With
warmer temperatures we will notice an emergence of outdoor running
enthusiasts. Unfortunately for some, the
efforts towards a more regular fitness habit will be plagued by the development
of lower leg pain that may force a hiatus.
Lower leg pain experienced while running, but not exclusive to running,
is often broadly referred to as "shin splints"; however, there are a few
distinct conditions that you may experience in the lower leg (i.e. shin), each
having its own possible causative factors and relieving strategies.
True
shin splints are known as Medial Tibial Stress Syndrome (MTSS). The location of pain is the inner (medial)
border of your shin (tibia), typically over a broad area, and develops over
time. It is common in newbie runners or
when running volume is increased too rapidly without ample time for your body
to adapt. Hard running surfaces and hill
running are also potential aggravating factors.
Pain is initially felt after a run or the next morning as the tissues
start healing. Calf muscles which attach
along this edge can become irritated.
The bone itself is subjected to more stress as well and can be a
contributing source of discomfort. Over-pronating
or having a high arch with a more rigid foot often results in suboptimal
loading mechanics which may also play a role.
As such, it is important to wear shoes with the appropriate amount of
motion control for your feet and orthotics may be a consideration for some. Relative rest with cross training (i.e. doing
a different activity that doesn't cause pain), treatment to manage pain and
inflammation, and then a gradual resumption of running is usually successful in
managing this complaint.
If
the pain does persist despite treatment and appropriate rest, or it becomes
localized to a small area along the bone, a tibial stress fracture diagnosis
should be considered. Also, unlike MTSS,
symptoms may be better in the morning after a period of rest. X-rays often miss a stress fracture so a bone
scan may be necessary to find the "hot spot" where the fracture is
located. A prolonged period of rest,
which may still involve cross training, is necessary for the fracture to heal.
Another
area in the lower leg where runners may experience "shin splints" is
the upper, outer portion of the front of the shin. Pain here typically comes on during a run and
forces you to stop running, but then resolves quickly over time. This scenario is descriptive of Chronic Exertional
Compartment Syndrome (CECS). Muscles in
this part of the leg are surrounded by a dense, inelastic tissue called
fascia. With exercise, the muscles
become engorged with blood and expand in a confined space determined by the
fascia. If your body cannot clear the
extra fluid quickly enough the pressure in the tissues increases and results in
pain. This is not to be confused with the medical emergency of Acute Compartment
Syndrome where pressures increase due to bleeding as a result of a trauma and
are not relieved with rest. Gradually
progressing your running volume and/or adopting a more forefoot running style,
which uses the muscles in this area of the leg less, may be effective in
managing this condition.
So,
as you head out in the nice weather to be active, wear good shoes and progress
your activity level gradually. After
all, as with most healthy habits, the desired results are achieved only if the
change is regular and sustainable.
This
article is for general information purposes only and is not to be taken as
professional medical advice.
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