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Injury Prevention & Rehab

Shin Splints

Shin splints, the plague of many a high school runner. I suffered through them for three years, myself. I did all the recommended exercises like walking on your heels, tapping your toes, spelling out the alphabet with your feet; I iced and took advil several times daily, and I often rode the stationary bike the day after races (it hurt too much at times to run). Many of the recommendations seemed to actually make them worse. Finally, a coach recommended I try a very simple exercise to see if it would help.

There are two basic types of shin splints, although the symptoms can be further broken down into any of several varieties. The first type, and the one I suffered from, is medial, or the inside of the shin. The second is lateral/anterior, or front/outside of the shin.

The exercise that was recommended is, as I tend to refer to it, best described as figure-eights. Although, that description confuses some people ... maybe just calling it circles in both directions is clearer. Find yourself an old bicycle tube (bike shops will usually give you a punctured tube for free) or some surgical tubing, and tie a loop at one end to put your foot through. Position your foot so that the ball of the foot is making contact with the tubing so that you have good leverage. This is best done seated. Pull back on the other end with as much resistance as feels comfortable, and rotate your foot in circles (point your toe, rotate clockwise toward you, then away from you, etc.). Vary how hard you pull so that the resistance stays fairly even as the foot comes closer and moves further away. Change directions from time to time, making slow, controlled movements. After five to ten minutes a day of this, my shin splints were gone for good within a mere week or two. Had I only known about this three years earlier...

After 6 years of coaching college and high school athletes, both sprinters and distance runners, I've found the above exercise to be amazingly effective, bordering on a miracle cure. Darn near 100% of athletes are better within 2 weeks, and most show marked improvement within a week, even after suffering regularly from medial shin splints for a year or more.

I have not seen this exact exercise recommended anywhere else, and it's rare to find a good description of the underlying physiological principles. Here is the way I understand the process to work: There is a long, slender muscle (anterior tibialis) that runs vertically along the front of your shin. Being a very small muscle, it can easily become weak in relation to the opposing calf muscle (muscles can only exhert force while contracting, so they always work in opposing groups). The result is muscle being pulled away from the bone and causing the un-scientific and very generic term, shin splints. It is surprisingly easy to counter this affect by strengthening the muscle as described above.

Furthermore, I have learned through experience that running on pavement does not cause shin splints. The pavement may aggravate the shin splints, but it does not cause them. Be careful to separate the symptom and the illness. When I had shin splints, running on hard surfaces was excruciating. As soon as they were gone (and I mean a mere week after they were gone) running on pavement never again caused me shin pain.

Important 2005 Update: As mentioned above, there are two basic varieties of shin splints. I have had exceptional success curing medial (inside) shin splints with myself and my athletes, but I've been frustrated in my inability to come up with an effective treatment for lateral/anterior (front/outside) ones. The tubing exercises help a bit, but they are rather hit or miss. Conventional and medical wisdom says both types are effectively the same thing, stem from the same issues, result in the same symptoms, and are "treated" (I say so in quotes because conventional wisdom is that they can't really be treated, only avoided or partially alleviated) the same. See here for an example. Originally, I thought this to be untrue, because the two types respond so differently to treatment, with the treatment being something geared toward correcting a muscle imbalance. However, through a collaborative effort with a former teammate (coach, personal trainer, and exercise sports science masters degree), I now believe the solution to be much simpler than previously feared.

What we determined is that lateral/anterior shin splints are effectively the same as medial shin splints, but they are a more extreme case and thus do not respond as well to the basic tubing exercise. (As an aside, lateral/anterior shin splints seem to be most common in more powerfully built athletes, especially females. This probably has something to do with more muscle increasing the likelihood of imbalances in small muscle groups like the anterior tibialis.) An exercise that I've found to be effective is a partner drill, with the 2nd person acting as an aid to carefully control resistance. The patient (for lack of a better term) is seated on the ground with one leg extended in front of them, toes pointed up. The aid is facing the patient and grabs the foot -- probably best done with shoes on for grip -- and gives steady resistance while the patient pulls the toes toward their body. Start with the toes pointed, pull to 90°, release, pull, etc. The aid should keep the resistance just below the point where the foot starts trembling. Do as many as possible, right to the point where it feels like there's no strength left in the leg (an attentive aid will know it when you feel it coming), then switch to the other leg. Do each leg twice. Two to three times per week of this exercise seems to work well.

Knee Problems, i.e. "Growing Pains"

I've long been critical of many aspects of conventional wisdom. That shouldn't come as any great surprise if you've read my previous ramblings. I believe it is now time to go even further and blow a major myth out of the water: Knee/Growing pains are not a structural (i.e. joint / growth plate) issue! As such, they actually can be treated, despite what most professionals would have you believe. It's too early for me to say so definitively, but my experience thus far with treating athletes has led me to the conclusion that such issues actually stem from tendon tension in the lower leg. Relieving that tension makes for a fairly dramatic recovery. Stretching helps, but the major aid is careful massage work, working cross-wise (as opposed to length-wise) along the affected tendon. My guess is that the pain is actually due to tendons falling behind the growth curve and being under a great deal of tension until they catch up. Regular massage work greatly relieves that tension and eliminates most of the discomfort.

Achilles

The most difficult aspect of rehabbing from an achilles tendon injury is how darn long it takes! This is largely due to the limited blood flow in that area. Also, the achilles rarely ever gets a rest. Be it walking, running, standing, or even sleeping, there is always pressure on it. Sleeping, you ask?! You doubt me? If you sleep on your back, the weight of the blankets pushes your foot down and interrupts the achilles' healing process.

The solution is a rather simple one, although rather annoying at the same time. Go to your local craft store and get some casting cloth (plaster cloth or several other names), then find some knee-high socks you don't mind making a mess of. You will need someone to help you with the next step. Lie on your stomach, with your feet hanging comfortably off the end of a table, couch, etc. Put the sock on the injured leg, and with your foot perpendicular to your leg (straight down), have your assistant create a cast of your lower leg. You only want to cast the back of your leg and the bottom of your foot, wrapping around the sides slightly and to the ball of your foot for stability. Remember, you want to be able to get it off! Once it has dried, take it off and cut it down to about mid-calf level. When you put it on at night, wrap it with an ace bandage to hold it in place.

Remember I said something about it being annoying? Well, if you get up at night to go to the bathroom, you'll understand... Especially if you have the cast on both feet!

IT Band

Like achilles problems, the IT Band can flare up with very little warning and take quite a while to go away. I was fortunate -- once I discovered the cause of the problem and how to stretch the tendon, the pain disappeared rather quickly.

The IT Band runs down the outside of your upper leg, from your hip down to your knee. It tends to be most troublesome closer to the knee. Because of the area it is located in, it is pretty difficult to stretch. Here's what worked for me: If you're trying to stretch your right IT, stand sideways on a step with your left leg dangling. Drop your left hip and push your right hip to the right. Keep pushing gently and you should feel a good, deep stretch throughout the IT Band. Like most stretches, hold it for 30 seconds, relax, and repeat. The other stretch that works fairly well is performed on flat ground. Again, if you are working on your right IT Band, cross your left leg in front of your right and bend over as if touching your toes. Instead of trying to stretch the back of your legs, lean to your left and push your hips to the right, similar to the first method. Lastly, you might have some success continually massaging the area that is overly tight. You will need your leg straightened for this to be possible, and relaxed. If you're sitting in class or at work and have nothing better to do, find something to put your leg up on and dig in!

Biking

This could equally be included under the training tips, but I like to look at it as a way to prevent injuries and recover from them should you be unfortunate enough to get hurt. It is often stated that bicycling in a standing position, specifically hill sprints, is the closest exercise to running. This is probably true, although the similarities do not seem all that great. At any rate, it can be an excellent way of maintaining conditioning while undergoing rehab -- I am unable to make the same claim regarding pool running.

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