Shin Splints: The Speed Bumps of Running
Shin Splints. Technically, medial tibial stress syndrome (MTSS). Shin splints are a pretty common ailment among runners; one PLoS ONE study identified MTSS as the most common injury (15%) among 254 novice runners (that would be me!).
Causing pain below the knee on either side of the shin bone, shin splints brought my mile-a-day running streak to an abrupt end on day 51. I was in the middle of a 5k run when I felt the pain in the outside (anterior) part of my shin, along the thickest part of the muscle. I limped home and got out the ice pack.
Painful, for sure. But shin splints are only speed bumps on a runner's road; they'll temporarily slow us down, but they don't need to stop us!
Nearly 30 days later, thanks to a lot of advice I got from runners in my Facebook running groups, there are no signs of shin splints and I'm easing back into running.
Here's the advice other runners shared with me, along with the research I did to discover the science behind the advice.
Rest. Ice. Compression. Elevation. Time-honored treatments for just about any injury. All four are intended to reduce swelling and prevent further damage to the tissues. For me, rest didn't mean hanging out on the couch all day and watching Judge Judy (sadly); it meant temporarily realigning my fitness goals. For the first few days of recovery, I stopped running and iced the sore muscle 3-4 times a day for about 20 minutes. To keep up with my cardio I did gentle walking and exercycling to cross train. Then I discovered compression socks...
#2. Wear Compression Socks
Oh, compression socks, where have you been all my life?
Runners in my running group were unanimous in recommending compression socks or sleeves for wearing both during and after activity. Runners recommended Zensah and PRO Compression, but there are many other brands out there.
I started with a pair of Zensah Tech+ Compression socks. The suggested uses are for "Training, Performance and Recovery." They are marketed to provide "Muscle Support, Enhance Circulation, and Race and Recover." I also found two types of CopperFit Energy Compression Socks at my local Dick's store. The package claims to "reduce swelling, increase circulation, reduce fatigue." Both brands are full socks that go to just below the knee; both are graduated to provide more support toward the ankle, with decreasing support below the knee. I haven't tried PRO Compression yet but they're on my list.
Sceptical as I am about these kinds of things, I have to admit that as soon as I put them on (an art in itself) I felt immediate relief. I've been wearing them for both walking and running ever since. My imagination? Or is there something to it the benefits of compression socks?
(Warning: what follows is more than you may ever want to know about compression socks!)
The idea behind compression socks - or compression in general - is to facilitate the movement of blood from the extremities back to the heart. Doctors recommend compression socks (sometimes called compression stockings) for a number of purposes, including reducing the risk of blood clots, treating deep-vein thrombosis (DVT), and reducing swelling caused by long periods of sitting or standing. Athletes use compression wraps and socks to apply compression and reduce swelling after an injury - the "C" in R.I.C.E.
There are a lot of claims made about the positive effects of compression socks on running, and there's a large body of research around those claims. I've included a list of research articles at the end of this post, but here's a brief summary, most of it from the article "Is There Evidence that Runners can Benefit from Wearing Compression Clothing?" a systematic review of 32 peer-reviewed studies published in the journal Sports Medicine:
Specifically related to running, there is evidence that compression socks can:
- reduce post-exercise pain
- reduce muscle damage (by limiting the amount of muscle movement)
- reduce inflammation (by facilitating the movement of blood and lymph fluids out of the leg)
Runners many experience small positive effects on
- time to exhaustion
- running economy (which looks at the mechanics of running and includes step length and frequency, time in contact with the ground, time of leg swing)
There is no evidence of positive effects on
- running performance
- oxygen uptake
- blood lactate concentrations
- cardiac indicators (heart rate, stroke volume, cardiac output)
- body temperature
Researchers also noted there are positive psychological effects on
- muscle soreness
- how hard runners think they are working (perceived exertion)
Finally, researchers acknowledged that some athletes report just feeling better and faster wearing compression socks. So go for it!
Bottom line: for healing shin splints (or other lower leg injuries), wearing compression socks during and after walking and running is a thumbs up!
#3 Stretch & Roll
Stretching the front and back of the lower leg was an important part of my recovery but also an important part of ongoing daily muscle maintenance. Several runners said the best stretch was to write the alphabet with the toes. This fun little activity creates a variety of movement patterns that stretch the foot and ankle in every plane of motion. I do it both standing and sitting, several times a day. You get a better stretch without shoes; I've found myself doing it automatically during meetings. Sometimes I do both feet at the same time.
The Sports Injury Clinic has some nice videos for the following recommended stretches
- shin stretch
- calf muscle stretch.
- soleus muscle stretch.
Rolling with a foam roller two or three times a week, especially after runs, helps work out knots in muscles and the surrounding tissue (facia). To roll the shins, get on your hands and knees with the roller under your shins, supporting yourself with your arms. Roll back and forth a few inches at a time, working up the leg. Just reverse to roll the calves.
Because I also have to be diligent about keeping plantar fasciitis at bay, I regularly roll the soles of my feet on a tennis ball or a TriggerPoint ball.
#4 Build Your Other Muscles
One of the causes of shin splints is an imbalance among the leg muscles, especially between the front and the back of the leg. Think of all the muscles that contribute to running and walking: feet, ankles, shins, calves, quads, hamstrings, hips, glutes. Seriously, just about everything below the belly button. We need to train those muscles evenly and regularly in order to maintain muscle balance that protects the other muscles and the connecting joints.
I've added these "4 Exercises to Prevent Shin Splints" from Runner's World to my regular lower-body workouts:
- Toe Curls
- Monster Walks
- Heel Drop
- One-Legged Bridges
#5 Run/Walk Backwards
I have to admit, this one surprised me. Several people in my running group reported regularly running or walking backwards as a warm up or cool down activity, and even during runs for short breaks. I've tried it, it feels good. Sure enough, there's a body of research on backward walking (also called reverse walking or retro walking) going way back to the 1970s.
Here's the short story: It's good for you. Walking backwards improves gait, balance, and leg muscle endurance. It activates the quadriceps, and has less impact on the knee joints; one study showed the stimulation between the knee joints and quads was more balanced.
The only drawback mentioned is the risk of falling.
Shin splints and other injuries can derail running plans in unpleasant ways. This time I'm approaching running more wholistically, incorporating what I've learned about stretching, rolling, strengthening and compression to my running schedule. I'm increasing my mileage slowly, and have added cross training for non-running days. Oh, and I always wear my sexy compression socks!
And my shin splints? Those speed bumps are now in my rear vision mirror!
- Berkeley Wellness. Compression Stockings: A Guide
- JOSPT (Journal of Orthopaedic & Sports Therapy). Mechanical Power and Muscle Action During Forward and Backward Walking
- Journal of Athletic Training. Graduated Compression Stockings for Runners: Friend, Foe, or Fake?
- Journal of Physical Therapy Science. Effect of Forward and Backward Locomotion Training on Anaerobic Performance and Anthropometrical Composition
- Journal of Physical Therapy Science. Therapeutic Efficacy of Walking Backward and Forward on a Clope in Normal Adults
- Journal of Sports Science and Medicine. Compression Garments and Exercise: No Influence or Pressure Applied
- Journal of Strength and Conditioning Research. The Effect of Compression Stockings on Physiological and Psychological Responses After 5-km Performance in Recreationally Active Females
- Journal of Strength and Conditioning Research. The Effect of Graduated Compression Stockings on Running Performance
- New York Times. Is Running Backward Good Exercise?
- PLoS ONE. A Prospective Study on Time to Recovery in 254 Injured Novice Runners (novice is defined as not having run regularly for more than a year, and not running more than 10k).
- Proceedings. Biological Sciences.
- Sports Medicine. Is There Evidence that Runners can Benefit from Wearing Compression Clothing?
- Runner's World. The Many Bennies of Running Backward
- Runner's World. Shin Splints