I went running the other day and my shin started hurting and I don’t really know what to do. So I went to the internet to hopefully try to find a solution to this problem. This is a really common statement that runners will make, “I went for a run and my leg hurt and now I’m at these crossroads of what to do.”
Now, when we start to have some shin pain, one of the things that we need to figure out is what is the tissue that is giving us pushback?
Let’s go back to high school anatomy. Now, if we look at all the things that exists from our knee down, we see that there’s a lot of stuff. We have muscles, we have tendons, we have fascia, arteries, veins, bones. There’s a lot of stuff. I want to specifically hone in on the bone and the muscle and how these two tissues work together.
Our bones provide a sturdy structure for our muscles to work and our muscles help slow our foot down every time it hits the ground. So they have to work a lot when we’re running. If we look along the inside of our shin bone, we see that there’s a group of muscles that blend into that area and their main job is to slow our foot down every time our foot contacts the ground when we run. They have to work a lot. For most people, when they’re experiencing shin pain, if they’re only experiencing pain, that’s most likely what we’re dealing with. This typically gets referred to as shin splints or medial tibial stress syndrome. Those are fancy words for saying my leg hurts. It’s important that we figure out what tissue is involved, because if it’s the bone, we probably have to stop running. If it’s the muscle, there’s a good chance that we can continue to train, maybe with some modifications.
One of the first tests that someone will do is they will palpate the area that hurts. Does this hurt? Does this hurt? Does this hurt? And what they’re trying to figure out is if it’s the bone or the muscle that’s involved. If it hurts for me to palpate or touch the bone versus the muscle, a lot of people think that’s going to give us information that’s helpful. And while palpation can be something that we use, it’s not great. I’ve had lots of runners that come in that have palpable tenderness over their shin, their bone, and they don’t have a bone stress injury. I’ve had lots of runners that have palpable tenderness on the muscle and not the bone, and they ended up having a bone stress injury. So we can use that as a very small part of how we figure out how to handle these situations, but it’s not definitive if someone is tender over one spot versus the other.
Now, if the bone is what’s involved, normally that’s going to continue to worsen and as we run. It doesn’t get better with activity. This is the opposite of what we see with muscles. Often if the muscle is what’s involved, we’re going to be able to warm up a little bit. Maybe it hurts at the start of my run, but over time my feet get under me and then I’m feeling okay after that.
The second thing that we have to look at is what is the location of the person’s symptoms? If that person’s symptoms are very focal in nature, the symptoms are five centimeters or less in length, there’s a higher chance that that’s the bone that’s involved. If the symptoms are of a greater length, if they’re above five centimeters, if I can press on the muscles on the inside of my shin and it’s painful for bigger than five centimeters, there’s a higher likelihood that it’s the muscle that we’re dealing with.
And the last thing is if it’s bilateral in nature. So if we’re experiencing pain that’s only on one side versus pain that’s on two sides, there’s a higher chance that it’s the bone. So if someone is having focal pain that’s present in a very specific spot that worsens with things like running, standing, and other weight bearing activities, there’s a higher likelihood that this is the bone that we’re dealing with. If someone’s symptoms warm up with activity, they’re broader in location and they’re present on both sides, there’s a higher likelihood that this is the muscle that’s involved. So we’re pretty confident that it’s the muscle that we’re dealing with. What do we do?
One of the things that we often want to do is improving the strength and endurance of the muscles along the inside of the shin. The first drill is the lateral toe tap. You’re going to stand on one leg. You’re going to focus on keeping your shoulder, your hip, your knee, and your foot perfectly stacked on top of each other. And then you’re going to extend your left leg out to the side, while you maintain those four points of contact. For most people, they’re going to feel this in the outside of their hip that they’re standing on, but we’re also focusing on maintaining that foot position, the knee position. And by doing that, we’re forcing those tissues to hold that position and get a little bit stronger.
The second exercise we’re going to go through is called a squat clock. You’re going to squat and reach in four different directions, focusing on not gripping your toes or losing one of those points in that perfectly vertical system as you go through a bunch of repetitions and get tired. This forces your foot ankle and all the muscles on the inside of your shin to be able to control those positions as you get tired.
The third exercise I want you to focus on is called the hip airplane. You’re going to stand on one leg. You’re going to hinge forward at the hips. And then in a slow and controlled manner, you’re going to rotate up to the ceiling and then slowly come back down. You should feel this on the inside of your shin or on the outside of your hip.
The last thing we’re going to go through as a calf raise. The calf muscle has a really important role in running and that it helps us create a lot of stiffness, control our impact, and propel us forward as we’re going. Having good strength there is important, and because the calf ties into that shinbone that we talked about, it plays a role with all these other muscles. Place one foot up onto an object. We’re going to place a decent amount of load in both hands. And then we’re going to focus on getting as tall as possible while maintaining our knee in a straight, not fully locked out position, as we go up and down through each repetition.
Thanks so much for watching. I hope you found this helpful. Make sure to like, subscribe, and comment with any questions below, and have a great rest of your day.