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Health, running, Shin Pain

Shin Pain and Stress fractures – Heal strong and fast

July 16, 2015 • By

marathonTreating your shin pain and foot pain from stress fracture the right way, as soon as possible, means you heal faster and stronger. In this series on stress fractures, I will tell you what a stress fracture is, what causes them and most importantly what rehab exercises and self-treatment you can do to get it right.

Following on from the first post in the series which detailed what stress fractures and stress reactions are and why endurance athletes are so prone to shin pain and foot pain and what to do initially, this post gives you the rehab to help it heal faster, by covering phase 2 and 3 of stress fracture rehab.

Phase 2 – Strength, conditioning and rehab

When to start: Phase 2 of rehab from stress reactions starts when general activities of daily living (walking, hanging out washing etc) can be done without symptoms – Pain is an indication of overload to the bone in many cases, so we need to listen to our bodies.

The main three aspects that need to be covered in home rehab of stress fractures are:

  1. Exercise to maintain cardiovascular fitness and prevent muscle loss
  2. Rehab exercises to address cause behind the injury

So let’s address those:

1. Maintain fitness

It is important to note that in most cases you don’t have to completely rest – there is always something you can do, and very important not to lose fitness. So with that in mind, and the fact that exercise actually boosts healing, here are some things that you could do:

  • Pool training – this can start light, treading water in the deep pool and swimming, progressing to jogging in chest-deep water.
  • Stationary bicycle or exercycle – this is a great way to keep up the fitness without causing pain
  • When poor walking etc is pain-free, begin going for short walks and build this up. Eventually you should be able to walk without pain for 30 minutes at the end of this phase

Tip: Remember, you cannot return to loading the bone until the bone is pain-free to tap on and touch

2. Rehab exercises

These should aim to:

  • Increase muscular endurance
  • Improve core and pelvic stability
  • Work on balance training
  • Address flexibility issues
  • Re-train running pattern

Here are some great options to work on:

Heel raises to build calf endurance

Calf raise, calf exercise, heel raiseLevel 1: Start these on two legs, aiming for 3 sets of 10 reps

Level 2: When comfortable and pain-free, progress to single leg heel raises

Level 3: Goal: 30 heel raises in a row

 

 

 

One leg squats to retrain pelvic and lower limb stability

Single leg Squat, hip stability and strength

Aim for 3 sets of 10 reps.

These need to be done with good technique so it can help to do them in front of a mirror

 

 

 

 

Wobble board balance re-training

Bosu ball, wobble board ankle and calf re-training rehab quick

 

Re-training your balance and coordination of the muscles is very improtant, and easily done with either a wobble board or a Bosu ball.

Aim for at least one minute on each leg.

If you can’t get a wobble board, try rolling up a towel firmly and standing on this

 

 

Stretching:

Calves

calf stretch , soleus, gastroc - self treatment for shin splints

Hang one heel at a time off a step and hold for 30 seconds

 

 

 

 

Hamstrings

doorway stretch

 

MTSS shin splints self treatmentStretch out your hamstrings up a doorway of wall as shown here and hold for at least 30 seconds each side

Alternatively you could use a Foam Roller to loosen up your hamstrings and calves!

 

 

Tip: Continue to ice after exercise and exercise should always be pain-free – a return of shin pain or foot pain can’t be taken lightly.

Phase 3: Safe progression back to full activity

Before starting this phase, you need to be able to do all the previous exercises and painfree and ideally be cleared by your physio or doctor.

When returning to running, a good guideline is to increase activity by no more than 15% to 20% per week. You should also be able to walk for 30 minutes comfortably and you can build this up the same way.

A good starting point, is to run 500m followed by a day of rest or a short walk. If this is pain-free, then you can jog 3 x weekly, ensuring that there are rest days

The distance above is just a guideline but basically start with a short distance and if this is pain-free, slowly increase this, never increasing by more than 15% per week. This is because bones take time to adapt, heal and get stronger – you need to give them this time and only increase in small amounts so as not to overload them.(1)

Numb feet when running lace up properlyTip: when returning to running, it is important to have the right technique – pay a visit to your local sports physio or appropriate professional to have this looked at and also to get some advice on footwear for you as this is very individual (but maybe stay away from minimalist or “barefoot” footwear and aim for motion controlled footwear initially (2).


Foot pain, Health, running, Shin Pain

1 in 5 people will get a Stress Fracture Running

July 2, 2015 • By

Stress fracture shinA huge 20% of runners get stress fractures – often when building to a big race! Find out here the most up-to-date information on what they are, why runners are so prone to them and also how to get them better, faster.(3)

What is a stress fracture?

A stress fracture is, as the name suggests, a small fracture in a bone. It is a partial or incomplete fracture caused by the build up of stress to a localised area of bone. So they aren’t your usual fracture that happen due to a big fall or collision, they are due to repetitive strain, which is why runners are so at-risk, but more on that soon.

What causes a stress fracture?

Bones get stressed when there is a load placed through them, whether this is from the shock of your foot landing on the ground or from your muscles pulling on the bones to move you and absorb the shock. Stress fractures can basically be classified into two types:

1. Fatigue; This is caused by an abnormal stress (more than the bone is used to) to a normal bone.

2. Insufficiency; These fractures arise from the application of normal stress through a bone that is abnormal – such as mineral deficient or abnormally rigid. This is most prevalent in nutrient deficient and older population with osteoporosis and arthritis.

The type that is most common in the active population, as you can guess I’m sure, is the fatigue stress fracture. Generally the “abnormal force” that causes this bone-fatigue is due to increasing training intensity or distance, wearing inappropriate shoes or not progressing into new shoes, training on hard surfaces or due to poor alignment of the feet. The problem with bones is that they adapt a lot slower than muscles – when muscles can adapt and improve within a few weeks, bones can take a few months! This means that as your muscles improve and your lungs do too, you can go further and faster. The only problem with that is that your bones are still trying to adapt to the initial increase in training.

stress fracture cycle

Romani et al. Journal of Athletic Training 2002;37(3):306–314

Think of bone remodeling like renovating a house: Winter hits, and without thick walls it is bloody cold. So you adapt and decide to insulate the walls. Your bones are the same, they get an increase in stress through them and think hey, I need to get stronger, but before your bones get stronger, just like insulating your walls, the current walls need to be taken downs first. The problem is if you increase training load or intensity in this time when the bone is actually weaker, when trying to remodel, you can push it over the edge and cause a stress fracture.

In fact, there’s even a window of about a month where bone becomes weaker after an increase in training stress because of the way the body remodels bone, as described above. Your body first tears out some walls in the bone structure before it can put in new ones, much like remodeling your house.

Where do they happen?

Stress fractures in runners are most common in the shin bone, the navicular bone in the foot and the 2nd and 3rd metatarsals (long bones in the foot) – stress fractures through these three bones make up over 50% of all stress fractures.(1)

Note: Shin splints does not mean stress fracture. Shin splints is a generalised, umbrella term that is used to describe pain in the anterior shin – this can be a number of things so be sure to have your shin pain diagnosed by a professional.

Why are runners so at risk for stress fractures?

Stress fractures account for a massive 20% of athletic injuries and are very common in endurance activities, especially distance running. This is hardly surprising as running requires thousands of repetitive steps on every run – now if you do any of these for example:

  • Increase training mileage too fast (more than 30% in two weeks for example)
  • Start using new minimalist shoes all of a sudden
  • Increase training intensity

Just to name a few! This will be putting more load through your bones than they are used to. If they then aren’t given time to adapt to this and get stronger – they will actually suffer repeated micro trauma and will fracture

A stress fracture typically feels like an aching or burning localized pain somewhere along a bone. Usually, it will hurt to press on it, and the pain will get progressively worse as you run on it, eventually hurting while walking or even when you’re not putting any weight on it at all. Sometimes, if the stress fracture is along a bone that has a lot of muscles around it, like the tibia or femur, these muscles will feel very tight.

 

So what can you do to help it heal strong and fast and get back to running ASAP?

Firstly, get it diagnosed by a professional. The vast majority of stress fractures heal within 8 weeks, but it is important to have it diagnosed as soon as possible so that yo know for sure what it is.

Secondly, rehabilitation of a stress fracture can be split into three phases:

Phase 1: Relative rest (rest and protect phase)

The goal in the first phase is to rest the injured area to give it time to heal, while maintaining aerobic fitness. This is the main goals:

  • RICE injury treatment, heal strong and fastRest the injured area: No running or loading up the area. Listen to it, if it hurts, stop. A moon boot may be needed and will definitely help you heal strong.
  • Maintain fitness through swimming and cycling
  • Seek treatment from a physio – This does help as it is important to maintain full range of motion and to unload the injured area
  • Ice to decrease inflammation and limit secondary damage
  • Do not take anti-inflammatory medication if you can help it (you don’t want to stop inflammation and slow healing)(2)

Phase 2: Strength, conditioning and rehab

In this stage we need to ensure the causative factors behind the injury are sorted out. Things such as, tight muscles, muscles with poor endurance or controlled and training error. This is the phase that you will enjoy as unlike the first phase, it isn’t all rest and unload – You can take control of your recovery by doing the right rehab exercises to ensure the stress fracture heals strong and fast. Your exercises need to address these areas:

  • Increase muscular endurance (calves, glutes and hamstrings)
  • Improve core and pelvic stability
  • Work on balance training (proprioception)
  • Address flexibility issues
  • Re-train running pattern

Phase 3: Safe progression back to full activity

This is where you ease your body back into it while allowing the bone to strengthen and heal – without overloading again.

In the second blog post in this stress fracture series, I am going to detail phase 2 and 3 – the exercises that you can do to help speed up recovery and have you healing strong. These are all exercises that can be done at home so there is no excuse for them not being done!

 


Health, Shin Pain

How To Treat Shin Splints At Home

December 1, 2014 • By

shin splint painAre the dreaded shin splints giving you trouble? Here is a video that will show you how to treat shin splints yourself – it is easy, effective and will really relieve tension and pain!

As explained in a earlier post, shin splints is the most common lower limb injury in athletes, affecting nearly 10% of all runners!

For more detailed info about what actually causes “shin splints”, check out the link above, otherwise you can get started right now on this easy muscle release…

 

 

 

It is so important to stick with it and persevere a you cannot sprinkle pixie dust and have this better in a few days, 1-2 weeks and you will feel a real difference, 4-6 weeks and you will be feeling a whole lot better.

Combine this with some good rehab exercises and technique improvement (if you are an athlete/runner) and you will be away!

And remember, reduce how much you wear jandals/thongs/scuffs.

 

PhysioPrescription, giving you the tools and information to help yourself,

Shaun


Calf Pain, Foot pain, Health, Shin Pain

Flip-flops and moon boots

April 26, 2014 • By

jandals profWhenever I see a patient with a lower limb injury come into the practice wearing flip-flops I cringe inside. Really, these simple bits of plastic are causing a lot of pain and injury and are not something you should wear all day.

Flip-flops absolute lack of arch or heel support puts you at risk of unnecessary pain and injury. We are (I am generalizing here) so careful to wear the best footwear when exercising, keeping up to date with the latest running shoes, orthotics, braces etc but when it comes to relaxing and what we wear outside of work and sport – we aren’t so smart. A study found that in a large shopping center, 43% of all women were wearing flip-flops(1) – That is a huge amount of foot, calf, shin, knee and back pain! Yes this may keep Physio’s and podiatrists in business but it keeps a lot of the population out-of-pocket – And often there is a very simple thing you can do to ease your pain and injuries….

Throw your thongs away!!

Really flip-flops aren’t that bad if you just wear them to the beach, around the changing room or shower etc – It’s when you start wearing them out shopping, to lunch, all day, everyday that they can cause real problems. What problems can flip-flops cause you may ask? and why? Flip-flops can lead to:

  • Plantar fasciitis
  • Stress fractures – Hence the moon boots
  • Shin splints
  • Calf pain and strains
  • Foot pain e.g. Mortons neuroma, metatarsalgia
  • Low back pain
  • and more

And Why?

Flip-flops change the way we walk

They wouldn’t be so bad if our feet weren’t so weak and de-conditioned. Yes we evolved to roam the open plains and jungles barefoot but now that we live in this concrete world – we need a little more protection for our feet. Also because we so often wear cushioned supportive shoes the rest of the time, our feet are not able to handle the complete lack of control and support when wearing flip-flops – Like sleeping on a nice comfy bed one night and then on concrete the next – You will get sore right?

And because they change the way we walk, we use our muscles in a different way, while increasing the shock going through and feet and legs due to lack of shock absorption. Wear them for a long time and the repetitive strain leads to overuse injuries. For example:

  • Every time you step, you need to squeeze and scrunch your toes to hold the flip-flops in place! Meaning your feet and calf have to work very, very hard = tight, tight calves.
  • Due to the total lack of arch support the arch can repeatedly over-pronate, increasing the stretch on your plantar fascia. Repeat this over hundreds of steps and you get micro-tears, inflammation and pain. You can read more about this here.

Good things in moderation

So, you don’t need to go and throw your flip-flops out but PLEASE limit the amount you wear them as they can be a huge cause of pain and injuries. This is also such an easy thing to change that can drastically improve your function and decrease injury risk, so why not do it huh?

jandalsAddendum: As a proud Kiwi I feel I should give a quick history on the proud origin of flip-flops.. or should I say Jandals! The flip-flops was originally invented in Auckland, New Zealand in 1950. The idea came from the original Japanese sandals which allied soldiers saw while doing occupation duty in Japan during WWII. The original name Jandal (Japanese sandal) was trademarked so that lead to other countries having t come up with other names such as:

  • jandals 1Flip-flops
  • Sandals
  • Slippers
  • Thongs, etc

So wear this great invention in moderation and save yourself a lot of trouble. Please Share, like and comment away!


Lower limb, running, Shin Pain

Shin Splints Treatment and Exercises

October 14, 2013 • By

runningShin splints is the most common lower limb injury in athletes and can lead to large blocks off training and serious injuries such as stress fractures if ignored. Here you will find out, what it is, what causes it and how to treat and rehab it YOURSELF with effective self treatment methods and exercises.

Shin splints is an Umbrella term that describes pain along the inside border of your tibia(shin) and covers a number of pathologies. The most common and Injury most often associated with Shin splints is Medial Tibial Stress Syndrome.

shin splint painMedail Tibial stress syndrome (MTSS) Is the most common Injury in runners (Lopes et al 2012) affecting 9.5 percent of all runners, coming in just ahead of achilles tendinopathy and plantar fasciitits.  In MTSS pain is felt along the inside border of your shin bone (tibia), it is tender to touch and the tender/ lumpy area is larger than 5cms.

MTSS is caused by repetitive contraction of the calf muscles causing excessive stress on the tibia. The calf muscles (namely the soleus, flexor digitorum longus and tibialis posterior) attach onto the inside border of the tibia, and the repeated pulling from any of these muscles at their attachment causes micro-tears which causes inflammation, pain and excess tissue build up.

Now this generally happens due to one or a number of the following reasons:

  • Sudden increase in training that your body isn’t used to.
  • Change on footwear or training surface, eg. going barefoot (minimalist running) or changing from flats to hill running.
  • Poor hip control causing excessive internal rotation.
  • Over pronated foot type.
  • Poor running form (See Ironing out your running).

 

Differentail Diagnosis:

Stress reaction and stress fracture

These also cause shin pain and can be causes by MTSS or occur by themselves due to over training so it is important to have these ruled out by your Local physio if there is pain when you: tap on your shin bone, jump on your heel or if the pain is localised to one spot on the shin.

 

MTSS is far too often ignored and put aside as calf tightness until it is far worse than is should have got, which means some serious time off training and a lot of money spent on rehab. Below we are going to run through exercises and self-treatment that will both help heal your MTSS/shin splints AND prevent them happening again.

 

Exercises: All of these need to be done 2 x daily if you have shin splints.

calf stretch1. Calf Stretch:  Drop your heel off a step and hold it for 1 minute.

 

 

 

 

 

 

MTSS shin splints self treatment

2. Foam roll your calf: Position as shown in the picture to get as much weight through the roller as you can. Spend 2-3 minutes slowly rolling your whole calf – ignore the pain!

 

Tip: You can also give yourself and self-massage, which is really effective at reducing tension and getting right to the point!

 

 

 

glut and Lat stretch - Hip flexibility

3. Sling stretch for hip range: Hold for 1 minute.

 

 

 

 

 

 

Bridge - increase leg strength, glute activation and decrease back pain.

4. Single leg bridge for hip stability: 

Hold for 5 seconds, 2 x 12 reps each side.

 

 

 

 

 

Single leg Squat, hip stability and strength

5. Single leg squat for lower limb strength and stability: To make it harder and better for lateral stability, keep your free leg out to the side.

Do 2 sets of 12reps each side.

 

 

 

 

 

Make the above exercises a routine even when pain-free!

Self treatment:

The main technique that will benefit you is self deep tissue massage. Check out this post for a easy video demo of this.

 

Tinker with your training:

– Decrease your training load to allow healing to take place

– decrease hill running and running or walking on hard surfaces

– Take a good look at your shoes and consult a Podiatrist of Physio re your foot mechanics.

– Once pain has gone, start SLOWLY building up your training again.

 

 

So there you have it, your guide to Shin Splints Treatment! Take some time to check out some other great posts that will help athletes and runners out a huge amount in preventing lower limb injuries as it is ALWAYS better to prehab!

Iron out your running – run faster, easier and injury free.

Quick balance and stability test.

Glute activation – the missing link

Please Share and like and let me know how you get on!