Shin splints treatment exercises
Earlier this year, you decided to increase the amount of training you do, and you boosted the time you spent daily on the football pitch, basketball court, volleyball surface, or running track. Things seemed to be great for a week or two; you could really feel yourself getting stronger and fitter. Then, a small problem showed up: you began to feel a dull ache on the inside, lower portion of your shin during the first few minutes of a workout. The discomfort went away once you had warmed up, so you weren't overly concerned.
Unfortunately, the pain returned on the following day - and lasted for a longer period of time. As the days went by, pain was present for the whole training session, as well as your cool-down - and even hung around during your regular daily activities. When you used your fingers to probe the area near the back, inside edge of the lower part of your tibia (the main bone in the lower part of the leg), you felt tenderness but no major swelling, and the pain seemed to centre in the tissues (muscles and tendons) near the tibia, not the tibia itself. What had gone wrong?
'Some experts contend that medial tibial stress syndrome (MTSS) is almost inevitable, since each shin absorbs a force equal to two or three times bodyweight with every footfall'
Of course, you had developed a classic case of 'shin splints,' an injury which is more accurately called medial tibial stress syndrome (MTSS). Many experts believe that shin splints are the most common injury among athletes who do a lot of running in their sporting activities ('Relieving Painful Shin Splints,' The Physician and Sportsmedicine, vol. 20(12), pp. 105-113, 1992). And it's an especially troubling injury, because it can stop quality training in its tracks and also tends to recur, defying conventional treatments. The actual site of injury in the shin area can be muscle, tendon, bone - or the connective-tissue wrappings which surround your muscles and bones.
Some experts contend that medial tibial stress syndrome (MTSS) is almost inevitable, since each shin absorbs a force equal to two to three times body weight with every footfall as you run across the soccer field, down the basketball court, or along a 10-kilometre cross-country course, if you're an endurance runner. This works out to be about 700 stresses per shin for each mile that you run (a soccer player usually covers six to seven miles per match). The cumulative effect of this repetitive stress on the muscles and connective tissues in the shin area is believed to be the origin of medial tibial stress syndrome (MTSS). For that reason, medial tibial stress syndrome (MTSS) is often called an 'overuse' injury, although as you'll see in a minute, the real problem is not so much overuse as it is a lack of preparation for use. Specifically, medial tibial stress syndrome (MTSS) occurs because the ankle dorsiflexors - the shin muscles which in effect pull the top surface of the foot toward the shin and also (as part of their eccentric functioning) keep the foot from being pulled away from the shin too rapidly - are not functioning as well as they should.
If people can hear you coming, watch out
The key role of these ankle dorsiflexors during running is in fact to control and limit plantar flexion - the movement of the foot away from the shin. During the very earliest part of the footstrike portion of the gait cycle - right after the foot makes contact with the ground, there's a tendency for the foot to slap hard against terra firma. In a 'heel-striker,' for example (an athlete who first makes contact with the ground with his heel), forward momentum tries to slap the rest of the bottom of the foot against the ground very quickly and forcefully, an uncoordinated and energy-wasting action which is resisted by eccentric contractions of the dorsiflexors.
If an athlete has weak ankle dorsiflexors, you can often 'hear him coming a mile away' if he is running on a hard surface, because his feet will actually make slapping sounds against the pavement (of course, such a runner will be at high risk for medial tibial stress syndrome (MTSS), because the rapid downward movement of the foot will tear at and overstress the dorsiflexors). In contrast, the athlete with strong, functional dorsiflexors will seem to pad softly along, even if he is running on rock-solid concrete.
Imitate the action of the Kenyans
In his fine book Fear and Loathing in Las Vegas, the great sports journalist Hunter Thompson wrote that one could tell the difference between good and bad runners by the sounds their feet made on the ground. The people who ran very fast, Thompson observed, also ran very quietly, while individuals who ran slowly tended to stir up a huge auditory commotion. Basically, quieter running means more economical, coordinated, stable running, which explains the performance difference Thompson noted.
If you doubt this, watch some of the elite Kenyan endurance runners, for example, and compare their foot-to-ground patterns with those of the average athlete. The Kenyans build up tremendous dorsiflexor strength and functionality because they spend their initial years of life running and walking endless miles while barefoot, instead of moving around with their feet clamped into a fluffy set of midsoles which shield the feet from hard work - or sitting around with feet propped up on a soft hassock. As a result, the Kenyans waste very little energy during the stance phase of the gait cycle - and seldom hobble off the track or roads with a shin injury.
In addition to controlling plantar flexion, the muscles we call the dorsiflexors must also deal with side-to-side motions of the foot and ankle during running - as well as the rotational motions which are a natural part of the gait cycle. Any tendency of the foot to pronate (roll inward) must be controlled by the shin muscles. Any tendency of the foot to supinate (roll outward) must also be reined in by the dorsiflexors. If there is relentless, stressful motion in any direction, the shin muscles can be damaged. That's why many of the exercise routines which supposedly prevent shin splints don't work so well; they often emphasise only front-and-back motions, rather than the side-to-side and rotational activities which are routine aspects of the biomechanics of movement. The bottom line is that if you want to prevent shin splints, you can't merely develop general strength in your dorsiflexors - or strength which exhibits itself in only one plane of motion: Your dorsiflexors must actually be stronger while you are moving around. More on that in a moment!
'The usual treatments may relieve symptoms but they don't prevent medial tibial stress syndrome (MTSS) from recurring'
That's why the classical mode of treatment for shin splints - RECEIPT (rest, elevation, compression, easy stretching of the muscles, icing, and possibly taping) - works fairly well at relieving symptoms but does a very poor job of keeping the injury from recurring. Only by improving the functional strength of the dorsiflexors and the strength and coordination of the entire ankle area can one be confident that medial tibial stress syndrome (MTSS) will be held at bay. If your dorsiflexors are strong enough to handle your total training load, and they aren't yanked around too badly by poorly controlled ankle movements, your training year should be unmarked by the pain and disruption of shin splints.
These are the exercises to follow
So what should you actually do to lower your risk of medial tibial stress syndrome (MTSS)? Well, simply utilise our shin-splint-preventing exercises, outlined here:
(1) Wall Shin Raises: Simply stand with your back to a wall, with your heels about the length of your feet away from the wall. Then, lean back until your buttocks and shoulders rest against the wall. Dorsiflex both ankles simultan-eously, while your heels remain in contact with the ground. Bring your toe