In the first of this year’s marathon focused features, Sportsister looks at what you can do to avoid lower leg injuries during your marathon training to ensure that you reach that start line in the best possible fitness.
Medial Tibial Stress Syndrome (MTSS), commonly referred to as shin splints is a common injury among runners during marathon training. Being aware of the symptoms and addressing them as required is essential to keep you training on track and help you achieve your goal.
The primary contributing factor to developing MTSS is increasing training volume or intensity too quickly. As the repeated impact increases, tightening occurs via the muscular system to the connective tissue layer surrounding the shin bone, called the periosteum. Repeated tension by muscles on their attachment to the periosteum and force through the bone itself causes aggravation and the appearance of a ‘hot spot’.
These ‘hot spots’ initially present as a nagging tightness at the inside of the shin or tibia, developing to pain on impact while running. It is tender to touch; while the deep calf muscles gradually tighten. As training continues, pain will gradually increase. If this is ignored and training continues further, a stress fracture is likely to develop and prevent training and competition for a considerably longer period of time.
What causes shin splints?
A number of other factors in addition to the changing training load can also contribute to the development of the condition. These include:
- Running surface - the harder the surface, the greater the impact, and thus the greater stress to the shin bone. Where possible run on grass or smooth trails, rather than tarmac or concrete.
- Lower leg muscle tightness - an early sign of MTSS is tightening of the soleus muscle, situated close to the back of the shin bone. Bent knee calf stretches and deep massage are beneficial to minimising muscular tension on the periosteum.
- Biomechanics - your foot is a natural shock absorber designed to minimise stress on the body. If the inside arch of your foot flattens excessively, called excess pronation, you loose the shock absorption which increases the stress transferred to the inside of the tibia. This also increases pressure to knees, hips and low back.
- Running technique is also an essential factor in minimising the impact of stress on the lower limb. An efficient, balanced technique is ideal. If stride length is too long, your feet cross the midline, or you have poor pelvic muscle control, these will all increase stress on the lower leg.
- Correct footwear - good quality running shoes to suit your foot type is essential. It is best to have shoes fitted by a quality running store. The life of the shoe will depend on the volume of training you do. They should have good flexibility toe to heel, but once you can twist or rotate a running shoe length-ways it has lost its lateral stability and it is time to move to a new shoe.
- Orthotics - if correct footwear does still not address excessive pronation, orthotic inserts from a physiotherapist or podiatrist can provide the support required.
How can I get rid of shin splints?
The best treatment of MTSS is to remove the impact. If the condition is recognised early, this can be achieved by lowering the training load and running on a soft surface. Icing is very beneficial after training and through the day. Use a tissue to hold one end of an ice cube and rub it up and down the inside line of the tibia. Deep massage to the muscles near the inside of the tibia and stretching of the calf muscles is also beneficial (although tender!).
If the MTSS is advanced and requires a break from running, non-impact cross training is still beneficial to maintain fitness. One of the best forms of this is water running with a floatation belt. Once symptoms have settled, a gradual return to run program can be introduced with close monitoring to ensure symptoms do not reappear.
If there is any doubt, or symptoms increase, it is always best to consult a physiotherapist or sports physician.
Andrew Griffin, Sportsister
The Women’s Sports Magazine
Andrew is an Australian Physiotherapist currently working with the English Institute of Sport, primarily associated with the British Synchronised Swimming team.
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