Treating shin splints - you can do better

Shin splints are miserable. They attack one of the boniest, most splintery places in the entire anatomy.

This writing is for those who have already tried the typical ice, soft tissue massage, electric stimulation, activity modification, and anti-inflammatory drugs, only to find the splints remaining firmly in place when they resume the provocative activity, which is almost always running and jumping.

At that point, you probably tried to rectify the problem with something like this:

Dear Shin Splints, ...

Contrary to common belief, shin splints are not due to splintering of bone, but from the tendons of the lower leg muscles being repeatedly pulled from their insertion point on the tibia (the thicker lower leg bone). Shin splints are an inflammatory over-use condition due excessive tensile strain along the lower leg muscles. There's simply too much force, too often, for too long, or some combination of the these.

"Two weeks off" is common first-line medical advice. But you can't afford to waste that two weeks droning away on a stationary bike or [YAWN] elliptical trainer. Running through this problem without treating the root cause can easily progress to a tibial stress fracture. And let me tell you that no matter how badass your lower legs appear in their elaborate kinesiotape patterns, you're going to need more than two weeks to recover from a stress fracture.

Here are some suggestions on how to spend your two weeks off.

1. Be evaluated by a physical therapist who's trained in this area. Seriously. A detailed look at the strength and mobility of the trunk, hip, knee, ankle, and foot, isolated as well as how they work in combination, will usually reveal something contributing to the excessive strain on the lower leg. Analysis of running and jumping technique is invaluable.

 Even if your personal trainer or athletic trainer has the knowledge to identify a portion of these, he or she probably doesn't have the time to assess much less correct the issues.

2. Along those lines, get strong in corrective exercises that target any identified poor movement patterns or other impairments.  Most resistance exercise demands very little impact. A handful of low intensity foot/ankle mobility drills and light resistance work can be performed multiple times per day in order to increase the resiliency of the tissue for when you return to high intensity activities.

3.  Give attention to your shoes. If you train regularly and intensely in shoes that were on sale at Kohls for $34.99, well, you get what you pay for. Serious athletes should not be training in random shoes made with materials fit for driving the kids to soccer practice. There's no substitute for quality shoes correctly fitted and suited for your foot type.

4. Orthotics (off-the-shelf or custom), braces, and taping techniques all hold great potential for decreasing the tensile strain demands of the involved muscles. It's difficult to say which of these may be best for any given individual, but we usually start with the least invasive and costly means and work from there as needed.

5. Return Gradually. Once your two weeks of "rest" are up, do not try to accomplish too much too quickly. That's likely a large portion of what got you into shin splints in the first place.

Keep careful tabs on distance, duration, and repetitions (that's foot contacts for jumpers etc.). Especially watch out for running on hard and graded surfaces. It's the down hill that kills, as well as the plod plod plodding, pounding along when the legs fatigue. This occurs relatively quickly for those who are generally deconditioned, especially if they are above ideal body mass.

I often advise clients to begin with some modified up-hill sprints, in grass if possible. Hill sprints are a semi-specific way to prepare the body for normal running, jumping, and cutting, with plenty of conditioning effect but far less impact.

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