Shin Splints Prevention Training Plan
What are Shin Splints?
Before we get into the causes of shin splints, it might be a good idea to clarify exactly what shin splints are and what they aren’t. In the past, shin splints was a generic term used to refer to virtually any pain or injury in the lower leg. They were loosely organized into one of several categories that described the location of the injury. The categories were called anterior (front of leg), posterior (back of leg), medial (inside of leg), and lateral (outside of leg).
Most athletes and many coaches still use the term “shin splints” when describing lower leg injuries, but health professionals no longer use the term because it is too vague. Shin splints are now separated into 4 categories. The current categories are: medial tibial stress syndrome, tibial periostitis, anterior compartment syndrome, and stress fractures.
Medial Tibial Stress Syndrome
Medial tibial stress syndrome (MTSS) is the most common form of shin splints. Pain from this injury is located along the inner part of your lower leg. The posterior tibial muscle is located on the back of your lower leg bone. It wraps around the inner part of your ankle and attaches to the top of the arch of your foot. A primary function of this muscle is to support and hold up the arch of your foot. Each stride you take places stress on the tendons and connective tissues of this muscle. The stress travels up the muscle to its origin on the back/inside of your lower leg. This inside area of the muscle and attachments are where the pain of this injury is felt.
Excessive pronation (rolling inward of the foot) is a major risk factor for MTSS. When your foot pronates, this muscle must work harder to hold up the arch of your foot. In addition to excessive pronation, other risk factors include: heel striking, high arches, running on your toes, overtraining and running on slanted surfaces. Running on hard surfaces can also be a factor, but is not a common cause of this injury. Running on very soft surfaces, such as grass or sand, can actually be more of a factor because of the potential increase in pronation.
There is a covering of the lower leg bone called the periosteum. The impact of your foot striking a very hard running surface can irritate the front of your shin bones. This irritation can be transferred to the periosteum which results in pain and inflammation. The pain from this form of shin splints is usually felt on the front of your shin bone, directly under the skin. It usually starts about 3 inches above the ankle and extends up the bone for 2 to 3 inches. The primary risk factors for this injury are running on hard surfaces such as concrete, running with heavy, high impact strides and heel striking.
Anterior Compartment Syndrome
The muscles on the front of your lower leg are encased within a “compartment” made of membranous walls. As you exercise, these muscles can become enlarged as they swell with blood. The compartment resists this swelling and pressure builds up within the compartment. This restricts blood flow to the muscles, which results in pain. The pain is usually located on the front of the lower leg, just to the outside of the shin bone. The muscle usually involved is the tibialis anterior muscle, which is responsible for flexing or raising the front of your foot.
Risk factors include: overtraining, rapid increases in training volume, a small anterior compartment and running on hard surfaces. In addition, there are mechanical risk factors involved. Calf muscles that are too tight will cause the muscles on the front of your lower leg to work harder to flex your foot. That increases the stress put on them and increases the chance of suffering this injury. This added stress happens at two phases of your running stride. The first is at toe off. Immediately after toe off, your foot dorsi-flexes so that your toes will clear the ground during knee lift. The second is just before, during and just after foot contact. At this point, the anterior muscles are working to slow down and stop the downward motion of the front of your foot.
Runners that over stride or land heavily on their heels are especially vulnerable to this injury because the anterior muscles must work especially hard to stop the downward “slapping” motion of the front of the foot.
Stress fractures are small cracks or micro fractures in the lower leg bone. These fractures are caused by the repetitive low grade impacts of running and other activities such as dancing and aerobics. A couple of theories have surfaced to explain why these fractures occur.
- Overload Theory – When muscles contract they pull and put stress on the areas in which they connect to the bone. This stress may cause the bone to “bend” slightly with each impact. It is thought that this repeated bending and straightening may cause the cracks to appear.
- Fatigue Theory – As muscles fatigue during exercise they become less efficient at supporting the bones, which is one of their functions. The decreased amount of support to the bones may be a cause of the stress fractures.
Pain from a stress fracture is usually localized to a small portion of the bone. This is opposed to other forms of shin splints which are more spread out. Diagnosis of a stress fracture should be confirmed with an X-Ray or a bone scan. If left untreated, a stress fracture can progress to a full fracture.
Causes of Shin Splints
As you have seen, each of the four types of shin splints carry their own causes and symptoms. But these are only symptoms. What is really causing the epidemic of shin splints? I mentioned earlier that I believe the problem starts with lack of conditioning and over protective running shoes. I developed that opinion though many years of coaching and running, but does the scientific community agree with me? There isn’t a lot of definitive information that points to a direct cause, but some recent studies back up the fact that lack of conditioning is a primary cause of MTSS.
The primary muscles involved in shin splints are your ankle dorsi flexors and plantar flexors. The primary purpose of these muscles are to move your foot away from (plantar flex) your shin and towards your shin (dorsi flex). That is not their only duty. They get involved in lateral ankle motions, rotary ankle motions, foot stabilization and also in preventing excessive pronation.
A study done at the Geelong Foot Clinic in Victoria, Australia, looked at the conditioning or endurance of the plantar flexor muscles. The researchers found that “…athletes with MTSS have endurance deficits of the ankle joint plantar flexor muscles, Rehabilitation of athletes with MTSS should comprise training designed to enhance endurance of the lower limb musculature, including the ankle joint plantar flexors.”
How did this weakness of lower leg muscles come about in today’s distance runners? I think it is at least partially caused by the highly marketed and over engineered modern running shoe. Today’s show manufacturers are constantly pushing the latest shoe that provides tons of cushioning and completely supports your foot. That sounds great except for one rather critical thing. The shoes are so supportive they are like a cast on your foot. As a result, the muscles in your lower leg no longer have a job to do. They don’t need to work as hard to stabilize your foot. They do less work during your running stride. So, your lower leg muscles get weaker and weaker. The result – a higher incidence of shin splints.
Reversing the Trend
So, how do you stop the shin splint epidemic? There is nothing you can do to complete prevent MTSS, but you certainly do something to reduce your chances of suffering from shin splints. If you strengthen your lower leg muscles and improve their endurance you have a great chance of eliminating this debilitating injury from your running life.
This shin splint prevention plan is designed to help you increase the injury resistance of your lower leg muscles and decrease your risk from MTSS. Note that this strength training plan focuses solely on prevention of MTSS and should be used in conjunction with your general running strength training program. This plan concentrates on lower leg and foot strengthening but also includes exercises for some secondary supporting muscles and motions.
In addition to this strength training and flexibility plan you should also focus on developing or maintaining proper running mechanics. Just a small inefficiency in your running stride can cause excessive, injury producing stress in your lower leg muscles.
One of the most important phases of running mechanics is the position of your foot when it lands on the ground. When you foot strikes the ground it will land either; toes first, ball of the foot first, flat footed or heel first. Many runners make the mistake of reaching out in front of their body and landing heel first. That type of foot plant is inefficient and can be the cause of a long list of injuries. When you land on your heel, your leg is straight and extended in front of your body. The combination of a straight leg and a hard heel landing transfers a lot of impact through your heel and up through your knee to your hip. The excessive stress a heel strike places on your joints can cause pain and injury to your hips, knee, ankle and foot. A heel first foot plant also means you are over striding. You are reaching out in front of your body with each step you take. When you reach out in front of your body, you will land heel first and will be putting on the brakes with each step. It is like trying to drive your car while pressing on both the gas pedal and brake pedal at the same time. You are wasting energy and making your training run harder than it should be. Landing toes first is not an efficient style for distance running. Toe first landings result in a lot of up and down motion and puts a lot of stress on the calf muscles. Toe running is more appropriate for sprinting than for distance running.
As a distance runner, your most efficient foot plant is one in which your foot lands directly under your hips or your center of gravity. You may land on the ball of your foot or flat footed. The ideal landing position is slightly toward the outside edge of your foot, just behind your little toe. Your foot would then naturally roll slightly inward while pushing off over your big toe. The slight inward roll of your foot is called pronation and provides some cushioning during the running stride. A small amount of pronation is normal and desirable, but excessive pronation can also be the cause of injury and stride inefficiencies. Excessive pronation can be prevented through the use of motion control shoes. That type of shoe has strong heel inserts that stop the inside rolling motion of pronation. While motion control shoes will temporarily solve the problem, it is like putting a band aid on a cut that will never heal. It solves the immediate problem but it not a long term cure. Pronation can be caused by weak muscles in your lower leg or stride inefficiencies. Doing some barefoot walking and running will help strengthen the ankle and foot stabilizing muscles in your lower leg. Doing exercises and drills on an unstable surface such as a wobble board or stabilization pads can also help with this problem. If you pronate severely I would suggest consulting with a physical therapist to find out of there are alternatives to motion control shoes in your specific case.
Years ago, when I was first learning how to run, I was taught to run with a very upright and straight posture. I was told not to lean forward or backward. Nearly every coach taught that same technique. They coached that way because it was the way they learned to run. I ran successfully using that technique in the early stages of my career but as I advanced to longer, more difficult training runs and higher levels of competition, that technique was no longer adequate. I began suffering from back pain and leg injuries. Running became more difficult and my enjoyment level plummeted. So, I made changes. If you watch world class runners on television, you will notice that they appear to run with no effort. They seem to be gliding smoothly along the road or track. I watched the most successful runners. Nearly all of them run with a straight and erect back, but they lean forward very slightly. This very slight forward lean gives them a completely balanced posture. Balance is the key word. You should always feel as if your upper body is in balance above your hips.
When you are standing still your upper body is very straight and balanced on top of your hips. Go ahead and try this. Stand up and feel your body. Lean your body forward and backward. When you lean forward you begin to lose your balance in that direction. When you lean backward you feel your balance shift to your rear. Only when you are standing with a straight upper body do you feel in balance.
Now start to walk forward. When you being to move shift your upper body very slightly forward. You are leaning into your movement. In a way when you walk you are actually falling forward and catching yourself with your legs. Running is the same. When you run you need to lean forward to keep your body balanced over your hips. If you kept your body straight your balance would be shifted to the rear of your body. You would not be able to continue the action of “falling forward”. You would have to reach out in front of your body and pull your legs back to create forward motion. That would make your running more difficult and inefficient.
The most efficient posture is one that is upright and relaxed with a slight forward lean. Your chest should be out and your shoulders back. If you lean too far forward you will begin a stumbling, high impact stride. You will also put excessive stress on your knees and back. A backward lean will cause you to over stride and land heavily on your heel, which will also stress your knees, hips and back. A visualization that may help is to imagine your hips and legs being a motor. You just want to keep your upper body balanced over your motor.
Keep your hips pressed forward and your butt tucked in. Visualize standing face first against a wall. Press your hips forward so that the bones of your hip touches the wall. Running with your hips forward will help your knee lift higher, with less effort.
Another common form error is called “sitting in the bucket”. This is especially common among beginning runners. This style is caused by the hip and butt being pushed back, into a slight sitting position. This causes your feet to be in front of your body with a very weak push off behind your body. Keeping your hips pressed forward will eliminate this form fault. Keep your body as relaxed as possible. Tense muscles will slow you down and force you to work harder. Concentrate on keeping your shoulders, jaw, torso and legs nice and loose.
The most common form flaw I have observed in runners I have coached is over striding. Forcing a long stride length will not improve speed or running efficiency. Just the opposite happens. Over striding will result in reaching out in front of your body with your foot and landing heavily on your heel. This will cause the braking action that I mentioned earlier. In a proper stride, your foot should land directly under your body with every step. Concentrate on running with a quick and light stride. Your stride should be like a rotary motion with your foot landing directly under your center of gravity at the bottom of each cycle. Over striding is a form flaw, but in order to run as efficiently as possible, you must extend your stride to its maximum, without over striding.
You should increase your stride length by opening up your stride or making “bigger circles” with your feet and legs. Do not reach out with your forward foot, but allow the forward momentum of your body to “catch up” with your forward foot so that no braking action is initiated. Your forward foot should land directly under your body. If you reach out with the forward foot, you will land on your heel and initiate a braking action with each step. This will excessively stress your knees, hips and back, in addition to slowing you down.
All of your effort should directed forward. There should be very little up and down motion. Runners that bounce or hop when they run are wasting energy. They are also putting excessive stress on the knees, hip and back. You should feel as if you are gliding along. Imagine you are running with a beanbag on your head. If you bounce too much the beanbag will fall off.
Your stride should be quick and light. Visualize trying to sneak up on someone while you are running. Your steps should be light and quiet. If your steps are heavy and noisy, you are running with too much up and down motion, or are leaning forward too much.
You should not exaggerate your knee lift when running long distances. A high knee lift is much more important when sprinting or when running hard for the finish line. An exaggerated knee lift will require the use of too much energy to maintain for a long period of time. Knee lift is a very misunderstood term. Many believe that knee lift means to lift your knee straight up, which results in a bouncy, up and down motion which wastes a lot of energy. A proper knee lift should feel like you are driving your knee forward, not up. A forward knee drive will result in a low to the ground and efficient forward running motion.
To initiate your foot plant, slightly pull your lead foot back gently so that it will match the speed of the ground moving under your body. That way you will avoid any braking action and will run very smoothly and efficiently. Immediately after your foot plant concentrate on quickly picking your foot up to continue the cycling motion. It may help to think of your legs moving in a continuous cycling motion, very similar to pedaling a bike. A rather amusing mental cue is sometimes use is imagining I am moving like the cartoon “road runner”. I imagine my legs spinning is a continuous circular motion and my body is just going along for the ride.
The main purpose of an arm swing is to provide balance and coordination with the legs. The arms should hang loose and relaxed, close to the body. Avoid excessive movement. You want to avoid any tenseness in the shoulders. Your wrists should be loose and floppy. Do not clench your fists. Your hands should be held in a relaxed manner. You may try imagining that you are holding a butterfly in your fingers. Do not crush the butterfly. Any tightness in your hands will transfer all the way up your arm.
During the arm swing, your hands should not travel above your chest or behind the midline of your body. Try to avoid crossing your hand in front of your body. Keep your arm swing compact and your elbows at about a 90 degree angle. Do not drive your arms forward. A forward arm drive will encourage over striding. There is only one direction for arm drive – backwards. Driving your elbows back when you run will help you run with a quick, light and efficient stride.
The Shin Splint Prevention Plan
This shin splint prevention plan is composed of a 4 week build up strength training and flexibility schedule that focuses on gradually and progressively building the functional strength of your lower leg muscles, followed by a weekly rotating maintenance plan. All strength and flexibility exercises are body weight based, so you can do them at home, the park, the trail or the track. No specialized equipment or access to a gym is needed. Barefoot strides are also included. These barefoot strides and even some additional barefoot running is important for shin splint prevention because it allows your foot to work and strengthen naturally, without the cast like suppression of natural motion that most running shoes cause. Barefoot running also encourages a more efficient flat footed or ball of foot first foot strike, which helps prevent shin splint injuries.
This shin splints injury prevention plan is presented to you below in PDF format. You can either move through the pages using your scroll bar or by using the PDF viewer controls at the bottom of each page.
This information is adapted from Bear Naked Strength Training for Distance Runners, by Rick Morris
Shin Splint Prevention
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