Shin Splints

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    Jun 05, 2007 1:36 AM GMT
    I have shin splints, and they're not healing (it's been a little over three weeks). If I can't start training soon, I won't be able to run this year's NYC Marathon again. Any suggestions for speeding up the recovery process?
  • SkyMiles

    Posts: 963

    Jun 05, 2007 2:10 AM GMT
    I hope you get a better reply than this one, 'cause I don't know crap!
    Consult an orthopedist's assistant or intern for simple stuff like that. That's what I did for my 'mallet' finger (don't ask).

    Hope it heals up in time for your marathon.
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    Jun 05, 2007 2:27 AM GMT
    Well, if they are still really painful, then you need to apply ice to get some of the swelling down...if the acute pain has subsided, then you'll want to do heat. I always alternate hot/cold if the acute pain has subsided some.

    If you do cardio, ride a bike or swim... the key is low to zero impact so they can heal. Shin splints are usually inflammation in the pariostium that surrounds the bone.

    Stretching is key. It will help to loosen up muscles that might be putting extra strain on the periostium. And if you or someone else can massage the muscles around the leg, that will help with some of the discomfort.

    Take an anti-inflammatory like ibuprofen like twice a day or so to keep inflammation down.

    If this doesn't do the trick, then you need to see a doctor. There could be more serious things happening...
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    Jun 05, 2007 2:53 AM GMT
    Shine splints are muscular over use of the pre tibibial muscle group. Once it is irritated, it has to rest. You may also want to check on your gait and shoe wear. A lot of times, at least with my patients, correcting the proper loading mechanism of the foot on the ground solves the problem.

    Just make sure you seek proper attention so it does not turn into compartemental syndrome. Also make sure it is not a vascular problem or other obscure issues like bone pathology (for example, cancer.)

    SOft tissue treatment also works well, especially ART (active release technique.)

    - Check your gait/running pattern.
    - Check your foot and shoe wear. USe custom made orthotics if needed.
    - Work out any lower extremity flexibility issues or muscle strength imbalance issues.
    - Soft tissue work, cold therapy, and NSAID.
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    Jun 05, 2007 4:46 AM GMT
    I had shin splints so bad in middle school I literary couldn't walk.

    Treatment (not very effective for me):
    rest, ice, compression

    Prevention once healthy (very effective for me):
    Wear shoes that fit.
    Do the duck walk (walk on heels with ankles bent 45 degrees) to strengthen the anterior tibialis.

    I've never had shins splints since.
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    Jun 05, 2007 4:51 AM GMT
    so I guess that's ^ not really helpful for "speeding up recovery" time, but I've never heard of anything (stretches or exercises) recommended to do WHILE you still have shin splints.
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    Jun 05, 2007 7:07 AM GMT
    When you are sitting st your desk or watching TV, tap your toes. Really, it works. I've had problems with shin splints over the years and this really speeds up the recovery.
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    Jun 05, 2007 1:25 PM GMT
    I never really believed in this reflexology BS, but I had bad shin splints about 8 yrs ago. They lasted for weeks. I read a book on resetting the knee. Google it. I will try to explain what it said. Place right hand over top of right knee. Your thumb index finger and you middle and ring finger form a tripod. Your index finger should touch the top of your knee cap. Squeeze for 20 seconds then release. Immediatly find the soft tissue in the front of your knee right below ur knee cap. Apply pressure for 7 seconds with middle and ring finger. Then release. Lastly raise your leg and drive your heel on the ground with a slam. I felt immediate relief. Repeat on left knee. Good luck.

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    Jun 05, 2007 3:03 PM GMT
    Well, since you are an avid runner already, you know that most likely your shin splints were caused from worn out running shoes or running in the wrong shoe for you.
    Correct this ASAP. Get shoe advice.
    I remember having shin splints in middle and high school. They were caused by wearing Converse "Chuck Taylors", the absolute worst shoe that I could have worn. No support in the heel, arch etc.
    Good luck in the NYC Marathon!!
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    Jun 05, 2007 3:10 PM GMT
    If the problem is systematic, you probably have some biomechanical issues, such as leg length discrepency. I agree with NYCMusc4Musc....get thee to a podiatrist who specializes in sports medicine...and you probably need orthotics to correct the issues.

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    Jun 05, 2007 3:20 PM GMT
    I had these and I had to stop running for quite a long time, was rather depressing. I've since gone to elliptical machines or tread-climbers (which I LOVE!) At the time I couldn't stand to do cardio in a gym, I like to be outside and have a change of scenery rather than stare at a television screen or some mass of sweating people. I got over it though.

    In my case the probolem was overpronation. Here is a link to webmd that contains some concise info:

    The pain was very severe in my case and I've been too chicken to take up running again. I have hopes to one day, but haven't in the past 5 years.
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    Jun 06, 2007 2:21 AM GMT
    Read some post above mentioned compression...

    It is only good if you ahve acute "shine splints."

    Chronic "shine splints" can become a much more serious condition called compartmental syndrome, which the muscles in the calves are so inflamed that the build up of internal pressure prevents adequate circulation, thus it is internal compression and more external compression may not make it better but worse... Some cases of compartmental syndrom does not respond to therapy and will need srugical intervention, basically slitting open the fibrous sheat that contains the calve muscles. This is not a great option as any surgical procedures produce more scar tissue, which is inelastic, causing more compression down the road...

    Rest, orthotics, gait training..and REST, REST, REST....

    Don't let it become compartmental syndrome...
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    Jun 06, 2007 3:03 AM GMT
    OK here it is, I have seen lots of people with shin splints and recovery from then will take a lot of extra work and time than normal training will.

    Some of these people are right in what they are saying.

    To keep training with shin splints the key is pool running. It is running in the water. You go and run on the spot in deep end. It is NO impact. This can be very boring and tedious so it is best to find someone that can either keep you company at the pool and or do it with you.

    Here is the first link I found on pool running from google.

    It is also important to seek some professional help and confirm that it is shin splints and not a stress fracture. Go to an athletic therapist or a doctor that specializes in athletes because they will know a lot more than your GP. You may also have to get some physiotherapy for it all depending on what it is.

    Now in terms of your shoes, this can be a possiblity causing the shin splints but its more than likely an overuse thing in your case having been training for a marathon.

    Orthotics are not a recommendation I would make to anyone because most of the time they are not necessary and really you can get a pair of shoes that does the same thing as your orthotics and it costs you hundreds of dollars less. Go to a specialty running store and have them look at your old pair of shoes and see if they are the right pair of shoes for you. They can also assess to see if there is a better pair. There is not a brand I would recommend over another because they are all about the same quality, the fit of each brand is very different. Also a pair of shoes should have about at the most about 400-500miles on it before it is garbage. I dont care whether it still looks new or not, after that there is very little cushioning left in it to support your training and your legs take a lot more of an impact.

    As for Ice and Vitamin I (ibuprofin) These are great for temporary relief of the pain and swelling but not always a solution to the problem.

    I would recommend to anyone that after a tough workout go in the bath with the water on its coldest setting and throw a few ice cubes in. Sit in it for 10-12min and your legs feel great afterwards. While your in the water stir it to maintain the cold throughout unless you have a jet in your tub. I usually just fill a garbage can with cold water and some ice cubes cause then I can just stand in it.

    Some people have said reflexology and shit well a trained physiotherapist will be able to help ya with any exercises that you can do to help get over your injury.

    If you have any other questions then do not hesitate to fire me an email. Or if you have any questions about shoes. But first go seek some professional help to correctly diagnose it.
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    Jun 06, 2007 3:39 PM GMT
    So can, as a corellary to that, if someone was going to start running, what would advice be to help prevent shin splints?
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    Jun 06, 2007 10:22 PM GMT
    Disagree with Can duathelte about use of orthotics..

    First of all, I am a professional at this. I am an ortho specialized PT and I am also a clinical instructor for interns on their ortho rotations...

    Not everyone needs orthotics, this can only be assessed when you are physically examined, statically and fucntionally.

    But you really cannot make a generalization that orthotics are not needed. Often times, they are needed, and many times, they can improve your gait/running pattern. Shoes, no matter how well made, can only accomidate a certain range of patients. Shoe manufactures wil not make shoes that can only fit a few, so the shoe lasts are made for a few general categories of feet.

    I think the problem is in the area of POORLY made orthotics... I would recommend orthotics made by an ORTHOTIS. Orthotics made by a regular podiatry is great for non athletic or diseased feet such as diabetic foot, but only an orhtotis has the extensive education SPECIALISED in orhotics (3 years after college just to make orhotics/prosthetics/braces.)

    A poorly made orthotic can do more hamr than good... Make sure a orthotist that is specialized in running make your orthotics... Cornell's Hosiptal For Special Surgry do not use podiatrist to make orthotics, they use specialised orthotis to make orthotics.
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    Jun 07, 2007 4:00 AM GMT
    -NYCMusc4Musc as a professional ortho specialized PT, would you make any other recommendation? I think its a biased opinion, because it is what you do.

    The truth is that I bet I could find a shoe to fit any foot. And I do stand by the fact that orthotics are expensive and most often not needed. I am not a medical professional but have enough shoe knowledge to fit the right shoe. Orthotics is often a recommendation made by an inexperienced doctor who doesnt have the knowledge of shoes and the orthotis is not going to turn down the opportunity to make money by selling another pair. 90% of people pronate to some degree.


    IN terms of preventing shin splints, stretching out your calves is important. Another thing is not to get into running too many miles too soon. Ease into it slowly. If your going from nothing to something start slow. There is no need to hammer out miles at a high intensity every run. Most people do too much too soon and that leads to overuse injuries such as shin splints. Dont be afraid to go for an easy run while training, and always stretch before and after a workout.
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    Jun 07, 2007 4:51 AM GMT
    Several years ago, I was almost crippled by stabbing pains in my left foot because my arch had collapsed. I spent $250 on custom made Foot Levelers orthotics, and they didn't do a damn thing. A friend then suggested those $25 orthotics sold on that TV infomercial... instant relief.
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    Jun 07, 2007 8:09 AM GMT
    First of all, physical therapists DO NOT make orthotics. We are not trained to do that. We are trained to spot improper loading of the lower extremity and any structral impairments. I therefore have no professional bias as you claim... And you were the one who mentioned to go to a professionl at this. And that is what I recommended as a professional...

    2nd of all, I have already pointed out that a poorly made orthotic can do more harm than good. What fits your foot can happend to be one made by an experienced orthotis, or by coincidence a pre-made off the shelf one you see on TV, or even a poorly made orthotic made by a podiatrists who is not specialized in athelets but mainly treat 60 year old diabetics... It all depends if the orthotic is properly made (casted weight bearing vs non weight bearing, flexible vs rigid, half vs full, combination flexible/rigid posting, etc, etc.) I have also pointed out that orthotics are usually made by podiatrists rather than orthotists in this country. And that I recommend orthotics made by an experienced orthotist specialized in treatin atheltes. Did you read my comments carefully...?

    And most importantly, I have also pointed out that "shine splints" is actually a muscular/fiberous impairment, and this is directly related to muscle over use. What usually causes muscle over use is improper loading of the weight bearing lower extremeity structures. Improper loading can be caused by the following primary causes: poor gait/running pattern, functional soft tissue/muscular strength and flexibility imbalance, structural impairment of the foot/ankle or even the entire lower extremity/spine complex, or all of the above.

    And once you have a problem, if you keep over loading the following 4 parameters: duration, load/force, angel of attack/ROM, and velocity, you will just exacerbate your symptons and run into acute local inflamtory response. Therefore, you should do every thing to not run into acute phase, and to cut down load and duration is bascially: REST.

    Besides decreasing the acute inflammatory condition with "shine splints" (I will try to use common langauge here...), one should address the primary causes mentioned above. It can be gait analysis/training, correct the muscle strength and flexibility imbalance, and whatever it takes to correct any static or functional structural impairment.

    The above mentioned primary causes of "shine splints" are VERY complex... "shine splints" itself is a VERY general term. People tend to think it is only anterior compartmental impairment involving the extensor muscles such as the tibialis anterior and extensor hallucis longus, but often times "shine splints" is involving the muchmore problematic deep posterior compartment involving the deep flexor muscles such as the flexor hullucis longus and tibialis posterior. Now if your foot has a very lax navicular joint and also a excessive laterally mobile subcalcaneal joint, the very fast loading of the foot may load the big toe too early in the gait phase and also excessively, forcing the flexor hallucis longus to constantly over use, you will inflam the posterior comparment. The inflammation build up pressure inside the deep posterior compartment and therefore decreases circulation. A shlef made shoe to prevent over pronation may decrease this sympton, but it never addressed the excessively laterally sliding sub calcaneal joint, and therefore not optimal in addressing the primary cause... This is just ONE SIMPLE example I come to see a lot. "Shine splints" are not that simple...

    Properly made orthotics helps to correct gait pattern abnormality and the consequent improper loading of the lower extremity. I still stand by what I recommended as a professionl over anything you may see online from a quote from jut anyone without any formal education on this matter...
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    Jun 07, 2007 8:19 AM GMT
    Juat one more clarification from above post:

    Joint structures behave differently in static phase and also fucntionally in motion and dynamic phase. For example, your leg length discrepency can be a static structural one, or a fucntional one. Statiic one is caused by actual bone length discrepency. Fucntional is casue by either aanteriroly rotated innominate bone (hlaf of a pelvis) that causes the thigh bone to drop lower, or a severly pronate foot with a severely laterally mobile subcalcaneal joint. the innominate bone can be correct by adjustments. hip flexor/hamstring flexibility, and posture training. The ankle/foot, orthotics. That is what I meant by static and fucntiaonl structural impairments.

    Also keep in mind the muscles in your calves are bundled in compartments made up of fibours sheaths... Once a muscle is inflamed, the compartment is presurized. It is NOT like your bicep or tricep where they are not wrapped in a bundle...
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    Jun 07, 2007 8:28 AM GMT
    Since I am also a trained ART provider, I also recommend soft tissue treatmetn such as ART.

    My other patients have mentioned muscle activation technique as well. I have heard good results with it.

    As far as recommendations...

    1. Prevention:
    - Proper warm up, proper stretches.
    - Know your impairments, whether it is static/dynamic structural, gait pattern, shoe wear, muscel flexibility/strength imbalance.
    - Do not over load the 4 parameters I mentioned above: duration of activity, avoid stressful angle of attack/ROM of joints, monitor load/force (uphill, lack of cushioning of the shoe wear, etc), and velocity of activity (too fast or too slow a run.)

    2. Corrective:
    - Anti inflammatory: NSAIDs, cold therapy, REST.

    3. Compensatory:
    - Soft tissue treatment to get you through the race. You ever see ART stands all over the place at IronMan..?
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    Jun 07, 2007 12:57 PM GMT
    I agree with Musc, repetetive stress injuries need, above all, rest.
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    Jun 07, 2007 3:30 PM GMT
    I gotta second the recommendation for soft tissue treatment. I've been going to a Rolfer every three weeks for a couple years, and she's done wonders for me. I'm actually a half an inch taller now. Rolfing fixed the pronation that was exacerbating my foot problem. Last week, she worked on my bad elbow, and it's vastly improved after just one session (I'm kicking myself for not mentioning it weeks earlier.)
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    Jun 07, 2007 4:56 PM GMT
    Musc - I do agree with the ART and it is great. I love it and wish it was free. Helps a lot.

    I do also agree that rest is extremely important for an overuse injury but when you have an athlete training for an upcoming event, rest is hard to get until after the event. Most will train through until the event is over.

    And in my comments I did agree that yes you want to get proper orthotics but my point is that they are wideley overused and used on a lot of people when they are not really necessary. I never denied what the purpose of them is. My point is that there are a lot less expensive options to orthotics out there but most people dont know of them, and that a podiatrist or orthotist is not going to turn away a customer or an opportunity to make money.
    Yes I made a mistake in assuming that an ortho specialized PT would be someone that would recommend patients to podiatrists/orthotists.

    When I said professional I didnt mean podiatrist, I meant sport medicine doctor and Physio therapist. I guess this comes from a biased opinion because I have seen a lot of people move away from orthotics in running once in the proper running shoe. There are a lot of people who dont know how to make orthotics out there and the podiatrist does not make an effort to educate people on the running shoes that they wear with orthotics. Because wearing a Motion Control shoe with orthotics usually leads to more problems. I am not claiming to be a professional at all on making orthotics either but running shoes do the majority of things an orthotic can. I have been running for many years and seen a lot of people deal with shin splints and yes there are a lot of causes of it but I still maintain that if you are training through shin splints for whatever reason pool running is the one and only thing for a fast recovery. It is also a lot of hard work and discipline to be able to do that while getting treatments.

  • UStriathlete

    Posts: 320

    Jun 07, 2007 7:47 PM GMT
    Active Imprints out of Boulder CO, makes the best orthotic. You can find them online and they will mail you the foam molds and questionaire with instructions, of course, send the molds back and they send you orthotics from the molds and the questaire. Check out their website. They have helped many, many athlete's, from weekend worrier to the very elite athlete, from all different kind of sports. I've been wearing their orthotics for 14 years (morton toe, being my reason). No style of running shoe can help me. However, I do really like the new running shoe Newton. they are worth price, they have lasted 20% longer than my asics.
    CanDuathlete is right about the aqua jogging, for alternative and peace of mind for the athlete. Rest is never an option dealing with athletes, only rest of the active that is causing pain, is common sense.
    Rolfing is great therapy.
    Shin splint is definitely an over use injury, especially with poor biomechanics. When i have clients switch over to Chi Running bio mechanics, they get better. Running doesn't injury you, it's HOW you run that injury's you.
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    Jun 07, 2007 10:05 PM GMT
    I also want to help members reading this thread on how to spot a poorly made orthotic (if you need one.)

    Most podiatrists have very little training on gait pattern and biomechanics. Specialized PTs and orthotics have very extensive and detailed training in this area because we are the ones on the frontier of making artificial limbs of all sorts, from a simple prosthetic leg to robocop like computerized limbs, to work well with amputee patients.

    Most podiatrits, when making custum orthotics, just take a cast of your feet in non-weight bearing position. They are assuming that non-weight bearing position is the most natural and comfortable state for feet, therefore all attempts must be made to restore this shape/state when the feet are weight bearing in shoes/orthotics. FALSE!

    An experienced orthotist will work closely with PT's and MD's with detailed gait analysis and determine the degree and aread of correctiveness orthotics need to be. The shape of the feet in both weight bearing and non-weaight bearing positions are considered in conjunction with gati study. The cast is made as a result of all considerations and you will ALWAYS get a few trial and temporary orthotics before the final one is made. This is no different from making prosthetic legs. Patients NEVER get just one leg as the final product. There is a lot of trial and error and repeated fitting and adjusting before a final leg is produced and the a few temporary ones junked on the way...

    So if the person who is making you the orthotics just takes one cast of you feet while you are on the clinic bed... YOU ARE GETTING BAD ORTHOTICS....