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Medial shin splints

I believe that medial shin splints have got to be one of the hardest running injuries to shake because: 

1. The pain dissipates after a few days, therefore we presume the injury has gone
2. We can't see any damage therefore we tend to choose to believe that it can't be all that bad.
3. It more than often comes in after a specific period of running, so it becomes more of a lottery every time we leave the front door.  

The way to approach rehabbing shin splints is by appreciating what's going on on the inside.

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A palpation test -

If you roll your fingers down your leg (let's go left!) directly on the front of the bone, you'll feel quite a bony ridge all the way down to your ankle, this is the anterior ridge of your tibia, if you now point your toes and foot up towards the knee, the muscle on the left (outside) of this ridge is the tibialis anterior. If you slide all the way over to the right hand side of the ridge you'll find a 'cliff edge' (the bone finishes + muscles start), that cliff edge is medial border, these muscles are your calves. 

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Why medial shin splints? 

When you run, your heart rate increases and sends more blood down to your legs. Considering your calves are the very first reaction to down force which causes them to load and unload often the muscles can get too pressured too quickly (as a result of very little warm up, or starting running up a hill) and start rubbing against the medial border of your tibia. 


A physical test - 

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Profusely rub the palm of your right hand on your left forearm about 100 times, what reaction do you get? Does it feel hot? does it feel painful? is there potential of superficial injury to the surface of the skin?  Think about that calf continuously repeating that rubbing process against your Tibia Bone 1700 a mile, the symptoms are not that much different.

Like any friction style injury it can often take weeks for the injury to heal, scab and finally disappear. This is no different to what's going on inside your leg, the greater problem is that we can't see how it is progressing, this is where we rely on guess work sprinkled with a touch of optimism and garnished with impatience!  
Shin splints can happen for a variety of reasons most frequently relating to your body reaching a muscle fatigue level due to an increase of intensity, duration or frequency. Rarely is it the trainers, contrary to popular marketing beliefs. Once shin splints are in, is more than often the often premature return to running that triggers the problem off again, so please consider this before taking out a deathwish on your therapist!

To overcome this injury, I prescribe the following: 

1. Chill out!   Rest from running for minimum 2 weeks (yes 2 whole weeks!) icing the painful area 20 min every hour for the first 48 hours. Chilling this hot, inflamed angry area allows a restriction of blood flow, thus reduces the damage and helps shorten the injury time. 

2. 48 hours onward... Heat. After limiting the damage by cooling for 48 hours, introducing the heat will start the repair process. Light calf stretching would help improve circulation too. Foam rolling is a great way to promote flexibility. By turning your foot inwards, you can really get into the heart of this tight angry muscle.  Stretch every day, whether at home when brushing your teeth or at work desk side, I cannot tell you how important improving flexibility is. 

3. Return slow! After that 14 days of running self deprivation, heat the muscle prior to leaving the front door (a 20 min hot water bottle works a treat), stretch using the foam roller, and gently go out for no more than 5 minutes. 5 minutes is more than enough time for your body and muscles to familiarise itself with the process of running, but not enough to cause any damage. After that 5 minutes, return home, stretch, ice 20 mins every hour. Providing you have absolutely no bad reaction to that run, repeat the exact process again the following day but add a further 5 minutes onto your running time. This accumulative training program is the safest, most sure fire way of returning you back to running safely.    

The greatest reason why runners struggle with overcoming injury is due to insignificant recovery time plus a far too hasty return to increase duration or intensity (distance, speed, or hills), don't learn this the hard way! 

Go belt and braces!

The full belt and braces approach...

Warming up on an exercise bike is a really good way of heating up the muscles without stressing them out. Just 5 minutes low resistance, mild to high intensity.
Compression socks work a treat as they keep muscles at optimum temperature and... compress!
Use a foam roller to 'investigate' any tight muscles in your legs, almost as good as having sports therapy.  


Please note:

It's important to appreciate that shin splints can happen for a number of reasons, and this step to step rehab plan is great for getting you back to running pain free, but may not rectify the reason for getting it in the first place. In most cases it's doing too much too soon, but if problems persist, it's time to have your running technique analysed!


Use these to read further spotlights

Heel Striking
Forefoot running
Minimalist running
Walking lunges
Pelvic instability
Hamstring strengthening
Why stretch
Runners knee ITB
Single leg squats
Glutes, are you standing comfortably?
Squat test
Migrating to a minimalist shoe
Richard Whitehead Paralympic 200m
Medial Shin Splints
The cumulative effect
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