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Dealing with Shin Pain | Boddicker Performance

Filed under: corrective exercise, injuries, regeneration, Running

Dealing with Shin Pain

by on Feb 10th, 2009

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Shin splints is one of those terms that is sort of a “catch-all” when it comes to issues that create lower leg pain and dysfunction–particularly along the medial border of the tibia. Runners are no strangers to such a gamut of issues, and just last season alone, three teammates missed training time on account of shin pain. As it is my goal with all of my athletes to prevent all unnecessary pain and dysfunction, the assessment of my athletes always includes a good look at the foot and ankle. The information gained can then be used to implement certain corrective and preventative strategies. Without getting too specific, generally in runners you are going to need to assess several things:

1.) Foot: Supinated or Pronated. People with flat and supinated feet tend to be very poor at absorbing the shock associated with distance running, which increases the impact forces on the tibia. This case necessitates consideration of reducing running volume a bit, keeping on soft surfaces, and even utilizing cushioned shoe inserts for the short term to enable continued training. On the other end of the spectrum, a pronated foot results in putting the soleus and the deep compartment muscles on stretch, creating a demand for more eccentric shortening to decelerate pronation at foot strike. This also creates a problem in concentric action, as the muscles must work over a greater distance to create a rigid lever to push off. With higher and higher volumes (and more and more fatigue) the shock absorbtion capacity dwindles. It is also a good idea to spend a bit of time barefooted. The foot is your body’s connection to the ground, and it is important for it to be able to function well for total health. I don’t suggest running barefooted right off the bat, but your dynamic mobility work can certainly be done barefooted. You may also consider doing a series of toe crunches, first just isometric holds, that are progressed to resisted exercises like towel crunches and Power Web squeezes.

2.) Ankle: Mobility in the Sagittal and Transverse Planes. The ankle is a joint that is designed to be mobile, and the repetitive stress of running contributes to a poor mobility in both planes–nearly always in the transverse plane, but also quite common in the saggital plane. As such, it is important to utilize active ankle mobilizations to help cue the nervous system to allow new ranges of motion. Two great exercises for ankle mobility include knee drives in the Sagittal plane, and lateral leg swings that will open up the grounded leg’s ankle in the Transverse plane.

3.) Gastroc and Soleus versus Tibialis Anterior: Strength. The vast majority of the time, you are going to see a motor control deficit skewed toward a much more powerful gastroc and soleus, with the tibialis anterior holding on for dear life. It is just one of those consequences of the sport’s demands. As such, we’ll spend a good bit of time stretching the poterior aspect of the lower leg, and strengthening the anteior portion with loaded dorsiflexion exercises. The initial progress is from gravity neutral exercises like band dorsiflexion, progressing to gravity resisted and externally loaded exercises.

4.) Lower Leg Tissue Quality. Generally, you’ll see pretty poor tissue quality through the entire lower leg, so it would behoove you to spend some time foam rolling and tennis balling the peroneals, gastroc, soleus, and tibialis anterior as well as the plantar surface of the foot. Often times this work will shake a lot of things free and will go a great distance in improving function and reducing pain.

5.) Other considerations: the entire kinetic chain. While it is possible to get resolution from the above strategies, it is important to keep in mind that the foot’s orientation can be altered by over/underactive tissues higher up the kinetic chain. The TFL and Biceps Femoris can externally rotate the lower leg. If the glutes are inhibited, the internal rotation of the femurs can result in a compensatory external rotation of the lower leg. As the TFL is generally hyperactive in runners, is a good idea to spend time with some tennis ball release accompanied with some activation of the posterior glute medius and glute max.

The take home message is this. When presenting shin pain, evaluate and correct it from multiple angles. Improve mobility, tissue quality, strength, and control around the joints. This local work should be emphasized a bit more, but for long term prevention, it is best to be intergrated with a holistic training program that optimizes the function of the entire kinetic chain.

Yours in strength,

Carson Boddicker

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