Selecting Running Shoes | ACSM Position Statement | “Research and injury patterns have shown that there are some general characteristics of a good, safe running shoe.”
How to Make An Educated Decision |Ian Griffiths at Kinetic Revolution | “He also takes the opportunity to dispel some of the myths and untruths that a runner may encounter whilst searching for footwear for themselves.”
Prescribing Running Shoes | Dr. Kevin Maggs at Running Reform | “Choosing running shoes need not be so complicated.”
Arch Support – Separating the Truth from Gimmicks | Run Repeat .com | “You should not choose a shoe based on wet test. That is a static test. A wet test or an other static motion test are extremely poor ways to prescribe footwear. You don’t stand still when you run. You move.”
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Shin splints compete with runner’s knee in two categories.
The first is, “Which one’s name is vaguer?” and the second is “which injury is more common?”.
What’s interesting about these two conditions is whenever anyone gets a twinge or pain in their shin, regardless of the details, they may label it as shin splints. With runner’s knee it is the same, often any knee pain is labeled as runner’s knee.
Terry Smith at Kinetic Revolution accurately described the pain and symptoms of MTSS:
In typical cases, shin splints pain is usually felt two-thirds of the way down the tibia, just off the inside edge of the bone.
In the early stages, shin splints pain is usually felt at the beginning of a run and then normally subsides during the training session itself. Commonly, symptoms also tend to reduce a few minutes after a given run session has finished.
If the injury worsens, shin splints pain is felt in less intense activities and can be present at rest.
It is often painful to apply direct pressure to the affected area. Because the anteromedial border (front/inside) of the tibia is directly under the skin, pitting oedema, and even callus formation, can be felt on upon close examination in some cases.
This is thought to be a response of the periosteum to micro-fracture formation.
I also really liked what Brad Beer has to say about the pain:
Shin splints is a continuum condition, whereby the shin bone will progress from being normally loaded, to slightly overloaded, to very overloaded, to eventually incurring fracture. During the ‘overloading’ stages the bone becomes painful as the outside of the bone (the cortex) develops tiny microscopic fracture lines. At a cellular level, when pain is experienced the bone’s repair mechanisms are being outstripped by the bone being damaged and broken down.
The very end stage of shin splints is a tibial stress fracture. At this point the bone fails and fractures due to being repeatedly overloaded beyond its tolerance or ‘failure point’ through continued stress and loading associated with running.
Brad Beer describes this comparison. They are often confused:
Many runners incorrectly believe that they have shin splints when they experience pain at the front and outside of their shin bone. Normally this is not shin splints but rather muscle and fascia tightness of the tibialis anterior muscle. The tibialis anterior muscles can be prone to becoming excessively tight when exercise is commenced.
Pain to the front and outside of the shin can result from reduced or restricted blood flow to the tibialis anterior muscle. Medically we term this pain ‘compartment syndrome’, and its cause is distinctly different to a true case of shin splints.
We’ll take a cue from John Davis at Runners Connect for this.
Scientists now hypothesize that the root cause of shin splints is repeated stress to the bone during running, caused not by straight-on impact, but a slight bending of the bone when it is loaded.
Much like a beam on a bridge or in a skyscraper bows slightly when it’s supporting a lot of weight, your tibia bends backward slightly on impact with the ground, putting compressive forces on the medial side of the bone.
In healthy runners, the bone stress after a long, hard run is not a problem. The body responds to the stress on the bone by remodeling the tibia to be stronger and thicker.
This is why shin problems are more common in less-experienced runners: their bone has not yet adapted to the stresses of a high-impact activity like running.
Unfortunately, this remodeling process takes several weeks to a few months to complete, and there is a period where the bone is actually more vulnerable to damage.
Just like remodeling your house entails tearing out some walls before adding new construction, your body has to tear out some of the old bone tissue before strengthening it.
As a result, having a small tibia or weak bones puts you at an increased risk for shin splints, since your weakened tibia is more vulnerable to injury when it is remodeling its bone structure.
And Steve Gonser at Run Smart Online discusses this process.
Ultimately, an unattended shin splint will progress. A slight “ache” transforms into pain that limits you from running (stress reaction) and ends with pain that is present with walking and standing (stress fracture). You’ll want to focus on strengthening key areas with runner-specific exercises. Targeting your hips, knee, and lower leg can help prolong fatigue and devastating tensile forces.
The treatment for shin splints becomes primarily about reducing the torque stress on the tibia. This is done in a number of ways:
To reduce impact one may increase the step rate / cadence while running. A slightly higher cadence, often suggested to be optimal in the 170-180 range, may decrease the loading on the tibia since a higher cadence can reduce over-striding.
To strengthen the bones you may consider supplementing with Vitamin D3, Magnesium, and Calcium.
And when it comes to strengthening the muscles every day should be hip day!!
So You Have Shin Splints, What to do Next? | Brad Beer | “Many runners incorrectly believe that they have shin splints when they experience pain at the front and outside of their shin bone.”
First, rest. Then:
When the athlete can hop on the single leg easily without pain, they are likely OK to go for an EZ run that day.
Upper Body Running Form | Steve Gonser at RunSmartOnline.com | “Moving your trunk generates large amounts of torque that benefits you as a runner”
Principles of Natural Running Video | Dr. Mark Cucuzzella | “Let’s review the essential features of natural running”
Proper Running Technique: Six Ways to Improve Efficiency | James Dunne | “Whether you’re a heel striker, forefoot / midfoot striker, barefoot runner, etc… there are a number of simple ways in which you can improve the efficiency of your running form.”
My Running Form Analysis | Kyle Kranz | “What did I learn from my gait analysis?”
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Sean Gerber at Kinetic Revolution suggests that..
Knowing what to do with or for an injury all begins with understanding how it developed in the first place. Going back to the cause can give you a roadmap to reversing the injury and running pain free.
Plantar Fasciitis tends to strike those who overdo it – which is a relative concept of course, depending on where you are in your running journey! This could be overtraining in general (too much volume / too many miles per week) or it could be more specific than that (too much speed work or hill training).
It could even be an appropriately aggressive amount of training but a lack of essential recovery work.
This frustrating injury develops as a response to training stress. When collagenous tissues such as tendons, ligaments and fascia incur repetitive stress, they will thicken to better handle the stress in the future.
This is a normal response to training. If changes in training occur too rapidly, or if you do not manage the tissue well during aggressive blocks of training, the stage is set for the tissue to adapt poorly and lead to PF pain.
My plantar fasciitis rehab routine that I suggest to people is largely based on what John Davis at Runners Connect recommends:
These are methods that are fairly simple, inexpensive, and can be done on your own at home.
1. Wear comfortable shoes with some cushioning and arch support, and avoid hard shoes or anything barefoot.
2. Ice your foot several times a day, either with ice cups or a round, frozen object like a plastic water bottle. If you run, ice immediately afterwards.
3. Stretch your calves at least three times per day. Each session should consist of 3×30 second holds, first with your knee straight, then with it bent.
4. Stretch your plantar fascia three times per day. Each session should consist of 10×10 second holds. Make sure you stretch right after getting up in the morning.
5. Use a low-Dye taping to protect your arch when you walk around or exercise.
6. Consider using an over-the-counter orthotic like SuperFeet Green or Powerstep in your everyday shoes and running shoes.
7. Wear a night splint or a Strassburg Sock at night to stretch out your arch, Achilles, and calf muscles.
8. Roll out your plantar fascia with a golf ball, taking care not to press too hard on the injured area.
Be A Fanatic About Your Running Gait And Heal Your Plantar Fasciitis | Miriam Diaz-Gilbert @ Huffington Post | “In an email correspondence for this piece, Dr. Legere explained two things that often cause PF. Muscle weakness in the foot or calf muscles that hold up the arch of the foot can cause PF. Muscle weakness and improper gait patterns (the movement our body makes when it walks or runs) stress and fatigue the muscles that hold up the arch.”
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The Evolution of Carbo-Loading | Matt Fitzgerald | “You aren’t still putting yourself through a depletion phase, are you?”
What not to eat before a marathon | Tad Kardis | “I follow a low-residue aka low-fiber diet during the last 24 hours. The purpose of that is to make sure my GI tract is as empty as possible when the gun goes off. If you haven’t run across the pictures of people who don’t do this, I don’t recommend you go looking for them. Eww”
Application of the Wet Test & Static Arch Height for Assessing Running Shoes | Pete Larson at RunBlogger | “despite significant differences in arch collapse between the groups during static testing, arch collapse was identical in all three groups during walking, and the only difference observed during running was a small but significant difference between the hypermobile and hypomobile groups”
Running Pronation & Over Pronation | Steve Gangemi at SockDoc | “If you want to move well you’ll want to pronate!”
How Does Your Arch Height Affect Your Shoe Choice and Injury Risk? | John Davis at RunnersConnect | “Overall, whether you have a high or low arch will not affect your risk of injury, nor should it affect what type of shoe you choose, but it could affect where you get injured.”
Do You Pronate? A Shoe Fitting Tale | Pete Larson at Runblogger | “If you pronate, you should get one of the shoes labeled stability.”
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