Shin Splints

“Shin splints” is a catch-all term for exercise induced lower leg pain. You may have noticed shin pain after WODs with a lot of jumping or running. Initially, the pain alleviates when you stop activity, but as time goes on it becomes continuous and your lower leg may become swollen.

What’s going on in there?
The lower leg has compartments that house muscle, nerves, and blood vessels. The muscles of the lower leg fatigue with high impact activity and then the shock absorbing effect of the muscle diminishes. The stress then gets transmitted directly to the bone and the forces start to overload the normal stresses the lower leg can absorb. The body then reacts by trying to heal the bone with inflammatory tissue or healing tissue. If this cycle continues one can then develop a stress fracture.

Structure vs. Function
There are two major contributors to you getting shin splints: the way your joints are aligned (structure) and the way you move (function). Current research is ambiguous, but suggests those who hyperpronate  (those with flat feet) are predisposed to shin splints. So are those with tight calves. Since everything is connected, it’s important to look up the kinetic chain to see if the knees cave in (genu valgum) or bow out (genu varum). Additionally, if you’re a heel strike runner or have poor pelvic stability and control you aren’t doing your shins any favors.

What can I do?
Categorize yourself with the statement that you most closely relate and read on for tips that align the severity of your pain with steps you can take to manage your shin splints.

If your shin splints have progressed to continuous, point tender pain, you could have a stress fracture. Speak with your medical provider to see if imaging or physical therapy is appropriate for you.  Here is a bone scan and MRI showing what a stress fracture looks like. They light up like a Christmas tree and are signs of bone swelling and edema.

shin-stress-fracture

shin-stress-fracture-2

If you have intermittent pain, you may be caught in a cycle of chronic, subacute inflammation. Keep in mind, some combination of structure and function is contributing to your pain. There are a number of steps you can take to manage flare ups before getting to the root of your specific contributors.

Ice massage is a way to apply cryotherapy to an isolated area. There are commercially available ice ups (as seen here à), but it’s easy enough to make one yourself. Freeze a half full Dixie cup, peel away the base and push the ice through as it melts.  Apply to the affected area for 5-10 minutes at a time.

Old shoes? Replace them. You may also wish to utilize supportive or cushioned insoles to help ease your pain. The structure of your foot (flat feet) can be a contributor to your shin splints, so keep that in mind when choosing the proper footwear.

Compression sleeves may help reduce or keep swelling at bay.

Stretch/mobilize all the muscles of the leg. Remember, tight calves can contribute to shin splints. Coincidentally, ankle mobility plays a large part in the Olympic lifts.  So why aren’t you working on it right now? Check out Mobility WOD Episode 270.

Scale or modify your movements. High rep box jumps, double unders, and running may not be the best choices if you’re experiencing shin pain. Try rowing or burpees (provided they are pain free) if you’re aiming for a similar cardiovascular response.

Lucky for you, you’re pain free. This is the ideal time to address some of the biomechanical reasons for your history with shin splints. Let’s start from the ground up. The way your foot interfaces with the ground determines how the muscles are going to react. Everyone should pronate when they walk. However, hyperpronation is when the entire instep of your foot (longitudinal arch) is in contact with the ground throughout your stride. This puts undue eccentric stress on the muscles that allow you to dorsiflex. Those muscles just so happen to run along your shin. Throw in a ton of heel strikes, sending ground reaction forces through the tibia and surrounding tissue and it’s no wonder you get shin splints.

Moving further up the kinetic chain, your hips and pelvis control how you position your leg before your foot hits the ground. If you aren’t engaging the muscles that create proper alignment, your lackadaisical movement just forced your leg muscles to work overtime, resulting in inflammation.

Thankfully, you control the way you move.

Take video of yourself in an activity that would usually exacerbate pain (ex. running) from the front and the side. If you have a smart phone, try an app like Ubersense that allows you to see yourself in slow motion. Share it with your coaches and seek feedback.

Do you heel strike? Try the mid-foot landing of Pose running. It likely won’t come naturally and your leg muscles will probably fatigue quickly at first, but endurance will come with time and practice.

Do your knees cave in? Work on activating your glutes more by keying in to the external rotation you create when coming out of the bottom of a squat. The movement won’t be as explosive, but learning to maintain that position, keeping your toes and knee pointed forward, will ease excess joint reaction forces.

Are your movements unintentional, or sloppy? Read up and try some of the running techniques endorsed by the CrossFit Journal found here. Box jumps seem innocuous enough because everyone can jump onto a box, but they are a highly technical movement that can get downright ugly with fatigue. Check out this video about proper box jump positioning to avoid injury and increase efficiency. As in most 321GoMD posts, start with a comfortable height and gradually build up your endurance and jumping to higher levels once your technique has been perfected. Shin splints are avoidable, we don’t want to see you with crutches or splints.

 

Written By Liz Caruso

1 Comment

  1. Great article. I noticed with certain shoes I could avoid shin splints pretty well. But other years my team gave me the wrong type and I had them the entire season. Exercise equipment help too on certain things. Here’s a few for the shin splint sufferers. http://www.shinsplintsclinic.com/shin-splints-equipment/

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About Me

Dr. Sean Rockett is an Orthopedic Surgeon specializing in Sports Medicine. His group is Orthopedics New England with offices in Dedham, Natick and Newton, Massachusetts. Dr. Rockett is a CrossFit Level 1 Trainer and has been a CrossFitter at CrossFit New England since 2007. Dr. Rockett is on the Medical Team for the CrossFit Games and the Northeast Regionals.

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