Dealing With Shin Splints

With the track season being in full swing and with better weather pushing people outside to run and hike, I'm seeing a lot more problem with Shin Splints.  Shin Splints are best described as aching pain on the front part of the lower leg.

Shin Splints are a very complex problem, influenced by a number of things, but at the core of most cases are impact forces.   What are impact forces?  Basically, it is pounding on the legs from walking, jumping, or running. 

There is a lot of speculation and no small amount of research that has looked at exactly what a Shin Splint might be.  Many studies have offered that it is an injury at the point where the tendons that attach to the front of the shin.

Others have indicated that it is an injury to the bone (tibia) itself.  I would suggest that it is likely both. 

In my experience, the consistent common denominator are impact forces on the lower leg.   So let's look at those.    

Most of the people that get Shin Splints are runners.  If you think about it, the running gait is really just a series of hops from one leg to the other.  If one is running a marathon, that's about 33,000 hops.  

Hikers get Shin Splints too and a big factor there is descending, when you are really sort of falling forward and catching yourself with your leading leg.  A load (backpack) on your back just makes it worse.

In both of those, you are really pounding on your feet, ankles, and lower legs.   But lots of people run lots of miles and there are hikers all over these hills every single day and none of them are any worse for the wear.

I would suggest that there are two problems that can lead to the development of Shin Splints.  The first of these are the "too's."   Too many miles.  Too many hills.  Too fast.

Big changes in your running program are almost always a mistake.  Any good coach will tell you to increase your mileage gradually.  You don't run 2 miles at a time, several days a week and then suddenly double your mileage.  The extra impact forces can lead to problems...like Shin Splints.

The other big factor is the way the foot hits the ground.

I'm not a big fan of running barefoot or with the thin foot covering popular today.  I'm not much of a fan of the "minimalist" running shoes either.  I do know that a lot of people do well with these things but most people need the support that good running shoes give them.

And more people than you could possibly imagine have mechanical issues at their feet that increase those same impact forces.  Flat footed people, for sure.  Just listen to them run.  Slap, slap, slap--the sound is revealing.

A lot of runners and hikers are also "pronators," which can best be explained as an inturning of the middle of your foot during the middle of the stance phase of gait. 

One of the things that I do in my clinic is to do a video analysis of the running gait, video-taping a runner while they run barefoot on a treadmill.  Often, it is only in stop action that you can see how much pronation you get in a foot that appears to have a really great arch.  I've been surprised more than once.

The solution then comes from more support to the arch of the foot.   The first choice is the "over-the-counter" arch support.  I recommend them almost every single day.  Look for one that isn't really spongy.  It really should have some firmness to it.

If the OTC arch supports don't work or if the problem is too complex, it may take custom orthotics to fix the problem.  With custom orthotics, a mold is taken of the foot and an orthotic is made from that mold that only fits that person. 

With good orthotics, those insufficiencies in the way the foot hits the ground can be corrected and those darn impact forces can be minimized.