I’ve
read a lot of articles and books on injury prevention and biomechanics for
running and I’ve been disappointed with what has been written with regards to
shin-splints. In fact, the physiotherapy textbook Movement System Impairment Syndromes (2011) by the highly regarded
Shirley Sahrmann only has a couple paragraphs devoted to the subject.
My
main issue has been that the research often equates “shin-splints” with “medial
tibial stress syndrome” (MTSS). But, MTSS is a bone injury. What about all
those runners who complain about the front of their shins feeling stiff? Is
this due to simply having a weak tibilias anterior? This was my case in grades
9/10. I trained this muscle by leaning back against a wall and using my shin
muscles to pull my feet up. The recommendation was three sets of ten, but I
couldn’t even perform one set. Improving the strength of my tibilias anterior
gave me temporary relief and may have set me up for success later down the
road. I’ve always wondered if these symptoms could be due to blood getting
trapped in around the shins. This is called compartment syndrome and in extreme
cases requires surgical intervention to release the pressure. Fortunately, I
can only think of one runner who required this: Said Aouita, arguably the most
versatile runner to ever live.
A
recent study on shin-splints by Breen and Colleagues (2015) used the terms “chronic
exertional compartment syndrome”, “exercise induced lower leg pain”, and “anterior
exertional lower leg pain”. They listed symptoms as incremental pain on
exercise described as “tightness” or “constricting pain”. The pain gets worse
until the runner is forced to stop. Often the pain reduces the function of the
lower leg causing the foot to slap. Symptoms are usually worse when running
uphill and will only decrease with rest. Myofascial release, stretching, orthotics,
massage, and reduced training have been used to treat this condition, but with
little success.
Previously
Diebal and Colleagues (2012 and 2011) had good outcomes on reducing symptoms
through teaching runners to adopt a forefoot strike. Adopting a forefoot strike
might be ultimately how I eliminated my shin-splints. Drawing upon this
research, Breen and Colleagues (2015) went one step further and taught runners
with shin-splints several ways to reduce the exertion on their lower legs. Using
video analysis they were able to show the runners what technical mistakes they
were making and then used video analysis to show improvements. Technical
changes were given through verbal feedback and sessions consisted of drills and
walk/runs. Verbal cues were catered to the runner and included the following:
Midfoot strike
Earlier foot lift-off to promote
greater stride frequency
Slightly increased
hip flexion (i.e. lifting the knees higher to offset any shuffling from the
increased stride frequency)
Decreased forward
lean
As
expected the initial changes in technique led to an increase in effort. Magness
reports research in The Science of
Running (2014) that runners are most economical at their self-selected
stride length. However, after one year following the intervention 9 out of the
10 subjects responded to the gait changes with 7 runners running pain-free and
one runner now able to run pain-free for 80 minutes. The extra training volume
would easily overcome any temporary decreases in running economy.
A
recent review study supports Breen’s and Colleagues (2015) results. Sullivan
(2015) highlights research showing that gait retraining in the form of changing
to a midfoot or forefoot strike as well as increasing stride frequency by
10-15% is effective at preventing lower extremity overuse injuries. He was
careful to note that changing to a midfoot or forefoot strike alone wasn’t enough to reduce ground
reaction forces. The foot must land under the body.
Adopting
a forefoot or midfoot strike, increasing stride frequency, and decreasing
forward lean are all ways to eliminate shin-splints. Gait retraining is an effective
way to eliminate shins-splints and other overuse injuries in the lower body.
References
Effects of forefoot running on chronic exertional compartment syndrome: a
case series by A. R. Diebal and Colleagues (2011)
Forefoot Running Improves Pain and Disability Associated with Chronic
Exertional Compartment Syndrome by A. R. Diebal and Colleages (2012)
Gait Re-Training to Alleviate the Symptoms of Anterior Exertional Lower
Leg Pain: A Case Series by David T. Breen and Colleagues (2015)
Movement
System Impairment Syndromes of the Extremities, Cervical and Thoracic Spines by
Shirley Sahrmann (2011)
Retraining
Running Gait to Prevent Lower Extremity Overuse Injuries: A Review of
Literature by Daniel P. Sullivan (2015)
The
Science of Running by Steve Magness (2014)
Stay fit,
Jonathan Pratt
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