another from SportsDocDC.com
Sports, we love them over here. We strive to push you and have you training in full swing and full intensity. We’re all pushing ourselves to go faster, stronger and longer just like you. And then the dreaded shin splints start up?
Agh! What are you to do? rest and ice? No
Give it a month? Nope, that’s not going to work.
Look, No one has time to waste a month on HOPE and more than likely shin splints come right back when you start up again anyway.
The dreaded shin splints is a condition that most of us will have at least a few times in our sports career. This issue is usually painful but still a low enough level that you can still get going and move. So what do you do when you have this?
First off, you need to understand the condition (or conditions). There are about 20 different versions of shin splints and the name by itself means almost nothing. “Shin Splints” just describes the area of the pain.
You may feel this issue throughout the inside, outside, top or bottom of the shin, sometimes across the entire bone. In any case, by the time you have the pain, you are already having a stress reaction. In fact, the medical term for this issue is “Anterior Tibial Stress Syndrome.”
Look at the bicep in your arm: flex it – this muscle acts like many in the body. When you bend the arm, your bicep contracts and gets shorter and bigger. The calf is similar to this. The muscle is attached at two points and free to move and contract in the middle. It’s a HUGE muscle, and yours looks great!
The tibial muscles in the front of the shin are completely different. These muscles are attached the entire length of the bone. That’s a lot more muscle connected to bone and why even a little issue can cause big problems and a lot of pain. These muscles holler loud when they are aggravated. Subsequently, the bony attachments get angry and loud when they are irritated and therein lies the pain.
Most of the time, the actual issue causing the pain is that the calf muscle (on the back of the leg) is overworking. That’s right, the calf, not the area of pain is the culprit.
Not sold on the idea? Just think about it. Shin Splints come on as you increase mileage, demand or speed…when the calves have been asked to contract harder and longer. The anterior tib muscles (the ones screaming) are the antagonist of the calves, so as the calves continue to contract harder and stronger, the smaller anterior tib muscles are getting pulled. They are elongated and overstretched. Don’t forget, they are attached the length of the bone, so they start screaming, especially when they are called to use. They become very irritated and inflamed.
The treatment then is a multifaceted approach. First, put out the fire, USE ICE. The old school massage cups seem to work best…freeze a small paper cup and create a little ice cube. Peel off the top of the cup and you have a nice little ice cup to use “ice massage” to run up and down the shin where it hurts and is inflamed. This method is way more effective than an ice pack but is not used often anymore. That’s too bad, it works.
Second, we need to fix the ratio.
Relax and stretch the calves. We need these to stop pulling so hard.
While working on that don’t forget to contract the ant tib muscles. Working both muscles is the key to getting better faster. It is the HACK that we always talk about in the office. (see below)
In effect, you want to undo what sports is doing. Remember the calf is over working and is short and tight, stretch it, massage it, get it back to happy!
ADDITIONALLY, the pain is coming from the front, from the tibialis muscles, they are over elongated – so contract them. The best way I know is to walk on your heels – ten steps with toes straight, ten with toes pointed out and 10 with toes pointed in. These are little muscles and respond with little efforts. I tell my athletes to put a rubber band on their toothbrush as a reminder and do the walks while they brush. You get 2x a day that way and that’s plenty.
The last thing is the value of a good chiropractor, physiotherapist, PT or athletic trainer that can mobilize the joints. Certain bones in your foot and ankle are the attachment points for these muscles and adjusting them allows the muscles to get back to the correct tension much faster than rest and wishing. At my clinic and at many great clinics around the world the use of a few extra tricks and release of adjacent muscles (such as posterior tib) and techniques that are geared to releasing adhesion that just work fast. Speed up the process, rest isn’t the best answer. We want you back on the track, court and field as fast as possible.
- Ice the inflammation (ice massage is best)
- Get the ratio fixed. Balance the muscles. I have no reason why clients refuse to do heel walks but it helps so much. You have homework to do!! Do it.
- Get the feet adjusted and speed up the healing process.
You may need to take time off it the issue becomes unbearable, the last thing you want is a stress fracture in this area. It happens – so try to prevent it! Typically if you haven’t responded well in 3-4 visits a bone scan or further imaging should be ordered and if there is a fracture, rest is now mandatory.