I was asked about shin splints, preventing and getting over them, but I dive a bit deeper and briefly discuss that an injury is so much related to what happened right before, a few weeks before, it could be nutritional, could be a dozen things.
First, why do runners get patellar tendonitis?
The patellar tendon is a short but very wide tendon that runs from your patella (kneecap) to the top of your tibia.
The reason you have a kneecap in the first place is to generate a bigger mechanical advantage at the knee—this allows your quadriceps to create strong forces at the knee, which are important in any sport with running or jumping elements.
However, the result of this is that the patellar tendon has to absorb a lot of this loading, and as a result, it’s prone to injury in runners and jumpers; one study found that patella tendonitis accounts for just under 5% of all running injuries.1
Unlike many common running ailments, patellar tendonitis is somewhat more common in men than in women.
Patellar tendonitis usually begins with a stiff feeling in the patellar tendon, especially when running downhill or descending stairs.
Like most tendon injuries, it may go away once you get warmed up, but as the injury worsens, it will remain painful for the duration of your workout.
It is also important to distinguish patellar tendonitis from patellofemoral pain syndrome: patellar tendonitis does not hurt along the top or the side of the kneecap but typically under it, and isn’t usually sensitive to the touch.
If squats hurt: Decrease the load. You can achieve this by decreasing the weight you squat, decrease the range of movement you use, decrease the number of repetitions you do, increase the rest intervals in-between sets, change your technique by getting your bum back more and loading more through the hips than the knees.
Do you find it hurts more running in shoes with a bigger ‘drop’: If so, you may find that switching to a more minimal running shoe, or even barefoot, is enough to offload the knee and switch the load more to the foot and ankle.
If running, in general, is irritating your patellar tendon:.
Try these running re-education cues. They all generally shift load away from the knee.
- Increase cadence. Increase how many steps you take in a minute. Aim for 5%-10% increase and assess how it feels
- Improve posture. Work on running up tall. This will prevent the foot landing excessively in front of you (over striding) as you try to catch a forward positioned centre of mass.
- Increase heel lift. Something like the piston cue will help to get an increase in heel lift at toe off leading to a more circular movement of the foot, better knee drive and making it easier to land under your centre of mass.
Patellar tendonitis can be a tricky injury to bounce back from, particularly if it’s become a chronic problem. Fortunately, new avenues for treatment have opened up in the past decade or so. The gold standard of conservative treatment right now seems to be Alfredson’s eccentric decline squat protocol. It’s summarized in the points below:
- The basic protocol is three sets of fifteen one-legged squats, twice a day.
- The squats are done on a 25° decline (most calf stretching boards will do just fine).
- Starting from a standing position, squat down on the affected side to 60° of knee flexion (see picture above).
- Use the unaffected leg to return to return to the starting position. If both legs are affected, return to the starting position using both legs, assisting with your arms (on a railing or similar) if possible. Of course, if you have patellar tendonitis in both legs, you should do 3×15 squats twice a day on each leg.
- Exercise into tendon pain, but stop if the pain becomes debilitating. Once you can complete the three sets of squats with little or no pain, add weight with a loaded backpack.
- In most studies, the protocol is carried out every day for 12 weeks. It is not a bad idea to keep doing this exercise beyond 12 weeks as maintenance.
- Most studies mandate 8 weeks of no sporting activity. It’s important to note, however, that the subjects in these studies usually have quite severe cases, and often participate in very high-impact sports like basketball and volleyball. Your own plan for returning to running is something you’ll have to work out yourself, possibly with the help of your doctor or physical therapist.
Injuries are a constant risk for people who are trying to improve their running.
No matter how careful we are, niggles, twinges, or injuries can happen. Luckily if you’re mindful and smart about them, you can minimize their impact on your training.
Let’s break down a few scenarios.
The first is what happens when you develop a full-blown injury:
Now let’s go through what I did when I strained my foot in the exact same scenario:
In one scenario the runner who was not willing to rest was forced to take two full weeks fully off and will likely require at least two more to return to normal training. In the second real life example I took only a few days off and was able to at least run daily for the next week.
Resting for a few days will almost always be adequate to let a potential injury regenerate.
That is one of the hardest things for many runners to deal with, being willing to rest.
Below are a few other links:
What to do When you Pull a Muscle From Working Out | Stephanie Lee at Lifehacker | “think about it for a second: if a pulled muscle is a result of overstretching, then stretching it further to its full range of motion won’t help.”
Think Twice Before Applying Ice | Kristi Anderson, MPT | “The conventional use of ice, particularly in the first 24-48 hours following injury, soothes the pain and slows the bleeding into the injured area, but some experts suggest that its effects on the circulation might slow the natural rate of the healing process. Heat stimulates the area to respond in ways that seem to promote healing but the current research is lacking direct evidence that it influences recovery time.”
Heal Running Injuries Faster with Heat | Steve Gonser, PT, DPT | “Clinically, I use this quite often. It’s a great way to nudge yourself down the path to full recovery. Both the use of muscles and heat can cause increased blood flow; however, the latter can do so without loading healing tissue. A simple “on for 20, off for 20” cycle can draw blood to a localized area and keep you healing even when you’re lying low. Your only hang up is applying heat too soon. Here are some general rules for avoiding the use of heat:”
I was just talking today to an athlete of mine who had taken an extended break from running due to a non-running related injury and operation.
The subject of this conversation was about getting back into running after a long period with little or no ability to do any impact related sports.
We were talking about the best method of easing back onto the road. This is where the benefits of a coach came up. I’ve said before that a coach is not there to tell you what to do, but what not to do. As a coach, I don’t care that my athlete only ran 5 minutes today, or that they really really want to run more. I have no problem with being overly cautious.
Years back when I was just returning to running after a short break, I started with 10 minutes of jogging. Very slowly and gradually I extended the duration. The longer a volume buildup takes, the more successful and safe it is bound to be.
In a recent Running Times article about sub-15 minute 5k athlete Sally Kipyego and her return to running after an injury induced break, Sally shared that her first run was 10 minutes where she alternated 1 minute of walking and 1 minute of jogging. Talk about self control!
Only after 2-3 months of training was she up to 30 minutes of running at one time, and it took many more months for her to run a 60 mile week.
Patience is a word that should be at the forefront of one’s mind when something new is being introduced into training, even if that’s training itself. Be it anything from new shoes to new terrain. Even intensity should be brought in slowly. Brad Hudson gives people following his training plans their first taste of a hill sprint with a single 8 second max effort!
Social Media has even been blamed at times, for the lack of patience people can experience. Seeing all of your friends logging miles or joining a run streak can place pressure on an athlete to run more.
But remember the important of gradual adaptation! Nothing good comes quickly in running.
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.
However, true shin splints are medically titled medial tibial stress syndrome. Runner’s knee is patellofemoral pain syndrome. These are very specific terms.
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.
Chafing is when your clothes rub against your skin and a wound develops.
This is a tricky injury to prevent because it can come out of nowhere! Extra warm and/or long runs where you sweat more than usual may increase the chances of chafing. Wearing a running belt for a short run may be fine but wear it for a longer run and it could cause some friction.
The best way to prevent chafing is to be mindful of your gear. Know which shorts are great for long runs and which ones you want to avoid spending 2 hours in. Same for shirts or any other gear.
If you’ve already developed some chafing it’s best to lube it up for a few days so it can heal. Typically this will be adequate and it won’t be an issue again (until you forget to lube up before a long run!)
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.”
You May Also Like: My Foot & Ankle Routine
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.”
You may also like: Best Articles on Shoe Selection
This can be a tricky distinction, but one that must be addressed.
Pain / Discomfort that you can run through is
Pain that you should Not run through is