So you’ve been a bit slack lately and notice you’re gaining a little extra comfort weight so you suddenly decide you’re going to run every day for the next month and lose that extra 5kg. The first week you expect it to be hard so you push through, the second week you start getting shin pain and by the third week you can’t even walk because every time your foot contacts the ground you get a shooting pain up the front of your shin and it’s really sore to touch? It’s highly likely that you now have…
Also known as Medial Tibial Stress Syndrome which is commonly associated with pain along the medial border of your shin bone this muscle is called your Tibialis Anterior and just behind that you have you Tibialis Posterior. The Tibialis Anterior is responsible for lifting your foot up during the swing phase of running and absorbing the force when your foot contacts the ground. The Tibialis Posterior is responsible for controlling the arch of the foot during weight bearing, if this muscle is weak the arch of your foot will collapse and your ankle will roll in or over-pronate which creates stress on the tibia or shin bone.
Why does it occur?
Shin Splints commonly occurs due to a sudden increase in physical activity, typically running or high impact sports. Often happens in sports when pre-season is just beginning, or when you have just joined a gym or in our current situation when the gym’s close and sports are cancelled so the only thing you can do is go for a run because that’s social distancing, right… Anyway, this sudden increase in physical activity is a lot of strain on your little Tibialis muscle, it’s being overused, it’s not getting time to rest and develop new muscle fibers, in addition to poor foot and leg biomechanics, it gets sore and inflamed.
A Quick Self Assessment
Let’s test your calf function!
The knee needs to be bent like the photo above, lift the heel and press through the big toe. Be strict on yourself and make sure your ankle doesn’t roll out and you can lift right up to the top of the movement. Hold for 1 second and then back down, slowly. 1 rep every 2 seconds, up to 25 repetitions – make sure you get full height … if your knee comes in and your hips stay straight it may be a sign that you have weakness in your tibialis posterior… if your hips lift or hitch you may have weakness in your hip abductors and if your trunk rotates then hip abductors and rotators may be an issue!
How do we stop it from being sore?
- Initially, reduce running load and ensure supportive footwear when running.
- Massage into the anterior and medial aspects of the shin.
- Begin exercises 5 & 6 as shown below to strengthen affected muscles.
- Return to reduced running load, seek advice on how to gradually progress, duration/distance whatever your goal may be.
- Complete strengthening exercises, some common exercises for shin splints listed below.
- Complete a running assessment once pain is managed to highlight any imbalances or abnormalities.
What to work on?
- Improve load capacity in the calf complex.
- Improve kinetic chain load capacity considering the key muscles that aid in managing load i.e glutes, hamstrings & quads.
- Include weight-bearing exercises to improve bone load capacity.
1. Crab Walks
2. Hip Hitch
Help reduce pelvic drop during loading. Adding load in the opposite hand is a simple progression.
3. Step Ups
Step ups achieve high levels of Glute Max activity as well as working Glute Med and providing a proprioceptive challenge. Gluteal muscles are vital in absorbing load during the stance phase of running.
4. Wall Sit with Heel Lift
Will challenge both the Soleus and Quads (slide down wall and hold up on toes for 20-30sec– 2 vital muscles in absorbing load during running.)
5. Bent Leg Calf Raise
Soleus helps to reduce the bending force that the tibia experiences during impact which is thought to be key to development of bone stress injury.
6. Tibialis Posterior Strengthening
Arch strengthening to prevent over pronation when weight bearing.
7. Straight Leg Calf Raise with Toe Raised
8. Single Leg Soleus Bridge
This will challenge Glute Max, Soleus and Hamstrings. The hamstrings are most active during swing phase but they also contribute to the loading phase through co-contraction with the quads.
Has this been reoccurring injury for you?
If yes, you will really benefit from a running assessment. Performance 360 have a very high-tech system and Colleague Dennis who loves his toys. This system is called ‘Vimove’ and ‘DorsiV’ which helps identify and assess running biomechanics. This can assess ground contact time, ground reaction force and initial peak acceleration. An increase ground contact time in the symptomatic side can be associated with poor control of tibialis posterior and pronation. Ground reaction force can indicate hard landing and weakness in the muscles absorbing that force or is that from weakness on the other side? We can identify that for you. Finally, the big one initial peak acceleration refers to the speed of the tibia (shin bone) from ground contact to take off – the faster this measure is the greater likelihood of shin splints… the reason – poor eccentric control from calf complex and tibialis posterior.
Stay tuned for a more in depth blog on running assessments and analysis from Dennis.