Shinsplints
Shinsplints
13 Ways to Soothe Sore Legs
Funny things about shinsplints. Most people know when they have them, but very few people—experts included—seem to know what they are. Most doctors prefer the terms tendinitis, or periostitis, though they can't say for certain which of those terms, if either, actually describes the condition.
"Shinsplints could be a variety of things," says Marjorie Albohm, a certified athletic trainer and associate director of the International Institute of Sports Science and Medicine at the Indiana University School of Medicine. "Many people say they're the beginning part of stress fractures, others say they're a muscle irritation. Still others say they're an irritation of the tendon that attaches the muscle to the bone. The problem in treating them goes back to the problem in defining exactly what they are."
That may explain why shinsplints plague so many active people of both sexes and of all ages. Shinsplints are one of the most common and disabling conditions in aerobic dance (about 22 percent of students and 29 percent of instructors have them), and long-distance runners (about 28 percent are afflicted) have probably suffered with them since the first road was paved.
This much is known—unyielding surfaces can produce shinsplints in an instant, and that goes for people who walk on concrete as well as for those who exercise on it. Other shinsplint culprits include faulty posture, poor shoes, fallen arches, insufficient warm-up, poor running mechanics, poor walking mechanics, overtraining, and so forth. Shinsplints aren't hard to get.
The symptoms are vague and often confused with those of stress fracture (see "When Shin Pain Isn't a Splint" on page 536). But shinsplints typically include pain in the shin of one or both legs, though there may or may not be a specific area of tenderness. Pain and aching will be felt in the front of the leg after activity, although it may occur during activity as the condition progresses.
The remedies here are designed to help keep that shinsplint condition from progressing to the point of stress fracture and to let you continue your active lifestyle without causing undue harm. Those remedies that call on you to stretch or exercise the calf muscles can be beneficial in preventing a recurrence. As always, let pain be your guide. If anything recommended here causes increased discomfort, don't do it!
Start with the ground. "Start by looking at the surface," advises Albohm. "If you're walking, running, dancing, playing basketball, or whatever on a hard, unyielding surface, then you need to change that."
For those involved in aerobic dance, injuries are highest on concrete floors covered with carpet, while wood floors over airspace are the least damaging. If you must dance on a nonresilient floor, make sure the instructor teaches only low-impact aerobics or that high-quality foam mats are provided. For runners, choose grass or dirt before asphalt, and choose asphalt before concrete. Concrete is very unyielding and should be avoided at all times.
Then move to the shoes. If you can't change your surface, or if you find that that's not the problem, then the experts say it's time to look at different footwear. "Look at the arch support," says Albohm, "look at the shock-absorption quality in the sole and through the arch. The support has to be there, and the shoe has to fit you right."
For those who participate in activities that cause a lot of forefoot impact, judge a shoe on its ability to absorb shock in that area. The best test is to try the shoes on in the store and jump and down, both on the toes and flat-footed. The impact with the floor should be firm but not jarring.
For runners, the choice is a bit more difficult. For example, research has shown that about 58 percent of all runners with shinsplints also pronate excessively (meaning the foot rolls to the inside). Choosing a shoe for pronation control sometimes results in a loss of cushioning, but if you're a pronator with shinsplints, control is probably what you need.
Choose shoes often. Of course, one way to make sure your shoes retain as much cushioning ability as possible is to change them frequently. Gary M. Gordon, D.P.M., director of the running and jogging programs at the University of Pennsylvania Sports Medicine Center in Philadelphia, gives this advice for avoiding shinsplint pain: Runners who put in 25 miles a week or more need new shoes every 60 to 90 days—less mileage than that means new shoes every four to six months. Those who participate in aerobics, tennis, or basketball twice a week need new shoes two or three times a year, while those who participate up to four times a week need them every 60 days.
Put it on RICE. As soon as you notice shinsplint pain, follow the rules of RICE: rest, ice, compression, and elevation for 20 to 30 minutes. The experts swear by it.
"Don't underestimate the power of ice," says Albohm. Keep your icing routine simple, she says. Just prop the leg up, wrap it with an Ace bandage, and place the ice pack on it for 20 to 30 minutes.
Go for contrast. A variation on the RICE treatment is the contrast bath, which seems especially effective for pain on the inner leg. With this method, alternate 1 minute of ice with 1 minute of heat. Do this before any activity that can cause shinsplint pain, and continue it for at least 12 minutes.
Stretch those calves. "We find that stretching the Achilles tendon and the calf muscles is an excellent preventive measure for shinsplints," Albohm says. "If you're a woman wearing 2-inch heels every day, you're not stretching either of those at all."
The reason stretching helps is because shortened calf muscles tend to throw more weight and stress forward to the shins. Place your hands on a wall, extend one leg behind the other, and press the back heel slowly to the floor. Do this 20 times and repeat with the other leg.
Now tend to the tendons. Dr. Gordon offers this simple technique for stretching the Achilles tendon: Keep both feet flat on the ground about 6 inches apart. Then bend your ankles and knees forward while keeping your back straight. Go to the point of tightness and hold for 30 seconds. "You should feel it really stretching down in the lower part of the calf," he says. Repeat the exercise ten times.
Learn to master massage. "For shinsplints in the front of the leg, you want to massage the area right near the edge of the shin—not directly on it," says Rich Phaigh, co-director of the American Institute of Sports Massage in New York City and the Institute of Clinical Biomechanics in Eugene, Oregon, and author of the book Athletic Massage. "If you work right on the bone, it just seems to make the inflammation worse."
To massage away shinsplint pain, sit on the floor with one knee bent and the foot flat on the ground. Start by lightly stroking both sides of the bone using the palms of your hands, gliding them back and forth from knee to ankle. Repeat this stroking motion several times. Then wrap your hands around the calf and, using the tips of your fingers, stroke deeply on each side of the bone from ankle to knee. Cover the area, using as much pressure as possible.
"What you want to do is restore length and relieve tightness in the tendons at the top and bottom of the shins," Phaigh says, noting that a good massage helps improve circulation in the area, too.
Correct faulty feet. Flat feet or very high arches can sometimes cause shinsplints, Dr. Gordon says. "If you have flat feet, the muscle on the inside of your calf has to work harder and gets fatigued quicker," he says, "making the bone take more of a pounding."
If you're flat-footed, you may need additional shock-absorbing material or arch support in your shoes. Inserts are available at sporting goods stores, but it might be best to see a podiatrist before adding inserts on your own.
Pain on the outside of the lower leg is sometimes associated with very high arches, Dr. Gordon says. "That requires a lot of stretching exercises, as well as strengthening the muscles and maybe adding orthotics."
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Build muscle, reduce pain. Shinsplint pain can sometimes be prevented by strengthening the muscles surrounding the shin. These muscles help decelerate the foot and reduce shock whenever you walk or run. Help strengthen them with the following.
- Try riding a bike with toe clips attached. Concentrate on pulling up with the muscles in front of the shin every time you pedal. (Bicycling also gives you a good aerobic workout without aggravating shinsplints.)
- For those who don't have access to a bike, walking around on your heels does much the same thing, forcing you to tighten and pull up with the muscles around the shin each time you take a step.
- If you're seeking a conditioner that's a bit more strenuous, try this. Sit on the edge of a table that's high enough to keep your feet from touching the ground. Place a sock filled with coins over the foot, or make a 5-pound weight from an old paint can by filling it with gravel (place this over the foot with a shoe on so the wire doesn't hurt). Flex the foot upward at the ankle, then relax, then flex the foot upward again. Repeat this as many times as you can, tightening the shin muscles as you pull the foot up.
PANEL OF ADVISERS
Marjorie Albohm is a certified athletic trainer and associate director of the International Institute of Sports Science and Medicine at the Indiana University School of Medicine in Mooresville. She served on the medical staff for the 1980 Winter Olympics and the 1987 Pan American Games.
Gary M. Gordon, D.P.M., is director of the running and jogging programs at the University of Pennsylvania Sports Medicine Center in Philadelphia. He specializes in podiatric medicine, foot surgery, and sports medicine.
Rich Phaigh is co-director of the American Institute of Sports Massage in New York City and the Institute of Clinical Biomechanics in Eugene, Oregon. He is also a massage instructor at East-West College of the Healing Arts in Portland. Phaigh is the author of Athletic Massage and has worked on the likes of running stars Alberto Salazar and Joan Samuelson.