How to Prevent and Self-Treat Shin Splints

MTA_ShinSplints

http://marathontrainingacademy.com/self-treat-shin-splints

Marathon Training Academy

September 12, 2015

In this guest post for Marathon Training Academy, you will discover the common causes for shin splints and learn simple prevention strategies and treatment options to quickly help aid in your recovery.

ShinSplints_Arrows_LandscapeThe term shin splints, also known as an anterior compartment syndrome, refers to pain along the shinbone (tibia), the large bone in the front of your lower leg. Shin splints can be excruciatingly painful to the point that you may struggle to walk or run. They are typically caused by inflammation in the anterior muscle of the lower leg known as the anterior tibialis muscle. This is the primary muscle needed to lift your foot. Shin splints are often considered an over use injury and unfortunately, are relatively common in runners. Discover the common causes for shin splints and implement these strategies to prevent and self-treat shin splints. Continue Reading

14 Tips and Strategies to Self-Treat Muscle Pain

Muscle pain is common and often occurs after exercise or activity.  Although the pain is uncomfortable, most types of muscle pain are benign and quickly pass.  Muscle aches and pains can affect your ability to compete or train at a high level.  It also can affect your sleep and mood.  Discover the possible causes of muscle pain as well as prevention and treatment strategies.

Possible Causes of Muscle Pain include:

  • Delayed Onset Muscle Soreness (DOMS). This soreness typically occurs 24-48 hours after an exercise session due to micro trauma within the muscle tissue. It tends to be worse after eccentric biased exercise where the muscle is lengthened.
  • Muscle Strain. If you strain your muscle either by over lengthening or over exerting the muscle capacity, muscle tearing may occur. Depending on the size and location of the tear, it may range from minor to severe (potentially needing surgical intervention).
  • Myofascial Issues. Layers of the myofascia (the dense, tough tissue which surrounds and covers all of your muscles and bones) may become bunched or knotted up and result in pain. This is typically due to poor posture, repetitive motion injuries or over exertion.
  • Neurological Issues. Many neurological disorders, including pinched nerves, can cause pain. Other medical conditions, such as muscular dystrophy, cause muscle dystonia.
  • Illness. Muscle pain can occur as a symptom in colds, flu, Rocky Mountain Spotted Fever, and other viral or bacterial infections.
  • Disease. Many diseases, such as Polio, Lupus, and Lyme’s Disease, cause muscle pain.
  • Medications. Certain medications, such as statin drugs for cholesterol, have been strongly associated with muscle pain.
  • Fibromyalgia. This condition causes muscle pain, joint pain, and extreme fatigue.
  • Rhabdomyolysis. A serious condition, due to either direct or indirect muscle trauma, which causes pain. It can be life threating due to the potential for kidney failure. Common causes include extreme exercise, statin medication, severe injury or illicit drug use.
  • Compartment Syndrome. A serious condition in which excessive swelling and pressure build up in a confined space. It leads to extreme muscle pain and eventually, numbness and tissue death.

This list highlights some of the many potential causes of muscle pain.  Many are benign while others are true medical emergencies.  The most common reasons include: delayed onset muscle soreness (DOMS); muscle strains; myofascial related issues due to posture and/or repetitive motion injuries; and fibromyalgia.

In order to properly treat muscle pain, first identify the cause of your muscle pain.  Can you correlate the symptoms with a certain activity or exercise?  Are you suffering from a cold or flu like symptoms?  If you are unable to correlate a reason for the pain, then you may consider consulting with your medical physician to rule out other possible causes for muscle pain.

Young man experiencing neck pain against a white background

The following tips and strategies to treat muscle soreness specifically address mechanical causes related to DOMS, minor muscle strains, and myofascial issues.  Many of these strategies are also appropriate in helping to manage fibromyalgia symptoms.

14 Tips and Strategies to Self-Treat Muscle Pain: 

  1. Fix Your Posture. Poor posture is one of the most common causes of muscle spasming and pain. This is particularly true if you spend a good portion of your day sitting. Sign up to receive my weekly blog posts via e-mail, and I will share with you My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain. These simple exercises, with complete instructions and photos, will help you to improve poor posture and can be performed at home.
  2. Massage. Contact a masseuse, physical therapist, athletic trainer or friend who is skillful in body work and massage to relieve the area in spasm. The specific massage technique to use will vary according to your preference. Massage techniques range from a light relaxing massage to a deep tissue massage or utilization of acupressure points.
  3. Foam Roller. The foam roller allows you to perform self-massage and tissue mobilization. The foam roller is a wonderful tool to prevent muscle cramping and spasms. Please refer to the following posts for more information: Foam Rolling For Rehabilitation and 5 Ways to Improve Range-Of-Motion. I highly recommend a High Density Foam Roller to help aid in your recovery.
  4. Other Self-Mobilization Tools. Many times, a friend or masseuse isn’t available to assist when you need the help the most. A foam roller cannot effective reach places in the upper back or arms, so other self-mobilization tools may be necessary. You can get creative and use a tennis ball or golf ball, but I like a specific tool called a Thera Cane Massager. This tool allows you to apply direct pressure to a spasming muscle. When held for a long enough period of time, the Thera Cane Massager will usually cause the muscle spasms to release and provide much needed pain relief! I am also a big fan of the Thera-Band Standard Roller Massager. I particularly like that its firmness allows for a deep amount of pressure. If you prefer something similar, but more flexible for the boney regions of the thigh or lower leg, I recommend The Stick Self Roller Massager.
  5. Topical Agents. Many topical agents can help to decrease and eliminate muscle spasms. The method of action varies greatly according to the product used. You may find that one product works better than another. Some of my favorite products in my medicine cabinet include: Biofreeze Pain Relieving Gel; Arnica Rub (Arnica Montana, an herbal rub); and topical magnesium.
  6. Magnesium Bath. The combination of warm water with magnesium is very soothing and relaxing. Magnesium is known to help decrease muscle pain and soreness. Options include: Epsoak Epson Salt or Ancient Minerals Magnesium Bath Flakes. I find that the magnesium flakes work better, but they are significantly more expensive than Epson salt.
  7. Oral Magnesium. You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates. Taking additional magnesium (particularly at night) can help to reduce muscle cramps and spasming. It is also very helpful in reducing overall muscle soreness and aiding in a better night’s rest. Most people are deficient in the amount of magnesium they consume on a regular basis. I recommend beginning with a dose of 200 mg (before bedtime) and increasing the dose as needed. I would caution you that taking too much magnesium can lead to diarrhea. Mag Glycinate in its oral form is the most highly absorbable. Although not as absorbable, Thorne Research Magnesium Citrate and magnesium oxide can also be beneficial.
  8. Stay Hydrated. The human body is primarily made of water, which is critical for all body functions. Your muscles are approximately 80% water. Dehydrated tissues are prone to injury and pain as they struggle to gain needed nutrients to heal and repair. Dehydrated tissues are less flexible and tend to accumulate waste products. Stay hydrated by drinking water. Try to avoid beverages that contain artificial sweeteners or chemicals with names you can’t spell or pronounce.
  9. Eat Healthy. A healthy diet is critical to avoid injury, illness, and pain. Your body tissue needs nutrients to be able to perform at a high level. Avoid processed food as much as possible. Limit sugary food and add more protein and healthy fat in your diet. Maintaining a diet with adequate healthy fats is essential in providing the nutrients to support all hormone function in the body as well as support the brain and nervous system. Adequate protein intake is necessary to support muscle health and development. Give your body the needed nutrients to combat illness and function at a high level.
  10. Move More! Not only has research proven that sitting for more than two hours at a time decreases your expected life span, but extended sitting also leads to increased muscle tension, cramping, and pain. If you sit most of the day, get up and walk. If you stand most of the day, frequently change your standing posture. To optimize health and joint function, you should take each joint in your body through a least one full range of motion (ROM) every day. If you are experiencing pain, I recommend performing more frequent ROM (every 1-2 hours).
  11. Stretch. Stretching is a wonderful way to help eliminate a muscle spasm. We instinctively stretch when we feel a spasm begin. Try gently stretching (lengthening) the muscle affected by the spasm. I recommend beginning with a short 30-60 seconds stretch, then repeating as needed. If the spasm or cramp is severe, you will likely need to continue stretching several times in a row, multiple times throughout the day. Stretching should always be part of a general fitness and lifestyle program. As we age, muscle and tendons tend to lose elasticity so stretching becomes even more important. I highly recommend a daily stretching routine or participation in a group class, such as yoga, which incorporates full body stretching.
  12. Acupuncture. I am personally a big fan of acupuncture. It is very useful in treating all kinds of medical conditions. It can be particularly effective in treating muscle cramps, spasms, and pain as it addresses the issues on multiple layers. Acupuncture directly stimulates the muscle by affecting the nervous system response to the muscle while producing a general sense of well-being and relaxation.
  13. Sleep and Rest More. Most people are not sleeping long enough or often enough to optimize health. Take a nap or go to bed earlier. Your body requires time to repair and heal as you sleep. Your body must rest in order to grow and develop. Training every day is not the best way to improve. It can lead to injury and burn out. Take a rest day and have fun. Participate in a Tai Chi or yoga class, take a leisurely bike ride or take a walk in the park.
  14. Speak with your Physical Therapist (PT) or Physician (MD). If your muscle pain cannot be correlated to a specific mechanical cause, please speak to your medical provider to determine if other causes are contributing to the problem. The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area. In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your physician’s opinion as well).

Most muscle pain and soreness can be self-managed and self-treated if you are proactive.  These tips and strategies are highly effective in managing muscle pain.  A healthy lifestyle is a lifelong pursuit.  If you are injured or not enjoying an activity, you will not stay engaged or motivated in the long term.  Seeking advice specifically from a running coach, physical therapist or physician can be beneficial.

How do you manage your aches and pains?  Which tip or strategy will you incorporate into your treatment?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

How to Self-Treat Shin Splints

If you have ever experienced shin splints (anterior compartment syndrome), you know how excruciatingly painful it can be.  You may struggle to run or walk.  The pain can linger for weeks and months–taking the fun out of running and exercise.  In the previous post, I discussed How to Prevent Shin Splints.  Now I will provide simple treatment options to quickly help aid in your recovery.  Shin splints can typically be easily self-treated if you don’t have a more serious medical condition, such as a stress fracture, causing the pain.

ShinSplints_Treatment_Landscape

How to Self-Treat Shin Splints: 

  • Ice. Although shin splints can occur insidiously, they are often associated with a specific event. An active inflammatory process typically occurs. Apply the ice to the anterior tibialis muscle (the muscle right next to the shinbone). The rule for icing is to apply ice no more than twenty minutes per hour. Do not place the ice directly against the skin, especially if you are using a cold pack. A bag of frozen peas can be a cheap alternative. Individuals with poor circulation or impaired sensation should take particular care when icing.
  • Rest. If you are experiencing an episode of shin splints, then you will need to rest. Avoid running (particularly downhill). At the very least, taper your training intensity and avoid exercises that place undue stress on the shins, particularly the anterior tibialis muscle. Utilize this time to incorporate cross training activities, such as yoga, to improve flexibility as shin splints can be linked to poor mobility.
  • Consider changing your shoes. Your shoes may be worn out and may be the cause of the pain. If you wear a shoe that helps to limit overpronation, remember that the inner cushion and structure of the shoe can wear out before its outer appearance. If this occurs, the shoe can no longer adequately control inappropriate foot and heel movements such as overpronation. This can lead to shin splints as well as IT band syndrome or other hip, knee, or ankle related issues. Shoes only last 350-500 miles. If you are nearing those miles, then it may be time to change.
  • Add an orthotic. Additional foot control is often needed to normalize gait mechanics. Many running stores sell an over-the-counter orthotic such as Superfeet Blue Premium Insoles. The blue tends to fit most feet, but a variety of options are available for customization. In my experience, these insoles can last 1,000 to 1,500 miles easily. If the over-the-counter options aren’t helping you, please see a physical therapist or podiatrist for custom orthotics. Seek assistance from a professional who is a runner and has experience with treating other runners.
  • Warm up prior to exercise. I recommend that you increase your normal warm up time by at least 10 minutes in order to increase blood flow to the area. This allows for better mobility and also prepares the tissues for exercise. Consider using a self-massage tool to roll up and down the anterior tibialis as part of your warm up. My favorite self-massage tools for this area include the Thera-Band Standard Roller Massager and The Stick Self Roller Massager. I also recommend using the massager on your calf muscles. Perform calf stretches, but be mindful that prolonged static stretching before exercise may worsen performance.
  • Cool down. After performing your exercises, take extra time to cool down and stretch. Focus on calf stretching as well as general lower extremity mobility stretches. Use the same self-massage tools as you did during your warm up. If you are prone to developing shin splints, I highly recommend regular massage and mobilization of the anterior tibialis muscle, as well as the calves. Tightness in the calves and Achilles tendon are a risk factor for developing shin splints. Be sure to emphasize stretching your calves. Hold each of the following stretches for at least 30 seconds, 3 times on each leg, 2-3 times a day. (These stretches shouldn’t cause more than a mild increase in pain or discomfort.)

Calves

  • Self-mobilize the tissue. Be sure to mobilize the tissue of the anterior tibialis. For this particular area, you may want to use one of the self-massage tools referenced above. You could also use a tennis or lacrosse ball to aggressively work out the tissue along the shin. Remember that mobility issues and myofascial restrictions in the lower legs are highly correlated with the development of shin splints. Use the foam roller to address any lower leg tightness or restrictions. I tend to use the foam roller for the larger parts of the leg including the thigh, back of the leg, calves, and buttock muscles. To learn how to use a foam roller, please refer to Foam Rolling for Rehabilitation.
  • Work on the stabilizing muscles of your hips and ankles. As part of a comprehensive rehabilitation protocol, I almost always have clients work on keeping the muscles of the pelvis, hips, and ankles strong. This will help to maintain normal gait mechanics during exercise and running. Not only will this help to prevent shin splints, it will likely help to prevent developing other orthopaedic issues such as plantar fasciitis and hip or knee pain. Please refer to Ankle Resistance Exercises and How to Safely Self-Treat Low Back Pain for my recommended hip and lumbar stabilization strengthening exercises.
  • Work on your balance. Poor balance is often associated with muscle weakness in the foot and ankle as well as the knee and hip musculature. Weakness and balance deficits can lead to poor foot mechanics, which can lead to excessive strain. I always include balance work as part of my recommended rehabilitation protocol. Please refer to Improving Balance by Using a Water Noodle, How Do I Improve Balance? (Part I), and How Do I Improve Balance? (Part II).
  • Kinesiological taping. The purpose of the tape is to assist the anterior tibialis muscle with its contraction and to possibly help with swelling and nutrient exchange by assisting the lymphatic system. I have had luck using the KT TAPE and Mummy Tape brands. When treating shin splints, I recommend following these step by step instructions for Kinesiological Taping for Shin Splints. For application and removal tips, please refer to Skin Care with Taping.
  • Use a compression sleeve or stocking. This condition is often associated with swelling and inflammation in the anterior compartment of the lower leg near the shinbone (tibia). The compression sleeve/socking can help to limit the amount of swelling and promote blood flow back out of the lower leg. This insures better nutrient exchange, waste removal, and can limit the swelling. I particularly recommend wearing a pair while you are in the rehabilitation phase or tapering back into full activity. There are many different styles of compression socks and sleeves, but I prefer Vitalsox Graduated Compression Socks. If you prefer a sock style, then I recommend choosing a pair that is at least knee high.
  • Start a supplement. Many herbs help to reduce inflammation and pain. One of my favorites is called Phenocane Natural Pain Management.  It combines the following: Curcumin, an herb that reduces pain and inflammation; boswellia, a natural COX2 inhibitor that also reduces pain and inflammation; DLPA, an amino acid that helps to increase and uphold serotonin levels in the brain; and nattokinase, an enzyme that assists with blood clotting and reduces pain and inflammation. (If you are taking blood thinners, please consult with your physician prior to use as the herbs could interact with some medications.)
  • Ask for help. If you’re still experiencing pain after implementing these self-treatment strategies, then it may be time to seek additional help. Your medical physician can help to determine if your pain is associated with a stress fracture. He/she could also prescribe stronger anti-inflammatory medication if necessary. The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area. In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to seek your physician’s opinion as well).

Have you ever experienced shin splints?  If so, which treatment techniques have you found to be the most effective? Please leave your comments below.

Looking for that exercise or book I mentioned in a post?  Forgot the name of a product or supplement that you’re interested in?  It’s all listed in the new Resource Guide.  Check it out today!

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

How to Prevent Shin Splints

The term shin splints, also known as an anterior compartment syndrome, refers to pain along the shinbone (tibia), the large bone in the front of your lower leg.  Shin splints can be excruciatingly painful to the point that you may struggle to walk or run.  Worse yet, the pain can linger for weeks to months, but it may not be severe enough to prevent you from exercising.  However, it will take the fun out of exercising and running.  I will address the common causes for shin splints and share my top tips to prevent shin splints.  I provide treatment options in How to Self-Treat Shin Splints.

ShinSplints_Arrows_Landscape

Shin splints are typically caused by inflammation in the lower leg anterior muscles known as the anterior tibialis muscle.  This is the primary muscle needed to lift your foot.  Shin splints are often considered an over use injury.  Unfortunately, shin splints are relatively common in runners and dancers.

As a physical therapist, I commonly treat acute cases of shin splints that occur when an individual suddenly increases his/her training volume by largely increasing the distance he/she is running.  This condition may also occur when an individual isn’t appropriately trained for downhill running.  Running downhill causes the anterior tibialis muscle to work very hard in an eccentric manner (meaning that the muscle is lengthening).  This can very easily overwork a poorly trained muscle and may cause pain and inflammation.

Common Causes of Shin Splints include:

  • Flat feet, which cause overpronation while running.
  • Poorly fitting or worn out shoes.
  • Tightness in the calf muscle or Achilles tendon.
  • Weak ankle muscles (particularly the anterior tibialis).  Shin splints are also associated with weakness in the other muscles of the ankle and foot.
  • Weakness in the hip, pelvic, and/or core muscles can lead to faulty gait mechanics, which causes shin splints or possibly other knee and lower extremity injuries.
  • A change in running surfaces.  This is most evident when transitioning from a softer running surface, such as dirt, to a concrete running track.
  • Stress fractures in the shin (tibial bone).  Also, stress fractures in the foot can cause alterations in running form which may lead to shin splints.
  • Training overload.  The muscles of the anterior shin (the anterior tibialis) are performing training intensities and volumes that they are incapable of doing.  This causes inflammation, swelling, and pain.

How to Prevent Shin Splints:

  • Check your shoes.  Your shoes may be worn out and may be the cause of the pain.  If you wear a shoe that helps to limit overpronation, remember that the inner cushion and structure of the shoe can wear out before its outer appearance.  If this occurs, the shoe can no longer adequately control inappropriate foot and heel movements such as overpronation.  Shoes typically only last 350-500 miles.  If you are nearing those miles, then it may be time to change.  If you’re unsure if your shoes are performing correctly, visit your local running shoe store.  The trained staff can inspect your shoes for wear and tear.  They may ask you to walk or run in order to watch your gait to fit you in the appropriate shoe.  Another option to help control overpronation is an over-the-counter orthotic such as Superfeet Blue Premium Insoles.  The blue tends to fit most feet, but a variety of options are available for customization.  In my experience, these insoles can last 1,000 to 1,500 miles easily.  If the over-the-counter options aren’t helping you, please see a physical therapist or podiatrist for custom orthotics.
  • Progress slowly into a minimalistic shoe.  If you are used to a standard built up shoe, progressing into a minimalistic shoe may be more difficult and take more time.  Unless you are a child or teenager, expect a safe transition to take at least three months.  Don’t transition during a period of intense sports.  I highly recommend waiting until the off season as progressing slowly is always a better choice.
  • If you change running surfaces, progress slowly.  If you are used to running on softer surfaces, such as dirt or a running track, progress carefully and slowly when you run on a harder surface like concrete.  Over all, softer running surfaces are better for your body.
  • Have your gait analyzed while running.  Gait or running abnormalities can increase your risk of developing shin splints.  Over striding tends to occur while running downhill.  Check with your local running store or a physical therapy clinic for a monthly gait analysis clinic.  If you’re unable to obtain a gait analysis, ask your spouse or a friend to video record you (from behind) while you’re running.  Then watch the recording to see if you notice over striding or any abnormalities.
  • Warm up prior to exercise.  I recommend that you increase your normal warm up time by at least 10 minutes in order to increase blood flow to the area.  This allows for better mobility and also prepares the tissues for exercise.  Consider using a self-massage tool to roll up and down the anterior tibialis as part of your warm up.  My favorite self-massage tools for this area include the Thera-Band Standard Roller Massager and The Stick Self Roller Massager.
  • Cool down.  After performing your exercises, take extra time to cool down and stretch.  Focus on calf stretching as well as general lower extremity mobility stretches.  Use the same self-massage tools as you did during your warm up.  If you are prone to developing shin splints, I highly recommend regular massage and mobilization of the anterior tibialis muscle.
  • Improve your mobility.  Mobility issues and myofascial restrictions in the lower legs are highly correlated with the development of shin splints.  Use the foam roller to address any lower leg tightness or restrictions.  To learn how to use a foam roller, please refer to Foam Rolling for Rehabilitation.
  • Strengthen the stabilizing muscles of your hips and ankles.  Strengthening the muscles of your hips and ankles will help to maintain normal gait mechanics during exercise and running.  Not only will this help to prevent shin splints, it will likely help to prevent developing other orthopaedic issues such as plantar fasciitis and hip or knee pain.  Please refer to Ankle Resistance Exercises and How to Safely Self-Treat Low Back Pain for my recommended hip and lumbar stabilization strengthening exercises.
  • Improve your balance.  Poor balance is often associated with muscle weakness in the foot and ankle as well as the knee and hip musculature.  Weakness and balance deficits can lead to poor foot mechanics, which can lead to excessive strain on the plantar fascia.  Improving your balance can help to reduce the risk of shin splints and is an important part of the rehabilitation.  Please refer to Improving Balance by Using a Water Noodle, How Do I Improve Balance? (Part I), and How Do I Improve Balance? (Part II).
  • Train for running downhill.  Running downhill forces the anterior tibialis muscle to work much harder than it would otherwise.  Running downhill causes the anterior tibialis to perform more eccentric (when the muscle gets longer) loading and repetition.  This can overload the muscle, particularly when running downhill very fast.  Although running downhill may not be as aerobically taxing as running uphill, it’s actually physically much harder on your body.
  • If you experience pain, seek help early.  Don’t ignore those little aches and pains that can develop as you exercise and train.  They may be early warning signs of a developing problem.  If you experience pain in your shins, start implementing my recommended treatment protocol.  If the pain persists or continues to progress, please seek assistance from your medical physician or a physical therapist.  The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.

Have you ever experienced shin splints?  If so, how do you prevent them from re-occurring?  Please share the treatments that have been the most effective for you by leaving your comment below.

Looking for that exercise or book I mentioned in a post?  Forgot the name of a product or supplement that you’re interested in?  It’s all listed in the new Resource Guide.  Check it out today!

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!