shin splints, shin splints exercises

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How to use your warm-ups to strengthen your shins
You can also incorporate the following shin-splint-preventing routines into the warm-ups which precede your regular workouts. The exercises develop shin-muscle strength and resilience as well as overall ankle coordination. Performing them before a training session transforms your warm-ups from humdrum routines into important strength-and-coordination sessions. Here's what to do:

1. Walk on your toes
a. Walk on tiptoe as high as possible with your toes pointed straight ahead for about 20m. Your legs should be relatively straight and your steps initially small;
b. Repeat with your toes pointed outwards. Your legs should rotate outwards from the hips when you perform this movement; don't simply turn each foot at the ankle - the whole leg must be involved;
c. Finally, repeat with your toes pointed inwards, rotating the entire leg in from the hip, not just the ankle;
d. Repeat each step at least once more before progressing to the next exercise.

2. Walk on your heels
a. Walk on your heels with your toes pointed straight ahead for about 20m, getting as high up on your heels as you possibly can. As above, keep your legs relatively straight and your steps small;
b. Repeat with toes pointed outwards then inwards, as with the previous exercise;
c. Repeat the whole sequence at least once more.

As the toe and heel walks become easy for you, graduate to doing the three variations of each exercise while jogging lightly, instead of walking, using a padded or grassy surface at first.

3. Skip for 20m
Landing in the mid-foot area with each contact with the ground, with toes pointed straight ahead. Repeat with toes pointed outwards, then again with toes pointed inwards. Repeat the whole sequence at least once more.

4. Skip high on your toes
For 20m, first with toes straight ahead, then pointed out, then pointed in.

Once the toe skipping exercises are comfortable, try some light skipping on your heels. Gradually build up your ability to heel-skip with toes straight ahead, pointed out, and pointed in for 20m at a time. Heel skipping is a great way to build dorsiflexor strength, but do it only on a padded or grassy surface to avoid impact injury to your heels.

5. Rhythm bounding
This doesn't mean leaping along with extra-long strides, at least not at first, but jogging along with very springy, short steps, landing on the mid-foot area with each contact and springing upwards after impact. As you rhythm bound, your ankles should act like coiled springs, compressing slightly as you make your mid-foot landing and then recoiling quickly - causing you to bound upward and forward.
a. Move along for 20m-or-so with these quick, little spring-like strides, alternating right and left feet as you would during running;
b. After 10-20m of regular jogging, rhythm bound for 20 more metres, alternating three consecutive spring-like contacts with the right foot with three with the left;
c. After 10-20 more metres of regular jogging, close the set by bounding along for the full 20m on your right foot only, followed by 20m on the left (making sure that you land on the mid-foot area with each ground contact and that your ankle area, not your knee or hip, is doing most of the work).
Make sure, at least at first, that all of this is done on a padded surface or soft grass. As you become stronger and more skilled, you can increase the length and height of each bound and include additional sets of bounds, up to a maximum of four.

6. Dorsiflexion bounces
Jump vertically 10 times at close to maximal height, landing in the mid-foot area with both feet and then springing upwards quickly after each contact with the ground. The interesting part of this exercise is that you should dorsiflex your ankles - pulling the tops of your feet toward your shins - on each ascent, plantarflexing your ankles just before making contact with the ground. Rest for 10 seconds or so, then repeat. Over time you can add additional sets and increase the number of reps to 30. When you are really strong and skilled, try this exercise on just one foot at a time.

7. Rhythm bouncing
Rhythm bouncing is actually just jumping around, but what jumping!
a. Start with 10 jumps on-the-spot, moderately fast, to a medium height and with maximal motion at the ankles, but little flexion and extension at the knees and hips. Over time, you can work up to 30 jumps;
b. After resting for a few seconds, reduce the height of your jumps to less than an inch and complete 20 as fast as possible, minimising impact time as if landing on hot coals! Again, almost all of the action should take place at your ankles, not at your knees and hips. As you become more skilled, work up to 40 quicksilver jumps without stopping;
c. After resting for a few seconds, complete five 'high-impact' jumps, reaching as high as possible. Over time, work up to 30 of these maxi-jumps;
d. Now make things interesting by jumping forwards and then backwards as quickly as possible, with a total of 20 ground contacts;
e. Rest for a few seconds, then jump from side to side for a further 20 contacts;
f. Rest again, then jump diagonally forwards, first to the right, then to the left, in zig-zag fashion for 20 contacts. Remember to use your ankle muscles to propel you, not the big muscles at the knees and hips.

As you gain in skill and strength, you can increase the number of sets of each type of rhythm bouncing from one to three, and then - the fun part - carry out each type of bouncing on one foot only. Moving in different directions as you bounce increases the ability of your shin muscles to handle all the forces created during running: the side-to-side and rotational stresses as well as the front and back forces.

Something has to give
Of course, carrying out these exercises doesn't mean that your risk of MTSS will drop to absolute zero. If you suddenly up your weekly training volume from four to six hours, something will have to give, and it might well be your shin muscles and tendons. So be careful to avoid dramatic changes in the frequency, volume, or intensity of your training; always progress gradually to more difficult levels of work.
Sports-medicine experts often recommend stretching the ankle area by slowly moving the ankle to each end of its range of motion in the straight-back and straight-ahead plane (ie fully dorsiflexed then fully plantarflexed), holding each position for anything from five to 60 seconds. The problem with that, of course, is that you are stretching the muscles in only one plane of motion and thus not adequately mirroring the actions of running. At the very least, you should also stretch each ankle by fully rotating it outwards and inwards and also by plantarflexing and dorsiflexing the ankle while the foot is pointed both outwards and inwards to various degrees, not just straight ahead.
The experts also recommend strengthening the ankle area by adding resistance to the above stretching movements by the use of surgical tubing or elastic bands. That is a good way to increase general strength in the ankle, and it will certainly make you stronger when you carry out surgical-tubing exercises in the future. The problem is, of course, that you run with your feet on the ground, not poised in the air in the clutches of elastic bands. To fully prepare your ankles and shins for the rigours of running, you're better off focusing on the specific exercises recommended in this article.
Does stretching actually help to prevent MTSS? There is no scientific evidence to prove this, but the idea is a logical one since over-taut muscles seem more likely to be damaged by pulling forces than relaxed fibres. Don't stretch your ankle area until after your muscles are warm and flexible, however; a good time would be after a thorough warm-up or even at the end of your training session.

What about other lower-leg injuries?
Of course, not all problems in the lower leg are due to MTSS. Two other conditions in particular can sometimes be confused with shin splints, namely compartment syndrome and tibial stress fractures.
Compartment syndrome is so called because the leg muscles are often grouped together into little sections or compartments, each enclosed by a tough wrapper of connective tissue. During the act of running, excess fluid can build up within one of these compartments, putting pressure on muscle fibres, nerve cells, and blood vessels - and also causing a great deal of pain. Frequently, the pain is severe enough to halt a workout or even a race. And it is usually accompanied by the two telltale symptoms of a compartment syndrome - numbness and weakness.
Numbness occurs because the excess pressure within a compartment hampers the activity of sensory nerves carrying messages to the brain. As a result, the runner with compartment syndrome may lose feeling in the 'web' of the foot - between the first and second toes - or higher up the foot, towards the ankle.
Weakness is a feature because motor nerves carrying impulses towards the muscles are also damaged by the high pressures within the compartment. If a compartment in the front of the leg is involved, a runner may have trouble dorsiflexing the ankle, and the foot may seem to flop loosely. In a posterior-compartment problem involving muscles in the back of the leg, there is often weakness when an individual tries to 'toe off'.
If you have a compartment syndrome, you will usually notice swelling in your lower leg which tends to subside when your leg is elevated. A doctor can diagnose the problem for certain by placing a catheter into one of your compartments and measuring pressure before, during and after running - usually to the point of pain.

And stress fractures?
These are small breakdowns in bony tissue, and tibial stress fractures, which are sometimes confused with MTSS, are the most common of all stress fractures in athletes, accounting for about 50% of the total. In addition to producing a lot of pain, stress fractures can actually develop into dislocation fractures, in which two parts of the bone actually separate. Stress fractures also may be 'warning signals' highlighting an underlying nutritional or hormonal problem.
Unfortunately, traditional X-rays often fail to detect stress fractures, so a more costly bone scan is often needed to confirm the diagnosis. With this procedure, radioactive material is actually injected into the blood; bony tissue which is remodelling and rebuilding itself at the site of a stress fracture will accumulate more of this infused radioisotope, causing the affected bony area to show up as a dark patch on a 'scintigram'. While it's often said that stress fractures take 2-3 months to heal, it can take up to six months to restore the bone to normal and remove most traces of pain, and a few athletes take more than a year to recover completely.
The discomfort associated with stress fractures, sometimes called 'crescendo pain', tends to build up steadily during running, starting as an irritant and developing into a throbbing torment as an athlete continues to run. There is usually little of the numbness, weakness, and swelling associated with compartment syndrome, and pain does not usually persist when an athlete is at rest. Often the bone will hurt when it is tapped near the damaged area, and sometimes a hard nodule appears on the surface of the bone at the site of the trouble.
If you're diagnosed with a stress fracture, you should be sure to have a nutritional analysis carried out, since your problem could be the result of inadequate calcium intake or poor calcium absorption. In addition, athletes who develop stress fractures should have their sex-hormone levels checked since adequate testosterone concentrations in males and oestrogen levels in females are required for optimal bone maintenance.

Telling one from the other
How can you differentiate MTSS from stress fractures and compartment syndromes? The pain of MTSS is usually less localised than that of stress fracture (tending to run up and down a region of the lower leg near the tibia) and usually can't be produced merely by tapping on the tibia. In addition, MTSS produces none of the numbness associated with compartment syndromes.
If you are unfortunate enough to come down with MTSS, your recovery period will usually last from one to six weeks, depending on how severely you are stricken. If you have a mild case (your shin hurts moderately, and only after workouts), you should immediately cut your training volume by about 30% and start doing the protective exercises recommended above. Start easily with only one set of each exercise, and stop if you feel any pain. Ice the affected area down thoroughly after activity, and of course keep the whole area as loose and flexible as possible. Within a week or two, you should be able to get back to your normal training, but be sure to carry on with the protective exercises.
If you have a somewhat tougher case of MTSS (mild pain crops up during workouts but doesn't seem to slow you down much), trim weekly training volume by around 50%, ice and stretch religiously, consider taking non-steroidal anti-inflammatory drugs (NSAIDS) - but only if you are not prone to the gastrointestinal upsets which have been linked with these compounds, and become a devotee of our shin-strengthening exercises (starting gradually since they can further inflame tender shins if overdone). Use cycling workouts to maintain fitness, and in 2-3 weeks, you should be ready for regular training.
If your MTSS produces sharp pain while you are training, stop all workouts, ice and stretch, take NSAIDS as directed by your doctor and - when pain subsides - begin using our exercises systematically, starting with a few two-legged wall shin raises at first and gradually progressing to the others. Use an exercise bike to maintain fitness, and return to normal training in 4-6 weeks.
Remember that if you carry out our shin-splint routine several times a week and refrain from making bizarre and sudden changes in your training, your encounters with MTSS should drop to a very low rate. Best of all, however, you will have unbelievably strong shin muscles, and as a result you will run much more quietly - and of course much more quickly, too!

Owen Anderson

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