Shin Splints – ICD-9 844.9
Shin Splints – Self Help Tips, Treatment and Prevention From The Barefoot Running Doctor at Team Doctors
Tips For Better Health
Ask the doctor, Dr James Stoxen DC
In this article is everything you ever wanted to know about shin splints and more!
Shin Splits ICD-9 844.9 are one of the most common causes of overuse leg injuries are also known as medial tibial stress syndrome (MTSS), soleus syndrome, tibial stress syndrome, periostitis, exercise induced leg pain and chronic exertional compartment syndrome. (1)
Some say shinsplints when it is really shin splints. I have even seen it spelled chin splints which should be reserved for boxing. ha ha
What are shin splints?
People come in with sore shins or pain in the shins, which is described as pain along the inner (medial) edge of the shin bone of the leg. Some complain of shin pain, inner (medial) calf and shin pain.
Shin splints are achy pain areas that occur with during or after over exertion or exercise and are aggravated by sticking your thumb into the shin bone and pressing down.
The symptoms of shin splints are not like that of the shin injuries you get from getting kicked in the shin.
Shin splints or the medical term, medial tibial pain that’s why they call it tibial medial stress syndrome because there is too much medial tibial stress.
Aren’t Shin Splints Only For Athletes? No!
When I tell patients this pain in the front lower leg is shin splints they ask me what is a shin splint? The say, “I thought you only get shin splints from running.”
Most think shin splints are more common in sports like track and field, distance running, basketball, soccer and dance (2) because of the repetitive high intensity training.
I have worked with the cast and crew from ‘Dancing With the Stars’, ‘So You Think You Can Dance’, Broadway national tours, track and field events and soccer teams. Many think it’s primarily a running injury because many get shin splints while running, or pain in the tibia after running.
More non athlete, everyday people have shin splints than athletes?
The problem is that not many doctors routinely screen for shin splints.
I screen every patient!
Most don’t know they have them, as they are not painful until you press down on the bone, then the pain is severe.
For some people simple standing or basic walking is stressful enough on the shin area to cause shin splints. If they walked without their cushioned shoes for a while, with sandals all summer or ran a block or two even with cushioned shoes, that would be enough stress to cause the shin splints to fill up with more inflammation fast, and hurt.
Many people have shin splints but the inflammation is not high enough to cause pain until you press down on the shin. That is how you screen for shin splints.
How do you get shin splints? What causes shin splints?
The medial tibial pain is caused by stress and strain in the area, that leads to the release of inflammation and when the inflammation gets high enough you feel pain.
Although the pathology of shin splints is understood the development or causes of shin splints are less agreed upon.
Why?
Because doctors cannot agree on the cause of shin splints it makes it difficult for physicians to diagnose and treat this common injury.
I explain why in this post…
If you are looking for a magic cure for shin splints there is not one single remedy.
That is because there are many causes of shin splints and to get rid of shin splints you MUST determine the cause or you are wasting your time with therapies.
Does the body move as a lever (them), a spring (Dr Stoxen) or both (Dr Stoxen)?
There are two schools of thought with respect to bio-mechanics and the causes of impact related injuries like plantar fasciitis, shin splints and other injuries.
There is the school of thought that the body moves through a series of levers.
Then there is the model I developed, the Human Spring Model which says the body moves, recycles energy and protects itself as a giant integrated spring mechanism.
This article will explain the differences in approach of the human spring and human lever model.
Many “lever model only” thinkers believe impacts will injure the body.
That is why they recommend cushioned shoes for all running activities.
First, I will agree with the human lever model school of thought that the abnormal impact stress is what leads to shin splints.
The key word is “abnormal” impact stress.
Normal impact stress is good for the body. We adapt to it and that is how we get stronger.
In fact, elite athletes and even athletes in grade schools now do high impact training to bolster explosive power by conditioning the body to react elastically.
They call it plyometrics and its employed at every training center in the world from the Olympic training center and currently the grade schools. I learned the principles of plyometrics from the father of modern plyometrics, Yuri Verkhoshansky, at the Central Institute of Physical Culture and Sports Sciences, in Moscow, USSR, in 1989, when I was 27 years old. Read the story here
Why have we been brainwashed into thinking impacts are bad for us and paying huge dollars for impact resistant soles for running shoes, orthotics, gel inserts etc?
If these impact resistant soles are required to protect you from impacts then how would you explain why this 50 year old doctor who stands on his feet all day then at night and on the weekends, runs barefoot on solid concrete or asphalt for 6200 impacts (6.2 miles 10 K) of 560 pounds per impact routinely with no shin splints?
To understand why I run barefoot read this article, click here
In fact, I run barefoot on hard surfaces to strengthen my human spring mechanism to be more capable of handling greater impact forces safely, resist aging and prepare my body for my later years.
Human spring model thinkers believe impacts strengthen the body.
In reality, impacts strengthen the spring as long as the spring is intact and can handle the force of the impact.
That is why top athletes do plyometrics or impact training to prepare for elite sports.
You would think that doctors are the ones we should trust when we are looking for advice on this, however we also have to think of what perspective they have when dishing out this advice.
If someone is running pain free, would they go to a bone doctor?
Of course not.
Few doctors examine joints that don’t hurt.
Most lever model doctors only examine the part that hurts.
Even fewer examine the normal joints of elite athletes.
Most doctors ONLY see injured patients.
When patients get injured the brain responds by stiffening up the area with spasms. So injured patients that see doctors have stiff or locked springs that have turned into levers.
They think everyone ambulates as a lever because all they see are levers. Few ever examine babies or top athletes so they don’t understand how patients (lever mechanisms) can absorb impacts without permanent damage.
Dont blame them. They just dont understand human spring. Help them by emailing them this article.
How do doctors who understand your body as a lever system examine and treat you for shin splints?
What causes the abnormal stress that developed the shin splints?
This is the key to eliminating them!
The reason why you have stress on your shin muscles and shin bone causing shin splints and stress fractures is because there is too much stress there.
Can we agree to that profound statement?
Over Pronation & Over Supination
One of the most significant factors leading up to stress fractures doctors should look for is the over rolling of the heel outside the safe range between rolling from the outside (supination) to the inside (pronation) when you are walking or standing. (21)
Why can some people walk, run and even run barefoot on solid concrete for miles without developing abnormal damaging stress in the shins and others cannot?
Its because whatever reduces impact forces that cause abnormal stress isn’t doing its job.
Safe and Unsafe Range
The mechanism that absorbs this stress to keep it from reaching your shin bone and other tissues is the human spring mechanism. One way you can get abnormal stress on your shin bone is when the heel bone rolls outside the safe range between rolling from the outside (supination) to the inside (pronation) on landing when you are standing, walking or running. (5)
They say this causes too much stress on your shins and other places. I agree with this!
The problem is that they cannot seem to argue on what causes the over rolling. If you don’t believe me jump into a professional forum with the subject of the cause of over pronation/supination and listen to them argue with each other. Yet, this problem is one of the must common causes of the majority of lower body pain conditions.
Since they cannot come to an agreement on what causes the over rolling, most of them just give you orthotics. Doesn’t it seem like the arch support-orthotic would actually inhibit the spring loading shock absorption you need to resist the impact force safely into the arch of your foot that would protect your shins from stress?
For more information, read this article I wrote: What Is Foot Pronation And Foot Supination? Is It Good Or Bad?
Orthotics vs. Natural Spring Down Motion
Since they believe in the lever model they cannot see how the body resists impacts as a giant spring, the spring model so they a shoe with an inch thick cushion.
How can a lever resist impacts without a cushion? Its impossible.
In reality your body has a natural spring mechanism which absorbs the impacts!
So, you walk out of the 15-minute office visit with $500.oo worth of shims that prop up your arch, a leather or rubber device that binds your natural spring mechanism that has an artificial spring-cushion mechanism that makes up for the natural one they took away.
A lot of you buy into this approach because it seems like it makes sense.
Why do a lot of people who wear cushioned shoes all day long, get shin splints?
Maybe if we strap pillows to our feet they would be even more protected!
Let me explain why this does not make sense.
What science has found is that surfaces that are too soft can actually weaken us.
Many people don’t have a lot of faith in their own bodies to protect itself.
Instead of restoring the spring in your step you had as a child that allowed you to run around barefoot its better to bind your natural spring and use this artificial one designed by the shoe company!
How does a 50-year old doctor who stands on his feet 10 – 15 hours a day and I run on the solid concrete street completely barefoot (no “barefoot” shoes), with no shin splints.
I don’t own a single pair of running shoes!
I’ve challenged this lever mechanism vs spring mechanism theory to 50,000 doctors and scientists speaking at medical conferences in Tokyo, Monte Carlo, Hangzhou, Guangzhou, Beijing, Kuala Lumpur, Frankfurt, Dusseldorf, London, Cambridge, Sao Paulo, Bogota, Mexico City, Capetown and others.
In fact, the most recent scientific presentation I did, Walk and Run For Life! Through Lever Mechanisms or Spring Mechanisms? in Shanghai was selected by the China government to be broadcast live on the governments official news portal, the China Peoples Daily. Enough doctors and scientists have heard the science and yet no one has refuted the new model.
Can levers spring you back from the 250,000,000 collisions you have with the earth over a lifetime? No way!
For more information on why your body is a spring mechanism read these articles;
Video Tutorial #12 Is Running Bad For Your Knees? How Does The Body Spring Back Safely From Impacts Of Running and Walking? click here to view
Video Tutorial #28 Self-Tests & Exercises To Reduce Over Pronation and Over Supination From Impacts During Walking and Running. click here to view
Video Tutorial # 162 How does the Human Spring Work to Absorb Impacts Without Cushion Footwear? My Research. click here to view
Why is there stress on the tibia and surrounding tissues?
What I have found is the spring mechanism that protects you from this stress is weak, stiff or locked completely.
a diagram of a mid-foot landing
What protects barefoot runners from impacts?
Its the same thing that protects shod runners!
Allow me to introduce you to your human spring.
What is the difference between an intact or locked spring?
- When your spring mechanism is intact, you spring off the ground.
- When your spring mechanism is locked, you bang into the ground!
That should make sense.
Human Spring Model
The natural spring mechanism is integrated into all 7 floors of the human body.
Essentially, the human body is a giant human spring. The body is a giant spring with 7 floors of springs:
- The arch
- The subtalar joint
- The ankle mortise
- The knee
- The hip
- The spine
- The head-neck
_______________________________________________________________________________
supportive cuff muscles
There are two mechanisms that allow the body to function as a spring:
- The configuration of the arch with the 26 bones and the ligament attachments.
- The spring suspension system which is composed of the muscles and tendons that attach on the under surface of the arch.
The cause of shin splints according to the human spring model.
The spring model says the cause of the abnormal stress on your shin area is
- Weakness in your spring suspension system causing stressful landings
- footwear that bind your natural spring causing stressful landings
- a stiffening or locking of the natural spring leaving you unprotected from the impact forces thus transferring the stress to the shins.
Think of how you would feel if you had no shocks in your car. Your bones and the cars frame/engine would rattle from the stress.
Why do most doctors think you are a lever mechanism not capable of absorbing impacts without an artificial cushion?
- When your spring mechanism gets weak your spring mechanism it drops and locks into a lever mechanism.
- When you move through levers vs spring mechanics, the brain senses the abnormal movement patterns stiffening up the body in a predictable pattern of spasms.
- This pattern of spasms compress the spring even further.
- Left unchecked and untreated, you spiral into a jail cell of chronic pain, chronic fatigue, often times misdiagnosed fibromyalgia and accelerated aging occur.
That is when you go to the doctor!
So most doctors only see levers in their office.
Also, insurance companies have developed codes for “regional examinations”. Some insurance companies and regulators may even consider punishing a doctor for a full examination of the entire spring mechanism when the patient presents with “regional pain” like shin splints. Its not the standard of care. In my opinion its pretty standard care.
These are the fundamental causes of weakness in the spring suspension system muscles.
- The spring suspension system muscles are not completely developed by running straight ahead. You must move the foot in all ranges of motion against resistance.
- You must develop the foot in these ranges of motion with impact forces that are equal to the amount of impact forces you plan on absorbing. That means if you are planning on running you must run drills in all ranges of motion so that the spring suspension system muscles are able to move and develop.
- In my opinion, binding footwear inhibit the movement of the bones making it difficult for the muscles to fully develop. So training must be done with bare feet.
Could you see how a weakness, stiffening and or locking of the human spring mechanism could, not only cause shin splints but widespread chronic pain, chronic fatigue, misdiagnosed fibromyalgia and inflammatory diseases of aging?
I recommend you read Anthony Fields book, How I Got My Wiggle Back to see how we treated his shin splints and many other conditions with this approach.
For more information look at Video Tutorial #157 Barefoot Running Is Normal. Shod Running Is Abnormal? Rationale Based On Solid Training Principles, click here to view
In this post I will explain how the body can spring back from impacts of running and walking.
Bouche and Johnson concluded that distal facial traction is generated by contraction of the superficial and deep posterior compartment muscles and this tension contributes to the development of MTSS (7)
Many say the stress that causes shin splints comes from stress and strain from the tibialis posterior, flexor digitorum longus and soleus muscles (8). Its interesting that when your spring mechanism locks these muscles are tight and tender.
In my opinion and the opinion of other researchers, most shin splints come from training errors and footwear. (6)
The human spring model states that the body is protected by a spring mechanism that can absorb high force impacts through positive adaptation (training).
This can be done through the combined training approach of the body as a lever mechanism through progressive resistance exercises of the spring suspension system and as a spring through spring training such as multi-direction running drills, jumping drills and/or plyometrics.
First we have to agree that impact stresses are good for the body as long as we have an intact spring mechanism.
When are they not? – when the forces are taken up by tissues and not the spring
Force Of Impact/Energy Stored And Released
The deeper the spring can load the impact forces or load safely, the more energy you will recycle through the spring with every step. This allows for maximum efficiency
The deeper the spring can load the impact forces or load safely, the more protected you are at higher speeds
If your human spring abides by hookes law it must function via elastic deformity vs plastic deformity. Don’t worry this is not complicated and in fact it’s a simple concept that will help you make sense of all this.
Elastic Deformity vs Plastic Deformity
Define elastic deformity
- The foot and body deforms it shape to accommodate the force of the impact into the spring mechanism
- While it is deforming its shape it is also storing energy in the elastic elements and the shape change
- Then when all forces are fully absorbed and the spring reaches maximum depth it begins its return to its EXACT ORIGINAL SHAPE. The ability to reform back to its EXACT ORIGINAL SHAPE is important because this is the key to being able to walk, run and perform sports for a lifetime
- As it fully reforms it fully releases the stored energy
- Elastic deformity of your body is how you recycle energy and maximum protection from impacts and the preservation of your joints for a lifetime
- If your spring is fully released of muscle tension and joint stiffness or locking, fully flexible, strong enough, to absorb the impact force with enough endurance enough to absorb the amount of impacts you are using then you achieve 3 things:
When you exercise with a healthy spring mechanism, you cannot get shin splints. In fact here are the benefits to living with an intact healthy spring.
- Each impact stress will make the spring stronger
- You are at maximum performance efficiency (using spring elastic elements vs muscle lever pushing elements)
- You are protected for impacts at higher speeds.
Yield
Notice on this graph ELASTIC DEFORMITY vs PLASTIC DEFORMITY how there is a point the body gets to a yield point. The yield strength or yield point is defined in in engineering where the amount of stress or kind of stress on the material begins to deform it plastically (permanently)
Prior to the yield point the material will deform elastically (snap back) to its EXACT original shape when the applied stress is removed (When you toe off). Once the yield point is passed, some fraction of the deformation will be permanent and non-reversible. We call this aging.
- True elastic limit – Up to this amount of stress, stress is proportional to strain your human spring can handle without remodeling your tissues. This means below this level you don’t get enough stress to improve your tissue strength
- Elastic limit (yield strength training zone) – This point and up to the deformity is when your muscles, ligaments, tendons and bones reorganize into a stronger mechanism. This is the zone you want to train in.
- Yield point – This is when your tissues damage by a negative stress It is a negative plastic deformity permanent damage occurs with every step or impact – ligaments stretch, discs weaken and bulge, discs degenerate, scar tissue infests elastic elements and muscles, spurs form, bones bend (bunions), micro stress fractures, shins splint, muscles ligaments tendons strain or pull, things start to stiffen and hurt.
- Failure Strength – this is when bones break, discs instantly herniate, meniscus tears, ankles sprain, muscles rip, tendons avulse or tear, ligaments tear
Here are the various impact forces of landings:
- Walking (1.25 x bodyweight)
- Jogging 1.25 – 3x bodyweight
- Running (3x bodyweight)
- Plyometrics (3-5x+ bodyweight)
The trick for athletes coaches and trainers is to stress your tissues enough beyond the elastic limit to begin to positively deform your tissues as much as possible without exceeding the yield point when you cause damage.
What is plastic deformity?
The foot and body deforms it shape to accommodate the force of the impact into the spring mechanism
Because of weakness in the spring suspension system, stiffness in the spring suspension system or spring mechanism or locking of the spring mechanism, or poor form and or technique in loading the mechanism the way it was designed, The body cannot store the maximum impact force in the elastic elements, your balance and performance is effected the body deforms but does not snap back to its original shape leading to permanent visible deformities. Also, it cannot fully protect you from the forces of the impacts. Instead of the force of the impacts being absorbed into the spring protecting the floors above from this stress, the stress is absorbed into the tissues as damaging stress. This leads to wear and tear, release of inflammation and inflammation leads to pain as well as accelerated aging and risk for diseases of aging.
Because all forces cannot be fully absorbed and into the the spring at full depth it cannot store maximum potential stored energy. Essentially your spring locks and turns into a lever. Instead of the tendons and spring of the arch complex springing you off the ground efficiently you morph into an inefficient poor impact protector, a lever which bangs into the ground then muscles have to push you across the ground.
Plastic or permanent deformity happens when:
- Your spring is locked you and you are constantly exceeding the yield point with every step.
- For some of you, forces of simple walking impacts exceed your springs yield point. That is because your springs are weak or your load exceeds the springs yield (overweight or obese) or both.
- Some athletic and tone runners spring exceeds the yield point because they run for cardio only forgetting that at a certain point in the training the fatigue of the muscles leave the tissues without support causing abnormal stress on the area leading to plastic deformity.
These are potential causes of a fatigued, weak, locked spring suspension system
- Standing on your feet all day? for more information read Video Tutorial # 159 – Foot Lock! What You Get From Standing Too Long And How To Prevent It, click here to view
- Wearing binding shoes that don’t allow your spring to load and unload to stimulate positive adaptation to get stronger.
- Because you have to wear shoes you have to constantly release the locking of the 33 joints of your feet. I work on my feet every day. You can stretch while you are sitting in a chair at work. Watch this tutorial where I show you how. Video Tutorial #88 Dr James Stoxen DC Demonstrates Stretching Of The Foot While Sitting At Your Chair, click here to view
- If you don’t strengthen the spring suspension system in all directions. Running only straight ahead neglects the spring suspension system muscles. You have to work your spring in all directions.
- You must walk and run with correct form so the spring is worked like a tool the way the tool is designed to be used. This is your human spring owners manual.
- Mental stress tightens muscles which, restrict the spring.
- All of the above
So when your spring is locked you are actually accelerating the aging process rather than slowing the aging process.
Video Tutorial #68 The Exercise Your Doing Could Be Aging You Faster!, click here
Examples of chronic plastic deformities (minor form flaw over millions of impacts)
- Muscle Strain/Pain, Aches
- Bunions
- Plantar Fasciitis
- Heel spur
- Shin Splints
- Degeneration of Joints (knee and hip replacements)
- Ligament, muscle and tendon scar tissue infestation – Poor performance from a loss of elastic efficiency
- Stress fractures the tibia, fibula, femur, pelvis, spine (2)
- Degenerated discs
Examples of instantaneous plastic deformities
- Acute Fracture
- Ruptured Tendon
- Meniscus Tear
- Muscle Pull/Tear
- Herniated Disc
Shin splints never exist alone. To think you have stress in ONLY one linkage point of the body defies the laws of physics, nature, and a few other laws. The abnormal stress and strain is negatively aborbed into the tissues through the entire flooring sustem of the bodyDoctors and therapist dont get arrested for violating these laws so you have to police their efforts yourself.
You need to be checked for:
Floor one – foot lock, plantar fasciitis, bunions, heel spurs
Floor Two: subtalar (heel pain), subtalar joint laxity and subtalar locking
Floor three: Ankle mortice locking
Floor Four: adductor (groin) strain or pull, Illiotibial band syndrome
Floor Five: Hip Strain/Pain, Hip degeneration
Floor six: lumbar facet syndrome, piriformis syndrome, disc irritation, disc herniation/bulge
Floor seven: Headaches, neck spasms and pain
for more information read Video Tutorial # 159 – Foot Lock! What You Get From Standing Too Long And How To Prevent It, click here to view
How do you diagnose shin splints? How do you know you have shin splints?
Most doctors don’t find the diagnosis of shin splints too difficult.
- Many just do a skin palpation test (SPT) , which is pressing on the skin around the shin checking for pain.
- Then there is the shin oedema test (SOT), which involves pressing into the shin to indent the skin to see if the indentation remains.
That is how many doctors examine you to see if you have pain and inflammation of the shins. (3) Its a good screen but wont give you the insight on how to reverse them.
Not all pain in the lower leg is a shin splint. In fact you are taking a risk by doing the self-help tips in this article for shin splints you may have any of the following which mimic shin splints:
In fact, tendinopathy, compartment syndrome, (2) calf strain, muscle tears, peripheral vascular disease, fracture, an infection, neoplasms (cancer), DVT venous thrombosis, peripheral nerve entrapment, popliteal artery entrapment, and stress fractures all mimic shin splints. (4)
If you are unsure if you have shin splints consult with your doctor to rule out these other conditions before you make a mistake and this gets worse rather than better.
Here are some pointers…
Shin Splints Vs Stress Fractures – Diagnostic Tests
Some think shin splints are tiny stress fractures of the shin (tibia). Shin splints are different from stress fractures. A stress fracture is a tiny crack or cracks in the tibia bone.
A bone scan is a good way to find a hot spot for a stress fracture. For 99% of you this test is medically unnecessary. Don’t you want to know exactly what it is? Yes but if it won’t change the way you treat the condition, then there is no need to order it.
The incidence of stress fractures is 23% tibia, tarsal navicular 17.6% , metatarsal 16.2%, fibula 15.5%, femur 6.6%, pelvis 1.6% and the spine .6%. (2)
The MRI is only for significant pathology. A doctor may order an MRI only after a few weeks of treatment where all recommendations are followed to the tee and still there is no progress.
The MRI scan may find periosteal edema or inflammation of the covering of the bone, fracture lines and even edema or swelling in the bone marrow. (9)
I have never had the need to order an MRI because I insist my patients follow my recommendations to the tee and so far all of them have recovered from shin splints.
I feel these tiny stress fractures and shin splints are treated pretty much the same so maybe you can get away with treating a shin splint not knowing it was a stress fracture.
They know you have shin splints but… dont do the more advanced evaluations you wont have the deeper insight as to what caused them or how to reverse them.
If all you know is that you have inflammation of the shins you are left with the same old song and dance treatments:
Shin Splint Treatment
Orthotics
Doctors that see your foot rolls too far out of the safe range between pronation and supination without knowing the cause will give you these.
The Standard of Care for Shin Splints (13)
- The standard ice the shins to decrease inflammation. I agree with that.
- Some prescribe anti-inflammatories. Does that stop the inflammation from flowing? NO There are more effective natural ways to reduce shin splint inflammation.
- Some fit you with arch supports. Your spring turned into a stiff lever so now you jam a support into the confined area of the shoe which may jam and or inhibit the movement of the 33 joints of the spring more.
- Some professionals recommend shoes with even more cushion. Your natural spring cannot handle the impact forces from the landings so instead of releasing and strengthening the natural spring they bind it down with a shoe and give you a thicker artificial spring to make up for the one that is getting progressively weaker because it is bound. I see people walking around with running shoes on all day. I don’t recommend this.
- Some recommend sports compressive stockings or neoprene sleeves. I have no idea how these would lessen the negative stress on your shins.
- They give you a walking cast when shin splints are bad or when they suspect a stress fracture. The boot casts your foot and turns your spring into a giant lever heavy lever. Now you have more weight on one side of the body than another. You are at risk for breakdown of the other floors due to this imbalance of load.
- Some recommend braces. – Most have found these comfortable for walking. (10) Your optimum support for the human spring are the spring suspension system muscles.
- Some recommend taping for shin splints or strapping for shin splints. I can understand shin splint taping in the heat of a competitive environment as a temporary measure to get you through but it is not practical for a long term solution. It is something I never do because I cannot stop by to change the tape when it weakens all the time. Did you ask the doctor if he could come by every few hours to change the tape?
- Surgery – Surgery is so rare for shin splints. In fact I have never heard of anyone having surgery for shin splints. Of those who had surgery, what ever surgery they did decreased pain in 72% but only 41% returned to their original training (11) What do you operate on? I would never recommend surgery for shin splints no matter how bad they are unless you had a compartment syndrome that was worsening.
- They recommend specific supplements to support tissue health. – A study in Finland found people with shin splints and stress fractures had lower levels 25-hydroxyvitamin D. The study also recommended supplementing with 2000 mg calcium and 800 IU of Vitamin D. (2) Of course, this would depend on if you were getting enough 25-hydroxyvitamin D and calcium in your diet. I’m in favor of all supplements that improve your bodies chemistry to promote healing and optimum tissue health and metabolism.
The Gait Evaluation – A more Thorough Examination
Do you know the proper abnormal stress and strain free form and technique of walking or running?
If you get a pogo stick it comes with a manual to teach you how to use this spring device. If you don’t read the manual how do you know how to use it properly?
Have you ever read a manual on how to use your human spring for safe and effective walking and/or running?
This is your manual!
Do you absorb impact stress through your spring when you walk or is your spring locked leading to abnormal stress in your tissues instead?
Videotape your walk—-
Watch it back advancing the movie slowly frame by frame. What do we see?
- Are your feet, shins and legs relaxed prior and during impact?
- At impact and while transferring the weight across the planted foot are any of the toes off the ground?
- Does your calf shake when it hits the ground (from the back)?
- Do you push or pull your body across the ground or spring your body off the ground?
- Does your foot land with the second toe pointing the direction you are going?
- Is your shin, ankle and foot in alignment or do you have a weak or weak ankles? (over pronation)
- Do you walk heel-toe or land heel first? There is no spring there. The impact goes bone (heel) to bone (talus) to bone (shin) The spring suspension system is in the middle/front of the foot!
Heel, Neutral, Forefoot Landing
If any of these are true, you must work on relaxing your walking form and technique to lessen the impact force.
How do we correct the form and technique of your walk?
- Land with foot-leg-hip directly more perpendicular to earth gravity and body
- When you are perpendicular to the pull of gravity is when your spring should be loaded at full depth.
- It shouldnt be when you hit your heel first
Regardless, it is impossible to walk or run with perfect stress free form and technique without all restrictions removed from the spring and for it to be strong enough to handle the impact forces of movement at the speed you want to travel, walking, jogging, running and/or plyometrics.
I have developed a 3-step approach to restoring safer, spring loading capacity:
- Release the spring from forces that create compressive forces on the human spring from muscle spasms
- Strengthen the spring suspension system muscles
- Impact train the spring suspension system
This three step approach will help you expand the force loading capacity of your human spring to better spring off from impacts, to have maximum performance and reduce risk of shin splints even at higher impact forces such as running and even running barefoot on solid concrete.
It is critical for you, your coach and your doctor to:
- Understand what causes the breakdown of the spring mechanism. It starts with weakness in the spring suspension system, that leads to a drop and lock in the spring suspension system, that causes abnormal stress and strain which leads to wear and tear, inflammation and pain.
- Learn how to check for abnormal movement patterns with gait evaluations (evaluations of walking or running movement patterns). Many, including myself feel that biomechanics is the most accurate predictor of the risk of shin splints (14)
- Learn how to check for the specific patterns of abnormal internal forces with hands on deep tissue palpation.
- Learn how to remove the abnormal internal compressive forces on the human spring caused by spasms that compress the human spring (joints). This is done with muscle spindle work and specific adjustments of the feet, ankles, knees, hips and spine.
What are the best shoes for walking or running with shin splints?
Most would think heavy cushioned running shoes are best.
Shoes with cushions dont absorb the stress to prevent shin splints, your natural spring does.
Weak Spring Suspension System Muscles – If our spring suspension system muscles are too weak to maintain the foot in the safe range between rolling from supination to pronation we must have a shoe with a counter mechanism strong enough and durable material to maintain the heel in the safe range to stop the abnormal stress.
I never put a patient in a running shoe to reverse shin splints! It doesnt work. They are too soft to stop the rolling out of the safe range from supination to pronation that leads to the abnormal stress that causes the shin splints!
The Best Shoes For Shin Splints will help keep the foot in the safe range
The best shoes for shin splints – Shoes with extended medial counter stabilizers. I opt for a leather shoe with a stiff counter support. No, they arent uncomfortable. Shin splints are!
For more information read Video Tutorial #97 On Your Feet All Day? Fatigued? Achy? Over Pronation? I Recommend Footwear with Extended Medial Counters, click here to view
For more information read Was My Chronic Pain, Fatigue, Fibromyalgia Cured with a Pair Of Shoes? NO!, click here to view
Releasing the abnormal stress from the shins with a stiff or locked spring
If you have a stiff or locked spring, you cannot run or walk without stress on your shins before you have released all the internal muscle and joint tension from your spring mechanism. Instead of running you should be spending the time preparing for better runs.
I spend at least 30 minutes doing the deep tissue treatments on my feet and legs before I run.
I dont want to find out I have a pattern of spasm from my foot to my spine that will inhibit the safe loading of the impact of my bare foot on the solid concrete.
Probe your body with deep pressure for pain and sore ropy spasms outlined in these video tutorials.
If you feel them treat them at the same time with the technique I recommend in the video tutorial.
Release all preload tension on the spring for maximum safe deep loading of the spring mechanism.
Now lets release the abnormal stress from the shins that is causing the shin splints by releasing the entire integrated spring mechanism from toe to head.
Watch above as Dr. James Stoxen DC Demonstrates the deep tissue release he uses to relieve shin splints.
Do all of these to start the day and before every run
Links to Dr Stoxen’s self help video tutorials for shin splints:
Video Tutorial #78 Deep Tissue Treatment Of The Knee Popliteus Muscle
Video Tutorial #79 Deep Tissue Treatment Of The Gluteus Medius Muscle of the Hip
Video Tutorial #80 Deep Tissue Treatment Of The Subtalar Joint Of The Ankle On The Inside
Video Tutorial #81 Deep Tissue Treatment Of The Ankle (Subtalar Joint Outside)
Video Tutorial #82 Deep Tissue Treatment Under The Big Toe And Second Toe
Video Tutorial #83 Deep Tissue Treatment Above The Big Toe And Second Toe
Video Tutorial #87 Deep Tissue Of The Ankle Mortise
Dr Stoxen’s best stretches for shin splints, video tutorials:
Video Tutorial #84 Scissor Stretching Of The Feet
Video Tutorial #85 Stretching Great For Mortons Neuromas And Heels
Video Tutorial #88 Stretching Of The Foot While Sitting At Your Chair
Video Tutorial #89 A Stretch To Increase The Flexibility Of Your Foot
Shin Splint Exercises
You must develop the spring suspension system muscles!
This requires you to:
SPRING RESISTANCE TRAINING– Strengthen the spring suspension system muscles like a lever. Train with resistance exercises adding cuffs strapped to the foot moving it in a variety of directions such as eversion, inversion, abduction, adduction, pronation and supination.
SPRING IMPACT TRAINING – Strengthen the spring like a spring. I restore the spring suspension system muscles ability to resist impacts with barefoot drills like zigzag patterns, circular patterns, shuffle patterns as well as doing multi direction plyometric drills with graduated increased speeds starting with walking, jogging, running plyometrics.
Because we are going to release our natural spring mechanism, artificial spring protection like heavy cushioned soles wont be necessary. In fact, we should set a goal to get back to walking and running barefoot like we did as a youth.
Why?
“The inability to walk or run barefoot safely is one of the first signs of aging “
Are we running to slow the aging process or speed it up?
Then when you’re in the competition you can cheat by putting shoes on that allow for additional recoil of the elastic of the shoe!
Please read these articles which discuss the training of the body to improve impact resistance.
Video Tutorial #12 How Does The Body Spring Back Safely From Impacts Of Running and Walking?, click here to view
Tutorial #28 Self-Tests & Exercises To Reduce Over Pronation and Over Supination From Impacts During Walking and Running , click here to view
Can I still run with shin splints? NO WAY!
If you cannot walk without banging into the ground you have no business running!
How do you know when it is safe to run again?
You just don’t go out and run and see what happens!
You have to videotape yourself walking, jogging and running at increased speeds which test the impact resistance of the spring suspension system to maintain the foot and limb in the safe range.
Watch this video below of national champion taekwondo, Christian Medina and Dr Stoxen running barefoot down the street. One of our staff was in the back of an SUV videotaping through the window while another staff member was driving.
These are the snapshots taken from the video analysis.
Dr. James Stoxen Dc barefoot running training with Christian Medina
There is no one perfect cure. However, we should approach heel spurs and other conditions with logic that follows the laws of physics and nature. I have tried my best to present to you my best recommendations based on these laws, the prevailing scientific literature and my many years of clinical experience.
You may not rush off to your family chiropractor or alternative medical center for this but I have found that conservative treatment at our chiropractic center with an integrative medical approach.
Please feel free to share your shin splint story in complete anonymity in the comments below. I will advise the best I can.
Thank you for sharing this article with those you feel it can help!
References
1. Reshef N, Guelich Medial tibial stress syndrome, DR. Clin Sports Med. 2012 Apr;31(2):273-90. doi: 10.1016/j.csm.2011.09.008. [PubMed]
2. Patel DS, Roth M, Kapil N. Stress fractures: diagnosis, treatment, and prevention. Am Fam Physician. 2011 Jan 1;83(1):39-46. [PubMed]
3. Patel DS, Roth M, Kapil N. Two simple clinical tests for predicting onset of medial tibial stress syndrome: shin palpation test and shin oedema test. Br J Sports Med. 2012 Sep;46(12):861-4. doi: 10.1136/bjsports-2011-090409. [PubMed]
4. Galbraith RM, Lavallee ME. Medial tibial stress syndrome: conservative treatment options. Curr Rev Musculoskelet Med. 2009 Oct 7;2(3):127-33. doi: 10.1007/s12178-009-9055-6. [PubMed]
5. Raissi GR, Cherati AD, Mansoori KD, Razi MD. The relationship between lower extremity alignment and Medial Tibial Stress Syndrome among non-professional athletes. Sports Med Arthrosc Rehabil Ther Technol. 2009 Jun 11;1(1):11. doi: 10.1186/1758-2555-1-11. [PubMed]
6. Jogging – Overuse injuries at the locomotor system, SPORTVERLETZ SPORTSCHADEN 1991; 5(1): 22-26 DOI: 110.1055/S-2007-993559
7. Reinking MF, Exercise Related Leg Pain (ERLP): a Review of The Literature. N Am J Sports Phys Ther. 2007 Aug;2(3):170-80. [PubMed]
8. Bouché RT, Johnson CH Medial tibial stress syndrome (tibial fasciitis): a proposed pathomechanical model involving fascial traction. Am Podiatr Med Assoc. 2007 Jan-Feb;97(1):31-6. [PubMed]
9. Mammoto T, Hirano A, Tomaru Y, Kono M, Tsukagoshi Y, Onishi S, Mamizuka N., High-resolution axial MR imaging of tibial stress injuries. Sports Med Arthrosc Rehabil Ther Technol. 2012 May 10;4(1):16. doi: 10.1186/1758-2555-4-16. [PubMed]
10. Moen MH, Bongers T, Bakker EW, Weir A, Zimmermann WO, van der Werve M, Backx FJ. The additional value of a pneumatic leg brace in the treatment of recruits with medial tibial stress syndrome; a randomized study. J R Army Med Corps. 2010 Dec;156(4):236-40. [PubMed]
11. Yates B, Allen MJ, Barnes MR. Outcome of surgical treatment of medial tibial stress syndrome. J Bone Joint Surg Am. 2003 Oct;85-A(10):1974-80. [PubMed]
12. Rathleff MS, Kelly LA, Christensen FB, Simonsen OH, Kaalund S, Laessoe U. Dynamic midfoot kinematics in subjects with medial tibial stress syndrome. J Am Podiatr Med Assoc. 2012 May-Jun;102(3):205-12. [PubMed]
13. Moen MH, Holtslag L, Bakker E, Barten C, Weir A, Tol JL, Backx F. The treatment of medial tibial stress syndrome in athletes; a randomized clinical trial. [PubMed]
14. Sharma J, Golby J, Greeves J, Spears IR. Biomechanical and lifestyle risk factors for medial tibia stress syndrome in army recruits: a prospective study. Gait Posture. 2011 Mar; 33 (3):361-5. doi: 10.1016/j.gaitpost.2010.12.002. Epub 2011 Jan 17. [PubMed]
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All content on teamdoctorsblog.com, including without limitation text, graphics, images, advertisements, videos, and links (“Content”) are for informational purposes only. The Content is not intended to be a substitute for professional medical treatment, advice, or diagnosis. Please remember to always seek the advice of a qualified physician or health professional with any questions you may have regarding any medical concerns. Dr James Stoxen DC and Team Doctors does not recommend or endorse any specific treatments, physicians, products, opinions, research, tests, or other information it mentions. Said Content is also not intended to be a substitute for professional legal or financial advice. Reliance on any information provided by Team Doctors is solely at your own risk.
- Fever: When you have a fever, your body is trying to isolate and expel an invader of some kind. Massage increases overall circulation and could therefore work against your body’s natural defenses.
- Inflammation: Massage can further irritate an area of inflammation, so you should not administer it. Inflamed conditions include anything that ends in itis, such as phlebitis (inflammation of a vein), dermatitis (inflammation of the skin), arthritis(inflammation of the joints), and so on. In the case of localized problems, you can still massage around them, however, avoiding the inflammation itself.
- High blood pressure: High blood pressure means excessive pressure against blood vessel walls. Massage affects the blood vessels, and so people with high blood pressure or a heart condition should receive light, sedating massages, if at all.
- Infectious diseases: Massage is not a good idea for someone coming down with the flu or diphtheria, for example, and to make matters worse, you expose yourself to the virus as well.
- Hernia: Hernias are protrusions of part of an organ (such as the intestines) through a muscular wall. It’s not a good idea to try to push these organs back inside. Surgery works better.
- Osteoporosis: Elderly people with a severe stoop to the shoulders often have this condition, in which bones become porous, brittle, and fragile. Massage may be too intense for this condition.
- Varicose veins: Massage directly over varicose veins can worsen the problem. However, if you apply a very light massage next to the problem, always in a direction toward the heart, it can be very beneficial.
- Broken bones: Stay away from an area of mending bones. A little light massage to the surrounding areas, though, can improve circulation and be quite helpful.
- Skin problems: You should avoid anything that looks like it shouldn’t be there, such as rashes, wounds, bruises, burns, boils, and blisters, for example. Usually these problems are local, so you can still massage in other areas.
- Cancer: Cancer can spread through the lymphatic system, and because massage increases lymphatic circulation, it may potentially spread the disease as well. Simple, caring touch is fine, but massage strokes that stimulate circulation are not.Always check with a doctor first.
- Other conditions and diseases: Diabetes, asthma, and other serious conditions each has its own precautions, seek a doctor’s opinion before administering massage.
- Pregnancy: No deep tissue work. Be aware: danger of triggering a miscarriage by strong myofascial work is greatest during the first 3 months (especially through work around the pelvis, abdomen, adductors, medial legs, or feet)
