i moved off the treadmill and onto the track about a month ago and am starting to get some serious shin splints. does anyone have any good info on shin splints? other than WebMD.com type info, i am having trouble locating info regarding prevention and treatment specific to exercise. thanks for any help.
shin splints?
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liftsiron
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Compartment syndrome is a general term which can cover a variety of different areas in the body but for this discussion we're going to focus on the anterior compartment of the lower leg as this is the primary area that would be affected in runners and triathletes. This article will cover what is typically called Chronic Compartment Syndrome as it is due to overuse and overtraining. Acute Compartment Syndrome is a medical emergency which requires immediate surgical intervention. I'll explain a little more about that later on.
The Anatomy
Muscles are surrounded by fascia which act a lot like a sausage casing, holding things in place. In certain areas of the body like the lower leg, bones and fascia combine to form well-defined spaces called compartments. For example, the tibia (shinbone) is bordered by muscles on both sides. The muscles that run up the outside (lateral) margin of the tibia make up the anterior compartment of the lower leg. This anterior compartment is defined by the tibia bone on the inside, the fibula bone to the rear, and the crural fascia surrounding it all. The crural fascia basically wraps the muscles and the bones of the lower leg. Now, the tibia and fibula are bones so they don't offer a lot of 'give', therefore on 2 of the 3 sides of this compartment you have very stiff walls.
By definition, compartment syndrome "occurs in anatomic locations that have unyielding, well defined osteofascial spaces."1 That makes the anterior compartment of the lower leg the perfect place for potential problems because it is bordered on 2 sides by bone. Furthermore, in some individuals the fascia that wraps the muscles is very tight, thereby allowing for little or no expansion, complicating the situation even more. The muscles of the anterior compartment are involved with dorsiflexion (upward movement) of the foot and toes. Also present in the anterior compartment are the deep peroneal nerve which supplies the shin and foot and the anterior tibial artery and vein.
What's Going On
During exercise which involves repetitive dorsi- and plantarflexion of the foot (moving the foot up and down), such as running, swelling can occur in the muscles of the anterior compartment due to increased blood flow. This can create an increased pressure in the compartment. If the fascia surrounding the compartment does not stretch enough (remember, the bony walls of the compartment don't give), the increased pressure will compress the artery and nerve, thereby causing pain or numbness or tingling in the distribution of that nerve.
Signs and Symptoms
Pain induced only by athletic activity and often at a specific point in the workout
Pain and tightness in the shin, located along the outside (lateral) edge of the shin bone
Decreased sensation on the top of the foot in the area above the second toe (the big toe is toe #1)
Weakness may be noted on toe extension and dorsiflexion of the foot
Tingling into the toes may be present
Decreased dorsalis pedis pulse may be noted by a trained practitioner.
Symptoms characteristically disappear quite rapidly once activity ceases
Triathletes may experience symptoms with cycling if they are pulling up on the pedals, or during running. Symptoms may be more noticeable while trail running because you need to lift the toes more to clear obstacles such as roots or rocks. I have experienced symptoms during the final miles of the bike in Ironman races and I've attributed that to the anterior shin muscles getting tired during the swim from kicking, followed by a long ride which also worked the same muscles. By the end of the bike, I was having pain and pins and needles in my toes. Thankfully, it did not present a problem once the run started.
What To Do About It
If you have been experiencing symptoms of anterior compartment syndrome your first approach to treatment should be to stretch the anterior muscles of your shin. This can be done kneeling on the ground with your toes pointing behind you and the top surface of your foot flat on the ground. Then you can 'sit' down on your heels and lean your body backwards over your feet. You should feel the front of your shins stretching.
Massage is also a useful approach to treatment because if the muscles are chronically tight they will be more prone to swelling.
When chronic cases do not respond to conservative care, fasciotomy is the treatment of choice. This is a surgical procedure where an incision is made along the length of the affected compartment through the fascia to release the pressure. Properly execute surgery has a success rate of close to 90%2. Prior to surgery, a patient would have to meet certain diagnostic criteria whereby pressure measurements are taken at rest and during activity to insure that the procedure is warranted.
Finally, I mentioned earlier that I would briefly touch on the subject of Acute Compartment Syndrome as this is a very serious condition which requires immediate medical care. The concept behind the condition is the same in that the tissues in a closed space are compromised by pressure in the surrounding area, however the cause is usually the result of significant trauma, fractures, crushing injuries or some kind of clot or other occlusion of a blood vessel. Because these conditions can cause a rapid increase in pressure and thereby damage nerves quickly, proper medical attention is a must. An acute compartment syndrome treated within 12 hours has a complication rate of less than 10 percent. However, after 12 hours the complication rate rises to 80 percent and the amputation rate to 40 percent!3
References
1. Reid, David C. Sports Injury Assessment and Rehabilitation. New York: Churchill Livingston, 1992: 285
2. Reid, David C. Sports Injury Assessment and Rehabilitation. New York: Churchill Livingston, 1992: 294
3. Reid, David C. Sports Injury Assessment and Rehabilitation. New York: Churchill Livingston, 1992: 296
The Anatomy
Muscles are surrounded by fascia which act a lot like a sausage casing, holding things in place. In certain areas of the body like the lower leg, bones and fascia combine to form well-defined spaces called compartments. For example, the tibia (shinbone) is bordered by muscles on both sides. The muscles that run up the outside (lateral) margin of the tibia make up the anterior compartment of the lower leg. This anterior compartment is defined by the tibia bone on the inside, the fibula bone to the rear, and the crural fascia surrounding it all. The crural fascia basically wraps the muscles and the bones of the lower leg. Now, the tibia and fibula are bones so they don't offer a lot of 'give', therefore on 2 of the 3 sides of this compartment you have very stiff walls.
By definition, compartment syndrome "occurs in anatomic locations that have unyielding, well defined osteofascial spaces."1 That makes the anterior compartment of the lower leg the perfect place for potential problems because it is bordered on 2 sides by bone. Furthermore, in some individuals the fascia that wraps the muscles is very tight, thereby allowing for little or no expansion, complicating the situation even more. The muscles of the anterior compartment are involved with dorsiflexion (upward movement) of the foot and toes. Also present in the anterior compartment are the deep peroneal nerve which supplies the shin and foot and the anterior tibial artery and vein.
What's Going On
During exercise which involves repetitive dorsi- and plantarflexion of the foot (moving the foot up and down), such as running, swelling can occur in the muscles of the anterior compartment due to increased blood flow. This can create an increased pressure in the compartment. If the fascia surrounding the compartment does not stretch enough (remember, the bony walls of the compartment don't give), the increased pressure will compress the artery and nerve, thereby causing pain or numbness or tingling in the distribution of that nerve.
Signs and Symptoms
Pain induced only by athletic activity and often at a specific point in the workout
Pain and tightness in the shin, located along the outside (lateral) edge of the shin bone
Decreased sensation on the top of the foot in the area above the second toe (the big toe is toe #1)
Weakness may be noted on toe extension and dorsiflexion of the foot
Tingling into the toes may be present
Decreased dorsalis pedis pulse may be noted by a trained practitioner.
Symptoms characteristically disappear quite rapidly once activity ceases
Triathletes may experience symptoms with cycling if they are pulling up on the pedals, or during running. Symptoms may be more noticeable while trail running because you need to lift the toes more to clear obstacles such as roots or rocks. I have experienced symptoms during the final miles of the bike in Ironman races and I've attributed that to the anterior shin muscles getting tired during the swim from kicking, followed by a long ride which also worked the same muscles. By the end of the bike, I was having pain and pins and needles in my toes. Thankfully, it did not present a problem once the run started.
What To Do About It
If you have been experiencing symptoms of anterior compartment syndrome your first approach to treatment should be to stretch the anterior muscles of your shin. This can be done kneeling on the ground with your toes pointing behind you and the top surface of your foot flat on the ground. Then you can 'sit' down on your heels and lean your body backwards over your feet. You should feel the front of your shins stretching.
Massage is also a useful approach to treatment because if the muscles are chronically tight they will be more prone to swelling.
When chronic cases do not respond to conservative care, fasciotomy is the treatment of choice. This is a surgical procedure where an incision is made along the length of the affected compartment through the fascia to release the pressure. Properly execute surgery has a success rate of close to 90%2. Prior to surgery, a patient would have to meet certain diagnostic criteria whereby pressure measurements are taken at rest and during activity to insure that the procedure is warranted.
Finally, I mentioned earlier that I would briefly touch on the subject of Acute Compartment Syndrome as this is a very serious condition which requires immediate medical care. The concept behind the condition is the same in that the tissues in a closed space are compromised by pressure in the surrounding area, however the cause is usually the result of significant trauma, fractures, crushing injuries or some kind of clot or other occlusion of a blood vessel. Because these conditions can cause a rapid increase in pressure and thereby damage nerves quickly, proper medical attention is a must. An acute compartment syndrome treated within 12 hours has a complication rate of less than 10 percent. However, after 12 hours the complication rate rises to 80 percent and the amputation rate to 40 percent!3
References
1. Reid, David C. Sports Injury Assessment and Rehabilitation. New York: Churchill Livingston, 1992: 285
2. Reid, David C. Sports Injury Assessment and Rehabilitation. New York: Churchill Livingston, 1992: 294
3. Reid, David C. Sports Injury Assessment and Rehabilitation. New York: Churchill Livingston, 1992: 296
liftsiron
Owner/Admin
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Shin Splints
updated 6/13/03
Sooner or later almost all runners experience pain in the calf or shin. There are several types of overuse injuries that may develop in this region as a result of the repeated pounding from running. Shin splints, stress fractures, and chronic compartment syndrome have a common mechanism of development. Understanding the circumstances that lead to these injuries is the key to preventing them.
The overall recurring theme that leads to overuse running injuries is excess training with inadequate recovery. Excess and inadequate are relative terms and must be judged against one?s usual training routine. The more that excess and inadequate deviate from the usual training routine the less time it takes for an overuse injury to develop. Keeping this theme in mind one can now examine the specifics for how shin splints develop.
A simplified view of the mechanics of running shows a foot-strike, then a loading/energy transfer phase, and finally a push off (?toe-off?) with the forefoot. Each foot-strike delivers a shockwave that travels up the leg. This energy must be absorbed by the musculoskeletal system. The harder the running surface the greater the shockwave. Soft grass, smooth dirt, asphalt, and concrete represent, in order of increasing ?hardness?, the usual spectrum of commonly encountered running surfaces. Concrete is very hard on the body and training on this surface should be avoided.
Distance running shoes are specifically designed to provide padding and support for the biomechanics of endurance running. They help absorb shock and facilitate efficient energy (motion) transfer. Matching the type of running shoe to the athlete?s specific biomechanics, and proper shoe fit are important. Similarly, worn out shoes should be replaced early because of reduced shock absorbing capacity. Runners with high rigid arches tend to experience greater pounding shock, whereas those with flat feet tend to experience greater fatigue of the muscles that support the foot -- and push-off. Both tend to develop shin splints
The term shin splints refers to a painful condition that develops along the inside (medial edge) of the shin (tibia). The usual location is along the lower half of the tibia, anywhere from a few inches above the ankle to about half-way up the shin. The repeated running cycle of pounding and push off results in muscle fatigue, which may then lead to higher forces being applied to the fascia, the attachment of fascia to bone, and finally the bone itself. Respectively, this represents a spectrum from mild to severe. On the relatively more severe end of the scale the injury may progress from stress reaction within the bone to an actual stress fracture.
In the early stage of shin splints a runner will describe a pain that is present when the training run first begins, but then disappears as running continues. The pain will often return after exercise or the following morning. As the injury progresses the athlete will experience more time with the pain, and less time without it. There is frequently a tender zone along the medial edge of the tibia that one can map out by pressing with the fingertips as they ?march up? along the bone. Eventually, if ignored and training continued, the pain may become quite sharp and may focus on a very small area of the bone. If this happens a stress fracture should be considered.
The treatment for shin splints is rest. Depending upon severity it is often necessary to completely stop running for a period of time. Generally this is done until day-to-day activities are pain free. When running is resumed ? and this is where many injured runners make a mistake ? it must be significantly different from the routine that lead to the injury. The concept of relative rest employs lengthening the interval between training as well as decreasing the volume and intensity of training. One can often substitute cross-training activities (e.g., bicycling) for running to help increase the interval between running days. There should be a graded and gradual increase in run training, keeping an eye out for the return of any shin splint symptoms.
Stretching and strengthening the calf muscles can help prevent the injury from returning. However the most important preventive strategy is not to repeat the mistakes that lead to the injury. Examine all the training variables ? surface, shoes, training volume, intensity, workout type, hills, weather conditions, etc. Seek help from a qualified trainer or coach. This all takes time and effort, but it is well worth it.
Related Stretches
The soleus muscle stretch(GIF 16k) and
The The gastrocnemius stretch (JPG 24k)
copyright 2003 ?
Mark Jenkins, MD
updated 6/13/03
Sooner or later almost all runners experience pain in the calf or shin. There are several types of overuse injuries that may develop in this region as a result of the repeated pounding from running. Shin splints, stress fractures, and chronic compartment syndrome have a common mechanism of development. Understanding the circumstances that lead to these injuries is the key to preventing them.
The overall recurring theme that leads to overuse running injuries is excess training with inadequate recovery. Excess and inadequate are relative terms and must be judged against one?s usual training routine. The more that excess and inadequate deviate from the usual training routine the less time it takes for an overuse injury to develop. Keeping this theme in mind one can now examine the specifics for how shin splints develop.
A simplified view of the mechanics of running shows a foot-strike, then a loading/energy transfer phase, and finally a push off (?toe-off?) with the forefoot. Each foot-strike delivers a shockwave that travels up the leg. This energy must be absorbed by the musculoskeletal system. The harder the running surface the greater the shockwave. Soft grass, smooth dirt, asphalt, and concrete represent, in order of increasing ?hardness?, the usual spectrum of commonly encountered running surfaces. Concrete is very hard on the body and training on this surface should be avoided.
Distance running shoes are specifically designed to provide padding and support for the biomechanics of endurance running. They help absorb shock and facilitate efficient energy (motion) transfer. Matching the type of running shoe to the athlete?s specific biomechanics, and proper shoe fit are important. Similarly, worn out shoes should be replaced early because of reduced shock absorbing capacity. Runners with high rigid arches tend to experience greater pounding shock, whereas those with flat feet tend to experience greater fatigue of the muscles that support the foot -- and push-off. Both tend to develop shin splints
The term shin splints refers to a painful condition that develops along the inside (medial edge) of the shin (tibia). The usual location is along the lower half of the tibia, anywhere from a few inches above the ankle to about half-way up the shin. The repeated running cycle of pounding and push off results in muscle fatigue, which may then lead to higher forces being applied to the fascia, the attachment of fascia to bone, and finally the bone itself. Respectively, this represents a spectrum from mild to severe. On the relatively more severe end of the scale the injury may progress from stress reaction within the bone to an actual stress fracture.
In the early stage of shin splints a runner will describe a pain that is present when the training run first begins, but then disappears as running continues. The pain will often return after exercise or the following morning. As the injury progresses the athlete will experience more time with the pain, and less time without it. There is frequently a tender zone along the medial edge of the tibia that one can map out by pressing with the fingertips as they ?march up? along the bone. Eventually, if ignored and training continued, the pain may become quite sharp and may focus on a very small area of the bone. If this happens a stress fracture should be considered.
The treatment for shin splints is rest. Depending upon severity it is often necessary to completely stop running for a period of time. Generally this is done until day-to-day activities are pain free. When running is resumed ? and this is where many injured runners make a mistake ? it must be significantly different from the routine that lead to the injury. The concept of relative rest employs lengthening the interval between training as well as decreasing the volume and intensity of training. One can often substitute cross-training activities (e.g., bicycling) for running to help increase the interval between running days. There should be a graded and gradual increase in run training, keeping an eye out for the return of any shin splint symptoms.
Stretching and strengthening the calf muscles can help prevent the injury from returning. However the most important preventive strategy is not to repeat the mistakes that lead to the injury. Examine all the training variables ? surface, shoes, training volume, intensity, workout type, hills, weather conditions, etc. Seek help from a qualified trainer or coach. This all takes time and effort, but it is well worth it.
Related Stretches
The soleus muscle stretch(GIF 16k) and
The The gastrocnemius stretch (JPG 24k)
copyright 2003 ?
Mark Jenkins, MD
N
Naughty Nurse
Guest
And there you have it!! Great post LI!!
DADAWG
Vet
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- May 15, 2004
- Messages
- 3,096
im definately not contradicting lifts medically backed advice but back in the day i was big into tennis , playing in all the usta leagues and a lot of people had serious problems with shinsplints and the local folklore blamed weak muscles on the front of the lower leg .many but not all got relief from the pain by working the front of the legs by doing weighted toe raises or something as simple as having someone place a towel around the toes and pulling up with the toes against the resistance . basically the resistance is in the opposite direction of normal calf excercises .
like i said im not promising anything , i didnt have splints myself but a lot of friends felt they helped so i figure its worth trying but make sure if you do that you stick with them long enough to give it a chance to work , as a member of a bb board we all know how long it can take to strengthen a muscle.
like i said im not promising anything , i didnt have splints myself but a lot of friends felt they helped so i figure its worth trying but make sure if you do that you stick with them long enough to give it a chance to work , as a member of a bb board we all know how long it can take to strengthen a muscle.
N
Naughty Nurse
Guest
Now that this was mentioned, I do recall hearing about this.
DADAWG said:
N
Naughty Nurse
Guest
Thanks for the update..glad to hear you're better!!
