a pain that only comes on while running, building in intensity enough that it eventually makes you stop running, and after a brief rest goes away. If you then resume running, the pain begins to rise to high intensity, forcing you to stop. This is a mark of compartment syndrome. It is important to get checked out by your family doctor.
If you try to push through tibial stress syndrome, you will probably end up sorry. It is helpful to stop the activity that caused the condition until your symptoms go away. Your doctor may refer you to physical therapy for pain control, rehabilitation, and training tips. Physical therapists can provide treatments to reduce your pain and can teach you how to properly stretch and strengthen your muscles. You will also learn correct postures and form to improve your running style and suggestions for avoiding muscle overuse.
Your rehabilitation is best done under the supervision of a therapist, but when you do return to running, increase your mileage slowly, no more than 10 per cent weekly. But to properly rehabilitate and avoid a recurrence of this injury, you must correct the factors that caused the condition in the first place, which can include any or most of the following: new or proper shoes for your biomechanics; consider changing your running surface (including hills); correct muscle imbalances; stretch after you run; and. most importantly, reduce the volume (number of kilometers run per week) and speed of your training when you return to running, and gradually increase volume and speed slowly over a long period of time to remain injury-free.
Kerry Senchyna is the owner of West Coast Kinesiology and is a provincially registered kinesiologist.