Year: 2019

background:

We would like today in the preventive area on a typical runner problem (but also at Gymnastic trainers, Dancers or other running / jumping intensive Movement sequences) to draw attention, with which we have already gained experience to have, especially in the more intensive training preparation for the Marathon / half marathon. It's about the so-called Shin splints respectively. in English Shin splints. The specialist literature describes the symptoms as “Medial Tibial Stress Syndrome” (MTSS).

Pain on the inside of the shin at the beginning of the running training is typical, mostly at the level of the middle of the shin. The pain from personal experience was approx. 10 cm above the ankle directly on the inside of the shin bone. In general, the pain can also run from the ankle to the knee. The longer the shin splints lasts, the longer the pain phases are.
Runners in particular are at risk, who overpronate when rolling. Overpronation is understood to be excessive pronation. In other words, the foot tilts excessively inward during the rolling movement, so that with overpronation a rotation of the foot around its longitudinal axis with the outer one (lateral) The edge of the foot is raised and at the same time the inner one (media) The edge of the foot is lowered. Pronation is the natural cushioning movement of the foot and supination is the opposite movement to overpronation. Shin splints are less common due to excessive supination in the forefoot (when the little toes are pushed off). Here the toe flexor muscle is overloaded and irritates the periosteum of the shin.

root cause:

At the Shin splint syndrome leads to irritation of the muscles (before especially the tibialis posterior and the soleus muscle) through overuse. The tibialis posterior muscle is very important for the tension of the Arch of the foot. There is even the possibility of a fatigue fracture if the Pain to be passed over. The pain occurs, because the beginning of the muscles is overexcited on the skin of the legs (= Tendon attachment tendintis). Through this Inflammatory stimuli can often harden muscle cells (z.B. Calf muscles) and Form myofascial trigger points, the local pain, but also can trigger radiating pain (z.B. Achilles tendon, heel, Knee joint).

Risk factors can increase the likelihood of MTSS:

• X-leg(-drift)/ If one
• Arched-flat foot
• externally rotated hydrograph
• weak foot- and leg muscles
• too hard surfaces
• severe muscular fatigue
• passive running style
• wrong running shoes or insoles
• Increased BMI and greater external hip rotation (Winkelmann, Anderson, Games, & Eberman, 2016).
• Excessive strain or overuse without sufficient recovery time

It should also be considered, that various factors cumulatively have a greater influence e.g.. increased BMI and a Foot deformity.

therapy:

First of all, stop training immediately in the event of acute pain and allow the aching shins to relax, even if it is often difficult. Especially with a training plan, that you have created for a competition preparation. We know this from our own experience, But to compete in a running competition with these complaints does not make much sense and, despite ambition, certainly does not improve the target time. It is also important, getting the inflammation out of the body. In addition recommends bSMART a good physiotherapists or sports medicine specialists to seek out. Even cooling using ice packs can reduce the pain / inflammation (several times a day for acute pain).

Further it would make sense to clarify, whether. there is a foot malposition e.g.. using a Laufanalyse or through a physiotherapist. We also recommend a for less acute complaints corresponding Warm-up Programm including the use of a Fascia roll, to put less strain on the muscles and to tighten them stretch. Here is a video, these exercises helped us preventively in preparation:

In addition As a preventive measure, it would be advisable to strengthen the muscles if there are no complaints are present. Here is an example video:

Many therapeutic options have not yet been clearly scientifically proven, that actually help with MTSS. For example, there were no treatment effects with "low-energy laser treatment", Dehn- and strengthening exercises, Sport compression stockings, Leg bandages and electromagnetic impulses were detected. Some studies suggest, that iontophoresis, Ultrasonic, Periosteum pecking and extracorporeal shock wave therapy should be effective, but none of the studies is free from methodological weaknesses (Winters et al., 2013). Our tips relate in particular to your own experiences.

…be SMART for pain, Care is important!

More bSMART TIPS: Use training break and adjust training plan, Browse through flow analysis, Running style and check running shoes. A kinesio tape could also help us run a marathon provide good preventative support. Walking barefoot on grass is usually. pleasant and man can also observe the running style and the foot position better. Possibly. to others Avoid endurance sports, if possible, z.B. swim, Ergometer or To go biking, Generally speaking, prevention is better than therapy.

credentials:

Winkelmann, WITH. K., Anderson, D., Games, K. E., & Eberman, L. E. (2016). Risk Factors for Medial Tibial Stress Syndrome in Active Individuals: An Evidence-Based Review. Journal of Athletic Training, 51(12), 1049–1052. https://doi.org/10.4085/1062-6050-51.12.13

Winters, M., Eskes, M., Weir, A., Moen, M. H., backx, F. J. G., & Bakker, E. W. P. (2013). Treatment of Medial Tibial Stress Syndrome: A Systematic Review. Sports Medicine, 43(12), 1315–1333. https://doi.org/10.1007/s40279-013-0087-0