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Shin splints and the avoidance thereof
Mad Jazz
gotta go fastAustinRegistered User regular
gotta go fastAustinRegistered User regular
H/A, I know you have an answer for me, so let's hear it.
I'm a pretty athletic guy, I play ultimate a few times a week and run when I can (which isn't much these days). I've also had problems with shin splints in the past. I know how to treat them once they're around, but I'd like to prevent it from getting to that point. Do you guys have any recommendations for how to keep them from coming back? I'm open to most anything, from cleat recommendations to insoles to technique, whatever.
I'm a pretty athletic guy, I play ultimate a few times a week and run when I can (which isn't much these days). I've also had problems with shin splints in the past. I know how to treat them once they're around, but I'd like to prevent it from getting to that point. Do you guys have any recommendations for how to keep them from coming back? I'm open to most anything, from cleat recommendations to insoles to technique, whatever.
Mad Jazz on
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hmm
what was the condition of your shin splints to begin with?
overused muscles
compartment syndrome
flat feet/arched feet
tight calves
(for simplicity I'll assume running is causign the problem, but the same steps apply to most other forms of exercise that cause shin splints)
If weight is a problem, consider trying an alternate low-impact aerobic activity. Swimming tends to be the best, lowest-impact aerobic activity, but pools are hard to come by. Cycling works well, but can be trouble if your knees also cause problems. If you're wearing a weight vest, try running without it.
Avoid running on concrete and asphalt. Run on a rubber track if it's available. Grass can work nicely as well (as long as it's even and there aren't any holes).
Running shoes with impact-cushioning soles tend to work wonders in this department. Your feet will be more comfortable and you'll likely encounter fewer injuries (although a bloody runner's foot from long distances (5+ miles) will likely be unavoidable).
If none of those solve the problem, your shin splints may be caused by your running mechanics. Make sure you're not turning your legs (particularly ankles and feet) too far inward (or, less commonly, outward). Try to keep a straight posture.
Finally, the problem may be a physiological problem. You may have flat feet or high arches or something else. Occasionally this can be corrected with footwear, but you may just have to try a lower impact activity.
It frustrates me how often I see this bit of misinformation.
What you said relies on a common sensical but wrong idea that shin splints are a bone problem in the lower leg, rather than a muscular problem. Actually, the pain felt comes from the extensor and anterior muscles coming under stress, tightening, and pulling at the points where they are attached to the bone. If this goes unchecked, in a worst case scenario the tendon can actually pull away from the bone, splintering it and stopping muscle function. In most cases, what you are feeling is a very early stage of that process where no permanent damage is done - the fact that the early stages can be quite painful mean that the later stages rarely occur outside of athletes, forced work, or where analgesics are used on a long-term basis. This is also why the pain from shin splints is inconsistent: at the start of exercise, the muscle is cold and tight and hurts more; it warms up during exercise and expands, easing the pain; and after it has cooled off and tightened post-exercise, the pain returns.
President Rex covered most of the key points about avoidance, including that it is not always impact shock from e.g. running on concrete - anything which overextends the muscle causing undue stress can contribute, which is why flat feet, bad shoes etc have an effect. Along the same lines, running on soft but uneven ground can increase stress, as the legs have to respond to different gradients each step, some of which will over-extend the muscles. That said, running on concrete is still pretty bad for you.
A final point: it is not true either that running with heel-strike is bad for you, or that it causes shin splints. If you think about the mechanics described above (look at an anatomy of the lower leg), running consistently on your toes can equally irritate the anterior muscle, because it will be consistently taking shock pressure it was not designed for, while the extensor muscles are being underused and therefore underdeveloped. Do that for long enough, and not only will you limit your muscle growth and flexibility of activity, but it will only take a slight change of routine to uneven ground (or sand, descending hills, etc) and a wrong footfall for an extraordinary injury to occur.
Humans instinctively run, at a steady pace or with long strides, with heel-strike rolling through to pushing off with the ball of the foot. Only running up hills or when running fast for short distances is the instinct to stay on the balls of the feet. Not going to explain it in detail here, but if you look at the mechanism of how movement works (again, Google) the legs are designed this way: the heel is essentially a hinge designed to absorb some shock by falling forward, and convey the rest up the leg bones through several other hinges (knees, hips). Momentum carries the foot forward through several points until it reaches the calves, which are large muscles designed to push the bodyweight off the ground and maintain momentum. If you only run on the balls of your feet, the calves and anterior muscles are taking all the stress of the impact - gravity then encourages the rear of the foot to fall backwards to the ground, so extra pressure from the calves is required to push off forwards while the natural position is falling backwards. This works at high speed because the momentum is enough to counteract it, and on hills because there is no ground to fall back to (but it still kills the calves, as anyone who has run mountains knows). It doesn't work at steady or low pace as efficiently as heelstrike and rolling through, and uses a smaller set of muscles in a more limited way - always a recipie for injury.
Instinct has been around for several thousand years longer than you or the latest fad in running magazines, so it's usually a good idea to listen to it. Running on the balls of your feet is fine under certain circumstances, but it is not the way we were designed to either walk or run for long, steady distances - go have a look at pictures of professional marathon runners on the web, 90% of them will be running with either the heel or middle of the foot striking the ground.
edit: and this included marathon runners
If you never run in shoes, you will develop a natural forefoot strike, which will lead to a stronger and more adaptable ankle on all sorts of terrain. if you always run in fat-soled running shoes, you will revert to a heel-strike, and the supporting muscles of the ankle will wither.
Long distance running on the forefoot is fine. You just have to build up to it slowly - you can't switch from a lifetime of padded running shoes to a thin-sole forefoot strike and expect your muscles to keep pace. My first month of running forefoot was very painful and tiring. After two years of it, I regularly do 10-15km's entirely on the forefoot.
At any rate, try not to confuse how you run with the barefoot vs. modern shoe argument. Evolution hasn't taken concrete into consideration, and just because people run a certain way without shoes doesn't mean it's the best way to run with shoes. If you have problems with shin splints, it stands to reason that you're either doing something which is causing undue stress or you have another health issue of which shin splints is a symptom. Try a different pair of shoes that provides better support for your type of foot. Or try going barefoot (they sell fancy flexy-shoe type things for that now). Just change it up and see what works. Neither one is going to destroy your life as long as you're careful and give each one an honest shot. Do consider that "reverting" to barefoot will probably take months of acclimation, given you're essentially learning a completely different way to travel.
If you're not an engineer, you don't think of pavement as flexible but it is. So much more so then sidewalks. That's why you see runners in the road all the time. I swear at them too, then I remember I was doing it like 45 minutes ago in the same place.
Very true. Tarmac roads have a little give in them. Not much, but it does make a difference over long distances when compared to concrete.
The other solution is to harden up.
Yeah, it seems like a fad, but with a kernel of truth - I wouldn't be surprised if traditional running shoes could mess with one's natural stride, but I was never a heel-striker myself and still had problems. There's probably a window of higher injury potential when altering one's technique (in any way) as well as when changing activity levels.
Yes.
Most of my running is on grass making basketball style cuts, so I'm up on the balls of my feet a lot. I guess better warm ups and stretches then?
In that case, subquestion: good stretches for shins?
I switched from a running shoe with good support to a lighter shoe (Nike Free 5.0) to increase my time. It did increase, but at the later expense of me missing three months from a knee injury due to those shoes.
YMMV. Ask the running store about your personal body configuration.
Let 'em eat fucking pineapples!
I'm also an ultimate player, have had a shin splint problem for years, so bad it's forced me to stop club play and stick to the most casual levels.
Just recently finally able to get insurance coverage and got to see an ortho and a PT. The ortho advised me to do calf stretches pretty much all the time, just whenever I have a free moment and it occurs to me. The PT recommended calf raises in sets of 20 a couple times a day (I think that's what they're called, standing straight, rising up to the balls of your feet, then back down).
The general theme of strengthening and loosening your calf muscles seems to be big, with strong warning words to spend a lot of time warming these up well before playing.
The PT also prescribed few more exercises that have to do more specifically with the fact that I overpronate slightly, which apparently puts extra stress on a particular muscle on the inner side of my leg, just above the ankle, which is causing my specific problem. If you don't know the pronation tendencies of your feet, and you should, you can get this checked out for free at a good running-shoe store.
Steam: badger2d
Probably the same way one can look at the construction of the hand (a lovely shock-absorbing spring in between the fingers and the palm) and the wrist (another lovely shock-absorbing hinge with lots of potential for musculature spring) and suggest that while walking on your hands is a possibility, walking on your fingers is probably bad.
Or perhaps these things don't translate quite so simply, and we should consider the other 25 muscles in the leg, basic mechanics, Newtonian physics and how they work together. The 'spring' concept you mention that holds true for motion on the spot or when you have little forward momentum completely changes if the leg is further extended during forward motion in running because the center of mass is not directly over the spring when the impact is made, but in motion. More to the point, it changes the absorbtion of your spring - if you are running on your balls, then the first point of impact is also the point of pushing off. Either your foot is falling backwards to absorb the impact while the rest of you moves forwards (so you have forces pushing in both directions, not amazing for efficiency or for your leg) or you are staying on the ball and taking all the impact into the leg right there. This is only mitigated by the extra momentum in sprinting where the weight is largely not on the ground but constantly moving forward, which is why it works at speed. With heel-strike, the leg works with the momentum, so in fact the heel does not conduct all the energy of your bodyweight striking the ground into your leg / knee, because much of it is being carried by the forward momentum.
It's not a hard concept - the mechanics of good running technique change according to gradient and forward momentum, among other factors. We instinctively know this, which is why we naturally run heel-to-toe much of the time. The solutions mechanics & scientists have come up with for amputee legs also incorporate the rolling motion of heel-to-toe - look at the common spring legs for amputees, and they are rounded at the base where it strikes the ground. Unfortunately most readily available advice for sports has been hijacked by 'experts' (for which read: fitness coaches with a 2:2 in sports science and an internet site / book to sell), and seems to be mostly based off the idea that sprinting requires the most refined technique, therefore that technique is the best for all running. It never seems to be addressed that this should therefore work the other way round as well, suggesting that walking would be more efficient by moving on the balls of the feet, probably because most people would think this was patently absurd and not buy book / subscribe to site.
One, dynamic stretch - stand on the edge of a stair or similar with the ball of the foot on the stair, and heel off the edge, supporting yourself with your hands on a railing, bannister, or wall. Then flex the heel all the way down, then push up until you are on your toes. Repeat.
Two, static stretch - stand against a wall with your ball / toes up on the wall and heel on the floor, then push your knee towards the wall until it touches. Hold for 10-30 seconds according to stretch (shorter for warmup, longer for growth stretches after exercise).
If you dont want to run actually barefoot, get a pair of vibram fivefingers. they are awesome.
I usually play quite a lot of 11 a side and 5 a side (smaller pitch, faster paced) soccer, around 2 or 3 times a week. I usually play in goal, but for the last few weeks I've started playing outfield as an attacker, which means a lot of stop-start running/sprinting.
11 a side is played on grass, and 5 a side is played on astro turf. I wear these kind of boots when playing both:
What would be the best way to run for me, and possibly the best way of getting rid of shin splints?
My mate reckons it's not shin splints but actually my muscle building up because I'm not used to running (as a goalie), but I'm not sure :-/
Thanks
Steam: badger2d
You will completely change your running gait within days of wearing them. Our feet are pretty well designed, and running on your foot-balls (which these encourage because they have zero padding, yes zero padding) allows your calves and Achilles tendon to act as a giant shock absorber, as our bodies were designed. Also, you'll put your foot down more gently.
Seriously, it's hard to describe the sort of incredible change that happens to your running when you move towards these "barefoot" shoes. Nike Frees aren't the only option, but they look unrediculous and are on the cheap end for running shoes (100-130)
Since you said you don't do distance runs that often, I'm going to assume that's probably the cause for your shin splints. You just need to condition your legs to the slow-impact nature of running distance.
http://www.youtube.com/watch?v=F0UlMam8-lw&feature=related
http://www.youtube.com/watch?v=TjrEyfQC5NQ
Like I said in my post, some body types (flat feet, bow legs, low arches) have a greater chance of injury by switching to shoes without proper support. Even moreso if the transition is done rapidly. I have been told by two doctors and an athletic trainer that these body types would be crazy to run "minimalist" shoes.
Let 'em eat fucking pineapples!
You have a point on the speed of transition, but the overall point is totally bogus.
Although when first doing it I would recommend going actually barefoot or wearing vibrams. The closer to actually being barefoot the better your bodies bio mechanics are going to work. And there is definitely a risk of injury when initially making the transition because those special running shoes basically leave your feet weak and crippled.
and if you do go actually barefoot, run on pavement. You might think grass is a better idea, but it's not. Higher chance of stepping on something you don't want to.
Don't be stupid like I was and push too hard though, running with shin splints can lead to stress fractures, or so I was told by a medi. tech.
Edit: This stretch: http://www.sportsinjuryclinic.net/cybertherapist/stretching/shin_stretch.php
Man, those shoes look like they have a silly-goose-load of padding. These are my running/climbing shoes of choice:
$19 Australian at K-mart, oooooooohhh yeah. So thin and flexible you can grip the ground with your toes.
As an engineer you should be ashamed at posting that without any actual analysis of what it shows. Unfortunately, those videos don't include any details or numbering for the graphs, or link to any complete data sets so this will be entirely unscientific being based off one example, but let's look at what you actually posted. I'm using pause to read off the numbers here, so you can check the working.
The heel video shows the following: (1st max refers to the height of the first impact curve of the heel striking)
Time
Force
Footstrike:
0.078
0
1st Max:
0.124
1.64
Total Max:
0.204
2.41
Total Time:
0.126
Therefore it takes 0.047 seconds to apply 1.64 of force for the 1st heelstrike, and 0.126 seconds to apply a force of 2.41 for the total movement.
The forefoot video shows the following: (1st max refers to the point where 1.64 of force has been applied, as with the heel video)
Time
Force
Footstrike:
0.106
0
1st Max:
0.145
1.64
Total Max:
0.208
2.71
Total Time:
0.102
Therefore it takes 0.039 seconds to apply 164 of force with the forefoot contact, and 0.102 seconds to apply a force of 2.71 for the total movement.
So what your videos show is that the forefoot strikes apply more force in a quicker time, therefore increasing the impact shock on the foot / leg not decreasing it. Even within the initial '1st max' heelstike that the text commentary on the YouTube page clearly implies is happening faster, creating more impact and therefore more damage, the numbers show that the forefoot strike applies the same force in a shorter or the same time (look at the other youtube videos).
Of course, this is all far from scientific because there are too many parameters and not enough data. But then your posting them in the first place was just intended to give the impression of science rather than any actual meaning, because one curve looks more jagged and has been stretched out to look longer, where the other looks smoother and shorter, which must be good! Which is generally what irritates me about this debate, the lack of actual study and honesty about results, and surfeit of theory and snake-oil.
This article is a pretty good start for anyone interested in looking at this a little more indepth.
This is a fantastic exercise to help build up your shin muscles to keep this from happening:
Requires: a bench / couch / bed / something you can sit on with your feet barely off it. A friend.
Sit on your object as though in a two legged ham string stretch, with your heels off the end. Have your friend put their hands on top of your feet, and push your feet down until your toes are pointed. Your friend should then apply gentle resistance as your pull your toes upwards. You should feel this working that long muscle that stretches down your shin. Do 20 or so on each leg, ramp up as it becomes easier, etc.
Also, if you feel like swimming as cross training, breatstroke kick works the shin muscles a lot as well.