Shin Splints: Painful to the Touch
One of the most dreaded injuries known to plague hurdlers is that of the dreaded monster we collectively refer to as shin splints. I don’t think you can run the hurdles and not suffer from shin pain to some degree. In most cases, the pain is manageable and doesn’t get too severe, but in many cases it becomes a chronic thing that can cause disruptions in the training schedule and subpar race performances, and in the worst cases they can be downright debilitating, leading to season-ending stress fractures. This article will address the causes of shin splints, ways to prevent them, and treatment options for them.
What Are Shin Splints?
I posed this question to Kelsey Armstrong, a friend of mine who ran the 400 for the University of Pennsylvania back in the 1990’s, has done a significant amount of coaching since then, and currently owns a podiatry practice in Raleigh, NC. According to Dr. Armstrong, “‘Shin splints’ is just a ‘catch-all term’ used to describe pain in the shins, usually related to running. The more exact term is ‘medial tibial stress syndrome.’” The tibia, of course, is the bone that runs down the front side of the lower leg.
Causes
The causes are obvious. Shin splints are an overuse injury. For hurdlers, shin splints are an occupational hazard. I would argue that they’re the most common injury to hurdlers, slightly ahead of hamstring strains and calf strains. They’re common among sprinters and hurdlers alike, but they’re more common and more severe for hurdlers because of the constant pressure put on the lower legs at each take-off into each hurdle (trail leg) and each landing off of each hurdle (lead leg). So when you add up all the hurdle drills we do, all the hurdle workouts, all the hurdle races, it’s clear to see why getting through a season without any shin pain is virtually impossible.
Medically speaking, “No one,” says Dr. Armstrong, “is exactly sure how medial tibial stress syndrome happens, but I believe it is related to muscles creating a pulling force (“traction”) on the fascia (a surrounding ligamentous structure) of the leg bone, the tibia. This causes not only the fascia to be stressed, but it also causes the periosteum (which surround the bone) to be stressed and inflamed.” All of this adds up to a whole lot of pain. As Dr. Armstrong describes it, “Most people with medial tibial stress syndrome feel a tenderness along the inside of the lower leg. The tenderness usually presents itself at the beginning of a [workout], subsides during the middle, and increases again at the end. The pain is more pronounced with movement of the ankle upwards and hopping.”
And of course, when pain in one shin starts up, pain in the other isn’t far behind. That’s because of the unconscious tendency to overcompensate for the pain by putting more weight on the other leg. So in many cases, by the end of a long track season, a hurdler will have two shins causing some serious agony. The pain usually begins as a dull ache that comes and goes. Then it lingers longer. Then it throbs every time you hurdle. Then it throbs every time you run. Then it throbs when you’re just walking around during the day. Then it throbs all the time, waking you up from your sleep. During workouts the pain spreads all the way down to the ankles and all the way up to the knee, and even into the quads. I’ve seen athletes in tears because their shins hurt so badly. One hurdler I was coaching a couple years ago had to stop competing in the 110’s and focus only on the 300’s because the 110 training put so much strain on his shins that it was jeopardizing his entire season. Without a doubt, shin splints ain’t no joke.
So what’s a hurdler to do?
Prevention
One thing a hurdler can do is train in flats instead of spikes as often as possible. A lot of athletes want to wear spikes in every practice, at all times of year. And when considering that many track athletes, including at the high school and youth levels, are competing 9-10 months a year and training year-round, the idea of wearing spikes in the majority of the workouts leads to the obvious conclusion that it’s only a matter of time before the shin splints kick in. In my opinion, almost all fall workouts can be done in flats, as the fall is a time of doing high-volume workouts that build a base. But of course, athletes want to train in their spikes in the fall because they want to pick up where they left off at the end of the summer or spring, and because the weather is still warm. I had a kid come up to me before a practice in early October last year talkin’ about, “We spikin’ up today Coach?” Hell no we ain’t spikin’ up. If you get shin splints because we’re spiking up in October, that’s on me. Even when the races start piling up – in the winter or the spring, depending on when whether you compete indoors or not – it’s wisest to wear spikes only on days when you’re working on your start or when doing a workout in which knowing your times is of paramount importance. Or they may be parts of workouts that can be done in flats, and you can put the spikes on just when they’re absolutely needed.
Another preventative measure when it comes to shin splints is to do warm-ups, drills, and even hurdle drills on the grass. Even some running workouts can be done on the grass. Of course, a grass field can often have divots and lumps that lead to ankle sprains, so make sure you survey the terrain first before getting started. The other downside of training on grass is that it puts more strain on your hamstrings. So if hamstring pulls are your issue, then stay on the track. But as far as shins go, a grass surface eases the cushion, lightens the impact.
Back in the day, tracks were made of cinder, and that’s the surface I trained on in high school. I don’t know if they’re still around or not, so you younger folks might not even know what I’m talking about. Cinder tracks were basically made of tightly-compacted gravel, and you needed very long spikes – as long as a 1/2-inch – to sink into them. Cinder tracks were very soft and therefore very shin-friendly. But even training on cinders every day, I and my teammates often complained of shin splints. But the pain was never excruciating. Modern day tracks are not shin-friendly at all. The rubberized surface on most high school tracks is very thinly layered, and a slab of concrete is awaiting you beneath it. After a year or so of use, you’re running on concrete more so than on rubber. Even the more thickly layered rubber tracks get very hard in the winter, providing absolutely no cushion whatsoever. And the faster mondo tracks? Forget it. Those tracks are built for speed. They’re race-only tracks. Training on a mondo track will guarantee you agony of the shins.
Another way to prevent shin pain, or at least to manage it, is to reduce the amount of reps you do in a typical workout, especially on hurdling days. This solution is far from ideal, because it’s so important to get the reps in so that you develop the necessary muscle memory to compete at your best. But this solution can help, and it can even improve your focus. Because if you know you don’t have a lot of reps to figure out and solve your mistakes, you will make every rep count. Which you should be doing anyway, but you get the point.
Finally, you can never underestimate the importance of proper sprint mechanics when it comes to preventing shin splints. Without a doubt, this may be the number one single most important factor. I know that when I was running back in the day, I ran with very low knee lift and I kind of stomped the track on the way down. So I was a prime candidate for shin splints. In my coaching, I’ve noticed the same thing to hold true – hurdlers with issues in their sprint mechanics seem to be more prone to shin splints than others. When you sprint efficiently – with your ankles flexed, your knees high, your legs cycling, your hips pushing forward so that you land on the ball of the foot with the foot under the hip – you provide a good cushion so that you can bounce or “float” above the track, lessening the impact your shins must absorb per stride. And of course, inefficient sprint mechanics leads to inefficient hurdling mechanics, exacerbating the problem and the pain.
Treatment
So if you have shin splints and weren’t able to prevent them, there’s still hope. Obviously, for the athlete, the most urgent need is for the pain to go away, or to at least not reach severe levels. As a hurdler, shin pain can directly affect your race performance. If you have shin splints in your trail leg, for example, and it hurts too much to push off properly, you’re going to end up line-driving a lot of hurdles, hitting a lot of hurdles, and having all kinds of balance issues that lead to speed issues. It’s a domino effect that’s very real.
Back in my day, the most common treatment wasn’t really any kind of treatment at all – globs and globs of Ben Gay or similar temporary pain-relief creams. These creams masked the pain so I could get through a race or a workout, but once the cream wore off, the pain kicked in ten times worse. By masking the pain, these creams ultimately did much more harm than good.
The most common treatment today is ice coupled with a pain-relief medicine such as Aleve or Ibuprofen. Some athletic trainers are notorious for always prescribing “ice and Ibuprofen for every imaginable injury. Got a stress fracture in your foot? Ice and Ibuprofen. Tore your acl? Ice and ibuprofen. But for shin splints, this prescription actually is helpful, although limited. The ice reduces the swelling, and the medicine manages the pain. But my observation has been that the reliance on the pain-relief medicine tends to increase, and can go far beyond the dosage advised on the label. Ultimately what is needed is rest, and giving oneself a few strategically placed days off here and there sounds like a better idea that endlessly popping pills. And continuing to ice on a regular basis, especially after workouts, should become the norm.
Also, ice massages can be more helpful than just wrapping an ice bag around the sore area. An ice massage involves putting water in a paper cup, putting the cup in the freezer, taking the cup out of the freezer once the water is frozen, peeling away the top of the cup, and massaging the ice up and down and all around the achy area. Twenty minutes a day of this should get you through the next day’s workout.
Another way to treat shin splints (and prevent them too, I would think) is to do some strengthening exercises. Think about it: in the weight room, calf-raises are a staple in just about everyone’s routine. And when we sprint on the balls of our feet, we’re strengthening our calves. But we don’t do any exercises to strengthen our shins, thus creating an imbalance. The back side of the lower leg is much stronger than the front side.
One exercise my high school coach had me do involved tying a five-pound dumbbell to my foot, using a shoestring. I would sit on a table or something elevated highly enough that my foot could hang over the edge without touching the ground. I’d then do reps of lifting my foot so that I could feel the squeeze in my shin. I would do three sets of thirty reps, and it really helped. Within two weeks, my shin splints disappeared in my lead leg, and became much more manageable in my trail leg.
The other issue, besides strength, could be flexibility. We always stretch our calves, but we never stretch our shins. A way to do so is to kneel with your knees on the ground, with your butt touching the heels of your feet. Lean back as far as you can without straining your knees. You should feel a good stretch in your shins. Hold that position for twenty seconds and repeat two more times.
The most important advice a hurdler can follow regarding shin splints would be, if you need time off, take time off. Don’t be a hero and run through the pain. As Dr. Armstrong states, “Treatment of this condition involves the usual REST-ICE-COMPRESSION-ELEVATE (RICE), especially during the beginning of the painful symptoms. During this time, I limit weightbearing exercise activity (usually one to three weeks). Once the symptoms improve, I start with various strategies to help with prevention and proper healing.”
These strategies include “achilles tendon stretching, along with hip strengthening exercises, in addition to insoles or custom-made orthotics. All these things will help reduce the traction force on the tibia. Then, we can start a slow, gradual return to running activity, starting with low stress activity, i.e., short jog, and progress to high stress activity, i.e., plyometrics.”
When asked how stretching the achilles tendon and strengthening the hips can help reduce shin pain, Dr. Armstrong made some keen observations. Regarding the achilles he said, “The muscles that are causing the ‘pulling’ against the tibia are the flexor digitorum longus, the soleus (part of the achilles tendon), and the posterior tibial tendon. The traction is caused by increased tension in the muscle, and the goal is to decrease it by stretching and gaining mobility.”
Regarding the hips he said, “If you work on strengthening and improving mobility of certain hip muscles (squat and hip abduction exercises), they also help to turn the entire leg away from the ‘foot collapse’ position (more toward the outside), decreasing the tendency for the foot to collapse.”
Orthotics and insoles, says Dr. Armstrong, have a similar affect as hip strengthening exercises. They “help to decrease the tension of the muscles because the foot doesn’t flatten out as much.”
As Dr. Armstrong makes clear, chronic shin splints are a serious condition. “If the periosteum continues to be inflamed, then the underlying tibia bone may become stressed, leading to a stress fracture.” And if that happens, you might have to sit out 8-12 weeks before you can do any kind of impact activity at all.
