Commonly runners are sidelined or limited by the presentation of leg pain during and often after runs. The pain is usually located at the sides of the "shin" bone and can be debilitating, even limiting the ability to walk. Over the years, this has been a problem that I sometimes have encountered in my running. Since I love running (and don't like not running), I have researched over the years some ways to limit the presentation of shin splints while training for a race, or in my case a marathon. I will discuss some ways that we can "run smart" and limit the injuries that have been commonly classified as shin splints.



What is a shin splint?

A shin splint can be located on the medial (inside) or lateral (outside) of the lower leg below the knee. Medial shin splints are commonly inflammation of the muscle attachment to the shin bone (tibia) and hurts as from pressure to the muscle just inside the bone. Lateral shin splints are commonly inflammation to the tendon (posterior peroneal tendon) and adjacent tissues in the front of the outer lower leg. In either case, the pain can present during a run, immediately following the run or sometimes the next day.

What causes shin splints?

The exact cause of shin splints are not known, but usually it is related to rapid increase in running or jumping (or sometimes walking fast), changes in shoegear, or pronation (flattening of the foot). Some secondary causes may be balance problems (leaning to one side during a run), poor training technique (progressing too fast, poor running technique or surfaces), leg length problems or even injury.

What I have learned...

1) Using correct shoes.

Since commonly over pronation (excessive flattening of the foot) or over supination (increased arch height - rolling out) can cause stress to the muscles or tendons in the area and create shin splints, a quality exercise or running shoe will help improve and prevent these symptoms. In choosing a shoe, price is not the most important, but cheap priced shoes are usually cheap shoes. Get a quality shoe, designed for the exercise you are doing (running shoe for running or walking, basketball shoe for basketball, etc.).

2) Training smart.

As you run or train, Run Smart! Let me explain...

If you are running on a track, understand that always running the same direction on the track will work muscles differently than switching directions. One of the possible causes for shin splints is working muscles at different rates, therefore switching directions regularly will work all muscle of the legs equally and reduce the chances for shin splints.

If you are running on a road, most roads in most locations throughout the country are canted (or tilted to improve water runoff). Therefore, running against traffic always will cause supination of the left foot and pronation of the right foot. With supination, you will work the lateral (outside) muscles of the leg more than the medial (inside) muscles of the leg. Pronation does the opposite. By switching sides periodically, you will again work all muscles equally and prevent the presentation of shin splint symptoms.

Lastly, in running smart, the speed of training should be carefully controlled. Start slow and progress slowly to the amount of running you desire. Give the leg muscles time to get strengthened before forcing them into harder regimen. The speed of progress will require understanding of how much running you have done and where you should start. Cross training (elliptical or bike) can also help even the muscle strength as you progress.

In all these aspects of running smart, it should be understood that shin splints are caused by overusing a muscle group and creating an injury. By adjusting the training to reduce this overuse, you will have a more enjoyable run.

3) Evaluation for possible "gait" abnormalities.

"Gait" abnormalities are best described as running or walking abnormalities. Do you have a leg length problem? Do you over pronate or over supinate? Do you have imbalance issues, back problems, knee problems, or other reasons to overwork a muscle group that may cause your shin spints?

Let me discuss some of these running issues:

Leg length abnormalities (left leg longer/shorter than right) can be a large problem when running. The APMA has found that running produces 4-5 times your body weight through your feet. If one leg is shorter, the body is designed to adjust...you will pronate the shorter foot to make it longer and supinate the longer foot to make it shorter. This will lead to overworking the muscles and cause leg pain and possibly shin splints. A simple adjustment to your shoes (or orthotics) will alleviate this problem and produce continued running without pain.

Imbalance issues, often caused by weakness of ligaments (like chronic ankle spraining) or ear problems. One of my patients is deaf in one ear and runs lopsided (towards the deaf side) and has issues with shin splints. With a simple orthotic, a custom item to replace a shoe insert in your running shoes that maintains your foot in neutral position and helps the foot function as it should, his shin splints have been eliminated.

Pronation or supination is also a form of imbalance of the feet and can cause overuse of some muscles and may also lead to shin splints. Orthotics are the answer here also.

By being evaluated for your running, your "gait" abnormalities can be evaluated and often adjusted to help you return to running without the pain.

Copyright (c) 2009 Mountain West Foot & Ankle Institute