Dear Running Doc:
No sooner had I gotten back into my running program, after backing way off for heavy business travel this winter, than I started getting a shooting pain up the front of my legs, especially at the beginning of each workout. My training partners say it must be shin splints, and that I was bound to get them eventually because I’m a forefoot striker and the impact goes right up the front of my leg. But I’ve also read that you really can’t change your natural stride. Am I stuck with this pain now?
Pat T., Englewood, N.J.
Thanks for the question, Pat. No you don’t have to have shin splints forever! This is one pain that favors beginners, or athletes coming back from a long layoff.
Shin splints are a condition that strikes where some of your calf muscles wrap forward around your lower leg bone, usually at the inside flat part just about a third of the way up from the ankle. Toe runners are constantly told they’re perfect candidates for the condition, but they’re not. It’s brought on by a combination of overly tight calf muscles and not what the foot does when it lands, but after it lands.
Picture a pronating runner with flat feet — the classic shin splint candidate. Airborne, his foot acquires a subtle curve where the rest of us have higher arches. Then the foot lands, flattens out, and as the ankle rolls inward or “pronates” the shin bone or tibia is forced to twist slightly in the opposite or outward direction. Over and over and over. So anything attached to it — like the calf muscle — is going to be yanked over and over and over too. That spells shin splints.
If this is the pain you feel, you’re lucky since it can be treated with ice, over-the-counter anti-inflammatories, and a reduced training schedule. Ignore these early signs at your own peril. The shin bone is covered with a membrane called the periosteum, which can in turn become inflamed from the muscle’s tugging. And eventually, of course, a twisting tibia is headed for a stress fracture which means TIME OFF RUNNING!
The single most effective step is to stop the foot rolling and prevent the seanario; only a proper orthotic that controls the entire foot can do that. Look for your orthotic to be full length (not stopping mid arch) and of a flexible material like leather; hard orthotics cause other foot problems in the long run!
Loosening the calf muscles also cuts your shins some slack. Try the stretches below. The more you do them the better. At the very minimum, do the stretches once a day.
Calf Stretch: Standing about two feet from a tree or wall, lean into it with your good foot forward, your back straight, and the affected foot behind you, heel on the ground. Hold for 20 seconds. Repeat 5 times.
Calf Stretch II: Repeat, with the knee of the affected foot slightly bent. Remember: Heel on the ground.
Stair Toe Raises: Stand with the balls of your feet on a stair, midfoot and heels over the edge, feet pointing straight forward. During a 5-second period, slowly raise your heels over the step and then hold for 10-seconds, then lower them below the step during a 5-second period and again hold for 10-seconds. Repeat 5 times.
Stair Toe Raises II: Same as above, but with toes pointing inward.
Stair Toe Raises III: Same as Stair Toe Raises, toes outward.
I hope this works for you, Pat. Please let me know.
Enjoy the ride.
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Lewis G. Maharam, MD, FACSM is one of the world’s most extensively credentialed and well-known sports health experts. Better known as Running DocTM, Maharam is author of Running Doc’s Guide to Healthy Running and past medical director of the NYC Marathon and Rock ‘n’ Roll Marathon series. He is also past president of the New York Chapter of the American College of Sports Medicine. Learn more at runningdoc.com.
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