Shin Splints Back In 1415!

R shin(top) shows obvious wear

I had a runner who came to see me this week. She had recently done a marathon in Australia and recently got back to training again after a break. She said she had been asking a fellow runner with shin pain to come see me. This friend of hers had been suffering from shin splints for the past six months!

Just in case you thought that was long. I saw an article that showed a case of documented shin splints from way back in the year 1415. Yes, you read correctly, it's 1415.

Researchers found a skeleton from a graveyard in Greece that showed medial tibial stress syndrome (or shin splints). They estimated that the man died between 500-800 years ago and was between 20-30 years old.

The researchers mentioned that shin splints are commonly thought to be an exercised induced injury. and that shin splints are most common in new runners.

Osteoarthritis in the ankle

The skeleton also showed signs of osteoarthritis in the ankle joint (which is rare); this suggest that the man probably engaged in some repetitive loading of his lower limbs. An indication that perhaps even in those days they participated in running as well.


Reference

Protopapa AS, Vladchadis N et al (2014). Medial Tibial Stress Syndrome: A Skeleton From Medieval Rhodes Demonstrates The Appearance Of The Bone Surface- A Case Report. Acta Ortho 85(5): 543-544. DOI: 10.3109/1753674.2014.942587.

Shin Splints Most Common In New Runners

Picture by Anne Sophie from Flickr

Latest published  research indicates that shin pain is the most common complaint among new runners. Shin splints or stress fractures is also our most popular article in this blog with over 200 comments and counting.

The researchers studied 933 new runners for a year to see how many were injured, what injuries they had and how long it took before they resumed running. They were considered new runners if they haven't run more than 10 kilometres the previous year. The runners were considered injured if they had running induced pain in their legs or lower back that prevented them from training (distance, duration, pace or frequency) for at least a week.

254 runners were injured during their first year of running. 15% of this injured runners had medial tibial stress syndrome (or shin splints), 10% had knee pain, 7% injured their Achilles tendons while 5% hurt their plantar fascia or soleus (deep calf muscle).

Stress fractures were relatively rare, probably because the new runners' mileage in their first year were not high enough. 75% of the injuries happened during the runner's first 201 kilometres.

Time to heal varied widely amongst the injured runners.Those who hurt their calf resumed training after 30 to 40 days, while those with shin pain took an average of 72 days to fully recover. The worst were those who had plantar fasciitis, it took an average of 159 days to recover.

Majority of the 254 injured runners recovered fully (220) by the end of the year long study. Only 34 remained injured.

The researchers concluded that their findings emphasized the importance of the need for new runners to be mindful of shin splints as it is most common injury in their study. Even among recreational and elite runners, shin splints was the most common injury with an incidence of 13-20% (Lopes et al 2012).

Wanna run pain free? Have a read here.

References

Lopes AD, Hespanhol Junior LC et al (2012). What Are The Main Running-related Musculoskeletal Injuries? A Systematic Review. Sports Med 42: 891-905.

Nielsen RO et al (2014). A Prosepective Study On Time To Recovery In 254 Injured Novice Runners. PLOS One. DOI: 10.1371/journal.pone.099877.

Even Kobe has shin pain. (Picture from Flickr)

Running Injuries Linked To Your Footstrike

Photo by Jordan Shakeshaft from flickr

I wrote earlier that the minimalist/ barefoot inspired type running shoes sales were declining, however researchers seem to be very keen on finding how they affect running still. To put it simply, researchers are very interested to find out if barefoot running, minimalist shoes or how you land (forefoot, mid or rear) can reduce injuries.

A group of South African researchers specifically studied how barefoot running (or forefoot striking) affects five common running injuries.

Bear in mind that many researchers and runners alike tend to assume "barefoot running" and running with forefoot/ midfoot strike as similar although some studies have shown differences.

Well, here are the main points on the five common running injuries. Regarding shin splints/ tibial stress fractures injuries are decreased by barefoot running although runners have to be extra careful with transition time from their previous more cushioned shoes.

Increased incidences of metatarsal (or your foot) stress fractures with barefoot running. I've seen some of our patients with metatarsal fractures after switching to Vibram Five Fingers.

As I've written earlier before, good news if you have knee pain as it may be reduced by barefoot running, but not so good news if you have Achilles tendon injuries as it may be increased with barefoot running.

For those of you with plantar fasciitis, barefoot running can reduce this if you gradually and correctly transition from your cushioned running shoes.

Well, as you can see, nothing is foolproof yet with barefoot running. What the researchers were sure was that bad training practices like training too much too soon, running too fast and hard are the major causes of running injuries. And my favourite, they mentioned that good (i.e. correct) running technique may be more important than shoe selection.

Reference
Tam N, Wilson JLA, Noakes TD and Tucker R. (2013). Barefoot Running: An Evaluation Of Current Hypothesis, Future Research And Clinical Applications. BJSM. doi:10.1136/bjsports-2013-092404.

Comparing Running Barefoot Versus Nike Free, Lunaracer And Own Running Shoes

Nike Free 3.0

This recently published article in the British Journal of Sports Medicine caught my eye as it compared highly trained runners running in four conditions namely, barefoot, running in a Nike Free 3.0, Nike Lunaracer 2 and their own running shoe. Well, good news if you have knee pain, but not so good news if you have ankle, foot, Achilles or calf pain.

22 highly trained, high-level runners (average 10km time of 33 mins) were chosen by the researchers. Each were given a pair each of Nike Free 3.0, Nike Lunaracer 2 and they had 10 days to run in them and barefoot to get used to them. In addition they also ran in their regular running shoes (on average 125-140 g heavier than the 2 Nike shoes given).

The runners were filmed and their running gait measured using 8 force plates. After a warm up, they did 10 running trials in each of the four conditions (running barefoot, Free, Lunaracer, own running shoe). Their average speed was fast, at 4.48 m/s (or 6 min miles).

And the results? Well, the study showed that running barefoot ia a lot different than running in shoes, but the different shoes did not differ much.

One real difference though was that the runners tended to have a shorter, quicker stride in the Nike Frees and Lunaracers compared to their own regular shoes (average cadence of 183.9 steps/ min versus 181.3).

Key differences between barefoot running versus running in shoes were numerous. Barefoot running elicited a shorter stride length than all shod conditions. There was also higher cadence than all shod conditions (average 187.7 steps/ min). Flatter foot placement at contact and greater ankle plantarflexion at toe off were also observed.

There were also less work done at the knee (24% less when barefoot compared to own running shoe). There was greater joint movements and more work done at the ankle though.

The authors summarized by adding that knee and ankle mechanics were different when running barefoot compared to all shod conditions, including minimalist shoes. Meaning that the minimalist shoe cannot entirely replicate the mechanics of running barefoot.

What does this all mean for you, the runner? Well, this article confirms that running barefoot mechanics are different compared to running in a well cushioned shoe. Running barefoot tends to reduce work done in your knees, but increase work done in your ankles.This means that barefoot running will help those with knee pain but may stress your foot, calf, Achilles and ankle more. So good for those with knee pain but not so great for those with ankle, calf, foot, Achilles pain.

The researchers also acknowledged that the Nike Free may not be really considered a minimalist shoe (given its elevated heel and cushioning available). Wearing a more "minimalist" shoe like the Vibram Five Fingers may be closer at replicating barefoot running although even ultra minimal running shoes will not be be a perfect replication to running without footwear.

Lesson here is that wearing minimalist shoes may not instantly replicate barefoot running. I personally feel your running form is more important. Please also see this and this.

Email me if you want a copy of the article.

Reference

Bonacci A, Saunders PU et al (2013). Running In A Minimalist And Lightweight Shoe Ia Not The Same As Running Barefoot: A Biomechanical Study. BJSM. 47: p 387-392.

*Picture from Nike.com

Shin Splints Or Stress Fracture?

I've seen quite a few of my patients recently with shin pain so I thought I'd write about it. This condition can usually be caused by any activity that involves running, jumping or even extended periods of walking. Patients usually present with pain at the beginning of exercise. During the initial phase, the pain may disappear during the warmup or after 15-20 minutes of exercise, but returns for several hours after exercise. In the more severe cases, pain is usually present during training and aggravated during daily activities like walking, squatting or climbing stairs. There is often pain at rest as well. The pain is often described as a dull, aching discomfort of varying degrees of intensity.

Left untreated, it can progress to a stress fracture in your tibia (or shin bone). Which is exactly what happened to one of my patients.

The picture shown above is the x-ray of my patient's stress fracture. The arrow depicts the callus formation of thickening of the bone indicating a stress reaction in the bone. Usually a bone scan is needed to detect a stress fracture as an x-ray only picks up the callus formation (about a month later) as the bone is healing.

The term "shin splints" refers to pain along your tibia and this is usually caused by too much pulling of your muscles along their attachments along the bone. Research has shown that it is usually the tibialis posterior and soleus muscles that causes this condition. With repeated pulling (or stress), this causes the shin bone to be irritated and pain results. That is why this condition is also known as medial tibial stress syndrome. Milder cases are treated fairly easily. Most physiotherapists will ask their patients to rest, ice the painful area, change footwear and modify your training routine to prevent shin splints from recurring. The cause of your pain should be addressed rather than just treating the shin pain alone.

Most of the time shin splints occur from overuse. It is commonly seen in athletes who suddenly increase their duration or exercise intensity of training. Overpronation is often listed as one of the common causes of shin splints. Now if you've been following our blog article Pain Free Running or running with the Physio or Sports Solutions team, then you will be happy to know that you can run pain free and even avoid getting shin splints. Our athletes with shin splints or stress fractures often do their rehabilitation in the pool as well to maintain their fitness.

I have had stress fractures in both legs before, early in my racing days, when I was just competing in track and field events. This was before I started competing in triathlons of course. I know exactly how frustrating it can be not being able to run. Will be most willing to help if you need any advice on this.

Please read this for more on shin splints.

Reference

Thacker SB, Gilchrist J, Stroup DF and Kimsey CD (2002): The prevention of shin splints in sports: a systematic review of literature. Medicine and Science in Sports and Exercise 34: 32-40.