Friday, February 20, 2015

Shin Splints

Now to put it nicely, the city of Boston is kind of a mess right now. I know I’m not telling you anything you don’t already know, but between the arctic temps and one million feet of snow, we have seen transportation routes, daily activities, work schedules, and exercise options change drastically in the past month. One of the biggest things I’ve noticed is how few runners are out and about in the city. If I know anything about these athletes, I know that the inability to get outside for their daily or weekly routes around Boston is driving them crazy. You want to see someone have a mini crisis? Try telling a runner who is used to jogging along the Charles everyday that he’ll be relegated to a treadmill for a month or two while the city figures out what to do with 10’ tall snow banks. It’s torture! Anyway, the point is that when I was walking around the city yesterday, my thought process started with the snow and went to: “No one is outside running. That’s so unusual. à Oh my goodness, I bet everyone is trying to make due on treadmills. à Ooooooo their bodies aren’t used to thattttt. à Ugh, bring on the shin splints.” So here we are talking about shin splints, all because Mother Nature seems to want the Northeast in a blanket of white until July.

Training for a sport or working to get back in shape is hard enough, right? No matter the activity or goal, it takes conditioning of your lungs, muscles, and mental strength just to get to the point where you don’t feel like you’re going to die every time you head out for some exercise. Given all of that, it seems pretty unfair that some people have do deal with excruciating and debilitating pain in their shins as well. Now unfortunately, shin splints don’t discriminate. Most people associate this particular injury solely with runners, but in reality I’ve seen it sideline cyclists, basketball players, and neighborhood walkers alike. If you’re active, changing up your fitness routine (like going from running outside to on a treadmill), or starting fresh in the New Year, shin pain can creep up on you and stop you in your tracks. If you’ve experienced it before, you know exactly what I’m talking about. If you haven’t, you’re one of the lucky ones! Let’s talk about some of the causes of this nasty pain, and how to treat it.

How in the world do your itty bitty shins cause so much pain and discomfort? Well, there are a few ways, some soft tissue and some bony in nature. First of all, the ‘shin bone’, also known as the tibia, is actually pretty strong and much bigger than you might think. Reach down and find the sharp ridge of your shin running down the middle of your lower leg. Grab hold of it with your fingertips. Now let your thumb slide toward the inside of your leg until you no longer feel bone. You’ve basically got your tibia in a pincher grip that’s probably about an inch wide. This bone travels from the inside of your ankle up to your knee, widening at the top to meet the end of the thigh bone (femur) and form the knee joint. Not only does it make up part of the knee joint, allowing the lower leg to bend and extend, but it bears a lot of weight while standing, walking, running, etc. Lying along the outside of shin is the tibialis anterior muscle. This muscle travels from just below the outside of the knee, down along the shin until it crosses over the shin toward the inner ankle. It actually attaches itself to the bones of the first toe. When it contracts, this muscle works to lift the top of your foot towards your shin. Imagine it as the muscle responsible for allowing you to walk around on your heels. If you sit with a leg out in front of you and draw your toes/foot back toward you, you will probably see the muscle along your shin pop out. There it is! Another important job of the tibialis anterior is to support the arches of your feet. Now which parts have the ability to become injured?

Sometimes, pain in the shin can be caused by tiny stress fractures of the tibia. Usually caused by repeated trauma (lots of running, jumping, etc.) or an initiation of a new activity too quickly, these stress fractures happen over time. Now I don’t want you to sit there and imagine your shin bone broken into a million pieces. Instead, think of little hairline fractures probably not even perceptible on x-ray, but present enough to cause inflammation, pain, and slight weakening of the bone.

Another cause of pain in the shin comes from stress on the tibialis anterior muscle. Repetitive activities like running, walking, stair climbing, and jumping all require the muscle to work overtime. Just like any other muscle in the body, overuse can mean irritation, spasm, and inflammation resulting in pain. Further, if the arches of your feet have fallen and you over pronate, extra stress is placed on this muscle.

Sometimes improper biomechanics of the low back, pelvis, hips, knees, and ankles are to blame. If the joints in any of these areas are not moving properly, the surrounding muscles react. For example, maybe the joints of the pelvis aren’t moving smoothly, affecting the way you walk. A muscle like the Tensor Fasciae Latae that runs from the outside of the pelvis to the knee, tighten. Now both your hips and your knee are affected, putting strain on a muscle like the tibialis anterior and causing you pain. Think of it as this crazy biomechanical chain of events that can happen from the feet up, or spine down to change how you move and feel.

Lastly, some pain the in shin is caused by a more serious condition called compartment syndrome. While this isn’t considered true ‘shin splints’, the two conditions occasionally get confused. During chronic compartment syndrome, the pressure in muscles of lower leg (such as the tibialis anterior) increases, usually due to some sort of injury or overuse. Because the muscle is surrounded by an inflexible covering known as fascia, when injury-induced swelling occurs, there is little room for the muscle to expand. Instead, venous and lymphatic drainage is stunted and waste and extra fluid are not cleaned out of the muscle. Blood supply to the area remains and pressure grows. Eventually oxygen to the muscles is decreased and nearby nerves and muscles have a chance of being damaged. Swelling results and now you’re in the middle of a nasty cycle of injury to the muscles!

So what can we do short of requesting shin transplants to feel better? Just in case that option doesn’t exist let’s explore other treatments:

·      Rest: I know that suggesting rest to active, motivated individuals doesn’t always go over well, but sometimes it’s necessary! If you’re in a lot of pain during/after activity, consider taking a couple of weeks off. If you’re dealing with over-worked muscles, you should be able to see a bit of improvement in that time. Ease back into activity at that point, starting slow, to gauge how you feel and go from there. Stress fractures, however, won’t heal in two weeks.
·      Ice: As a natural anti-inflammatory, ice can help reduce inflammation caused by both stress fractures and irritated muscles. Try filling a Dixie cup ¾ full with water, and freezing it. You can then peel back part of the paper cup to expose the ice, and use it for an ice massage along the shin and muscles. 4-5min of icing, 20min rest, followed by another 4-5min of icing after activity may help. You may really dislike me for those 5minutes of freezing cold, but your shins won’t!
·      Cross-train: Your body likes diversity! If you’re a runner dealing with shin splints, try cross-training with cycling or running in the deep end of the pool. Anytime you subject your body to the same motions or actions repetitively, there’s a chance that it will get cranky. Switching things up can help you develop different muscles, and give overused muscles a break. You can even try training on different terrain. Try trail running if you’re used to pavement!
·      Stretch: Before you begin activity, warm-up! Sit with your legs out in front of you and start by drawing the alphabet with your toes/feet. Then gently point your toes, hold for 3s, and relax, repeating 10 times to stretch the tibialis anterior before use.
·      Orthotics: As we talked about, sometimes the arches of the feet are to blame. If you question the integrity of your arches or notice any foot pain along with your shin splints, question your chiropractor about getting some orthotics to put into your shoes. They work to put your feet back into biomechanically appropriate positions, and make the soft tissues and joints much more cooperative.
·      Graston: Ask your chiropractor about this technique. It uses lotion and a stainless steel tool to work through adhesions and scar tissue that may have developed in the covering of the tibialis anterior muscle. Any time adhesions and/or scar tissue develop there is potential for inflammation, restriction of movement, improper function, and spasm. Any of these things can contribute to your pain. Now, I’ll never try to pretend that this is the most comfortable or pleasant treatment on the planet. That being said, a patient recently told me that the work we did on his shins with Gaston saved his senior year basketball season. He told me that without it, he wouldn’t have been able to make it through the games. I’ve also seen it help treat triathletes, cyclists, and long distance runners. Pretty cool stuff….
·      Adjustments: You can always have your chiropractor assess your low back, pelvis, hips, knees, ankles, and feet for joints that aren’t moving well and need to be adjusted, and for muscle imbalances throwing off your biomechanics and in need of retraining. These things can all help relieve excess stress on the shins.
·      If you’re experiencing extreme pain that doesn’t improve with a couple weeks of rest, or extreme pressure in the lower legs with exercise, consult your doctor about the possibility of stress fractures or compartment syndrome. Again, these fractures probably won’t show up on x-ray, but it can’t hurt to check. Longer periods of rest will be necessary to heal in this case. If compartment syndrome is suspected, further testing can be done to confirm and if necessary surgery may be a treatment option.

Until next time, switch up your exercise routines or take some time to let your body rest. Meanwhile, try to embrace the snow. It may be around for a while….

Dr. Lauren Doscher