Shin splints and shin pain in general can be an injury that crops up all of a sudden and ruin your running experience. Physiotherapist Tom Goom joins us once again to break down what can go wrong with the shin, what exactly are shin splints and how to best approach preventing, treating and recovering from shin injuries.
Hello and welcome to the Run aswell podcast with me Rick Pearson and me Ben Hobson today we’re talking with running physio Tom goom about all things shinsplints it’s a good one I say this about every single one of them but um Tom’s great at just breaking down what
What’s what the problem is what the problem may be what the many options that you have when it comes to problems and then how to sort of approach them and I think the shin is one of those ones where we have a multitude of recurring things all squished underneath
The shin splints kind of name very misdiagnosed kind of problem as well yeah yeah so um if you’ve got any form of shin pain discomfort issue listen on listen on because this is this is this is the one this is the one for you um we’ve both been running Ben um you’ve
Been doing the Ben Fleet 15 which was actually named after you I found out yes yeah yeah yeah um you spell my name b n and then the fleet is silent so no one ever says it but yeah my full name is Ben Fleet uh yeah I I went out and uh
And ran into a block headwind for for a good amount of time at the weekend which was good no it’s great race um yeah in and around uh Hadley and Ben fley in Essex okay yeah um along the seaw wall some off off road isn’t it yeah Trail
There’s a little bit of Road joining bits and pieces up here and there and you finish on the Olympic mountain bike course from 2012 Olympics and there’s a very nice little aggressive gradient to finish on Amazing yeah it was a really fun where did it with my my mates uh
Josh and Matt from the dog pack oh yeah yeah uh and yeah it was a good day out we were sort of in the car deliberating whether or not we were you it was one of those ones where we’ve all been tired and a bit hurt in different ways not
Like chronically but just like a bit like niggles or whatever it was and we just kind of went are we going to do this like should we is this and we went oh come on yeah good few yeah turned out to be a great day yeah I think if you’re
Racing in January you’ve already won agreed you’re saying yes to something aren’t you yeah and it was a good it’s a really good way of like benchmarking the start of the year yeah I’ve never raced a I’ve raced 50 m once before it’s been a while yeah it’s got rare isn’t it it’s
Not it’s not like a I mean we’re doing this I’ve done this one and I’ve got we got a 15 one in March the Orion so maybe this is the year for me racing 15 miles um but yeah it was really nice it was really good to sort of as you say like
January doesn’t feel like a month really where you you would race a lot but actually there was you know everyone was out the noise was good the crow cheering and it really sort of like didn’t feel January so it was yeah it was nice I
Think yeah I I so I went down to Canterbury for the can be 10 m which is like a kind of classic Road Race I think 10 mile distance one of my favorites as you know really is yeah um and the weather was it was a bit windy uh it’s
Pretty cold but it was similar it was like it was pretty low like low fuss good good sort average standard of Runner yeah um very well organized uh and and yeah I felt I felt good doing it I got this very strange like Stitch like
S and a half miles that ended up going like was quite low in my stomach and I actually had to stop for about a minute well you did at one point think that your appendix was about to yeah yeah and I was like and um the problem was I was
Wearing these shoes I won’t name the brand but one was red and one was blue all right when you’re when you’re on the side of the road walking in a pair of red and blue shoes yeah it’s a bit like it’s a bit like going turning up to a
Football match in white boots and being and being a bad play me it was a bit like you weren’t doing the shoes Justice yeah yeah ex I didn’t do the Sho Justice which I really like the shoes as well um but anyway I got it
Done and uh yeah it felt really I felt really good afterwards actually I felt like I actually kind of achieved something in January and like said it sort of set you up don’t necessarily to do your greatest ever performance but yeah I think that’s it it wasn’t like
The best race of you know it wasn’t I didn’t I felt really happy with the result having very little sort of like expectation or that sort of stuff and um I thought it was one of those races where a lot of the time I think if you don’t
Feel 100% ready to to like absolutely give it your all at the start of a race you’re already feeling a little bit on the back foot yeah you haven’t brought your best self to the to the day and I think that that that can be a bit like
Well what’s the point sure yeah whereas this wasn’t like that at all this was like well we’ve made it which is already a success and and on we go so yeah I had a good time good time look at us just racing around the country that’s what I
Say good well so you know if anyone else knows any more 15 Mile and 10 Mile races oh yeah please let us let us know podcast runw well.co all right um well let’s let’s get our let’s get our guest of the week on let’s do it guest of the
We here in the studio guest of the week sometimes on the phone could be an aete could be a complete Our Guest this week is a leading running physio based at the body rehab studios in Brighton and hve and he’s here to give us a Lowdown on shins
Spint so Tom goon welcome back to the runners World podcast thank you for having me back big one yeah think this a popular injury very Tom is this a popular one people really love this one is it a very common thing that you see oh yeah people people love a bit of shin
Pain definitely yeah I think that that’s let’s get into that then Shin pain shin splints Shin stuff like what because I mean people will probably think one is one and all are the same so kind of like let’s let’s talk about the shin and what it what it’s comprised of and and what
The the possible pitfalls of the shin are yeah so Runners tend to use the term shin splints to refer to nearly any pain that you can get in that Shin region um but but we tend to think of it as a a specific diagnosis which is a very long
Uh term which is medial tibial stress syndrome now what that that is is that the medial part of the tibia which is the larger of the two Shin bones so the bit on the kind of inside of the leg becomes irritated by the running and you get this pain and it’s kind of
Classically quite sort of spread out along that part of the of the shin um and it’s there with running and impact and then settles quite quickly with rest so that’s kind of the main diagnosis we see the most common cause um but there are actually lots of other causes of
Shim pain that people can get confused with and some that need quite different treatment techniques and things that’s interesting so so what could shins spits be kind of um misdiagnosed for do you think well the the biggest probably the biggest concern we have is actually sometimes people have a stress fracture
So rather than it just being a bit of irritation of that that Tibi of that um you know large shim bone actually sometimes they’ll actually have a stress fracture of that bone which obviously is more serious and and needs to be more carefully examined so we I always say
With shim pain particularly if it’s been persisting it is worth getting it checked out to rule those things out um the other thing is that the where the pain is where it’s located is quite important so this kind of shin splints we’re talking about the medial issue is
Around the inside of the shin whereas if you’re getting pain around the outside of the shin higher up in in in the muscle um around the outside that’s a different condition so um it’s where it’s important to try and work out what what’s the actual diag nois here before
We start managing it yeah I’ve always been confused that sort of like that that that front Ridge of bone that you can feel along the shin and like people have always sort of talked about muscle tearing away from that bone and is that sort of is that is that a shin splint
Like what’s that that just sounds awful I mean like that just that but I think that that’s that’s where a lot of confusion comes from yeah that that kind of idea we’ve thankfully moved away from because it doesn’t sound very nice and it and it isn’t really what’s happening
The muscle’s not pulling away from bone or anything drastic like that um i’ think of it more as the bone being just irritated from working too hard um you know we we’ve talked in the previous podcast that you know tendons and Joints they they don’t like being worked too
Hard with the running and and Bones similar so it’s almost becomes inflamed along the surface of the bone and that’s what we feel so it’s not muscles pulling away um or or you know there isn’t really a splint as such that’s why it’s not such a great term if you see what I
Mean yeah yeah I think it’s misleading um is it shins spits more of a um beginner injury I kind of associate maybe with some people who are new to running and get shins spins rather than maybe someone who’s been doing it for rather than like an overuse thing yeah I don’t
Know that many people who have done Ruby money for 10 years who suddenly talk about shins spins but maybe I’m Maybe I’m Wrong no I’d say it is more common in novice Runners actually yeah so so new Runners they haven’t built that kind of tolerance to running that that we get
You know if you’ve been running for several years your body does adapt and get used to it whereas new Runners don’t have that and quite often they’ll perhaps do a bit too much too soon and yeah so they they often will be the people that develop the Shin Shin pains
It’s also a little bit more common in female Runners than men and there are some other factors linked to it so things linked to running style muscle strength for example like weakness in the glutes can be a factor um so there’s quite a few different things that that
May play a role in uh in this injury developing I was going to ask Tom is this is this very much like a specific to the shin issue as in that we that muscle in the shin is weak or is it as you’ve sort of hinted is it actually
Just that it’s more of a smaller controlling muscle and the bigger issue tends to be something else or is it a combination of both I think it’s it’s probably not just going to come down to like one muscle or anything like that I think one thing we know now is that you
Know really any any bones in in the leg if you work them too hard they can react and that they react in a way that involves pain and really the key driver for that is is how hard and how much we’re training that’s kind of the the
Key thing it pushes it beyond what it can cope with the muscles do play a role you know we think stronger muscles work like better shock absorbers perhaps to help reduce the risk of these types of bony injury but that’s kind of the whole leg we we’re interested in rather than
Just just one you know one specific muscle you know when we’re thinking about these kind of medial tibial stress issues I’m always interested by those um those weights you can get you know this sort of it’s like a band that goes over your shoe or your foot and then you load
Up the sort of like a plate onto the the back end of it and you can kind of flex you can almost look like a bicep curl but with your foot and that sort of strengthens up that is that is that you know those sorts of exercises yeah so
Those are really popular at the moment but they’re they’re not they’re not actually something that’s been um sort of researched a lot and I think there’s one thing we probably you know want to talk about a little bit with this is you know that these couple of different
Diagnoses that can cause pain in this region so we talked about medial tibial stress we talked about stress fracture the other one um is more overload of tibialis anterior so that is more of a specific muscle issue so if people listening in are actually getting pain
Towards the outside of the shin in that kind of muscular bit of the top that that isn’t so much a kind of bony issue we think it’s that muscle fatiguing during running so it’s quite a different condition but it still comes under that kind of broad sort of shin splints definition that
Runners use and the the treatments will overlap a bit but there might be where we want to look a little bit at assessing that muscle and and you know addressing its needs really in terms of um running style does does that play a role is it something that maybe midfoot
Or four-foot strikker would have more issues with or heel Strikers or does running style not play such a key role in this yeah running running Styles does play um a key a key role I think so there is some research that those with a lower step rate or Cadence as Runners
Will often call it are more likely to develop Shin pain so people with a step rate I think is 164 or less seem to be more likely to go on to get Shimp pagne and is probably the case because when you have a low step rate you’re more
Likely to overstride and it’s that that puts more stress on the shin um it’s also perhaps more likely you’re going to develop some some issues around that medial Shin if you’ve got a very narrow stride so if you’re someone who who almost runs like they’re crossing over a
Line or you find your knees brushed together as you run again that can put a little bit more stress um on that medial part of the the tibia for that um you know tibialis anterior issue that kind of muscular part around the front that is also going to be linked to over
Striding because we tend to land with the foot more dorsiflex more raised up which works that that muscle more now if you move to midfoot then yes it will will reduce the stress um on that muscle to some degree but if you move all the
Way to for foot you end up working the calf more so um for a lot of people that the strategies we might use would be looking at perhaps increasing the step rate a little bit you know that can reduce the stress both on the the the
Shin bone but also on on tiis anterior that muscle that can be overloaded how much does uh things like uh ankle flexation um shoe Choice like your foot strength how how much does that come into play with with Shin issues I I think it’s quite important I
Think if you’re quite strong through the Foot and Ankle then generally I think it’s probably less likely you’re going to develop these Shin issues um although it’s fair say there’s not a lot of research on that it’s just sort of personal experience and the Footwear can
Make a difference too so with um with things like kind of your medial tibial stress that kind of uh pain around the inside we might suggest perhaps a more um supportive shoe uh with a larger Heel To Toe drop a little bit more support through the AR arch of the foot bit more
Cushioning might be quite helpful and actually going to a more minimalist shoe can increase the stress um on that part of the shin so we wouldn’t tend to do that now this is where the diagnosis matters though because that muscular pain I talked about on the on outside of
The shin responds the other way so they tend to do better with a lighter shin without so much Heel To Toe drop because it’s that muscle T anterior that’s got to lift the weight of the shoe so this is where actually seeing someone getting a diagnosis is really important because
It will change some of the things you do interesting when you talked about Cadence Tom because that’s obviously a term that gets discussed a lot and um it seems to be the cure for for a few injuries getting your Cadence up if if indeed if your Cadence is in the kind of
160 Mark how as a physio do you actually encourage a quicker Cadence this is really easy actually so first of all we obviously want to test what people’s um Cadence is um a lot of Runners listening in your your you know um GPS watches will often be able to tell you this
Fairly accurately so we start with the patient’s Baseline that’s really important and we usually try and increase it by about 5 to 10% using a metronome so there’s lots of different apps you can use that will play a a beep as a metronome so what you tend to do is
Use that you set it at the Target you want for your step rate and you literally just run to the beat and it’s very very easy to do it like that it’s the easiest way to to to change your step rate um often Runners will find if
They do this on a on a treadmill first it’s easier because your speed will be fixed um so you practice a bit on the treadmill run to the beat of that metronome and then when you feel comfortable with it you practice it um you know out in your normal running
Environment and it’s time for an ad break right back to the show have you done that before right I haven’t actually and I was told off cuz I did it during an ultra race and someone was like you cannot have that playing oh you wow cuz I was like wanted to get into
Like a 180 I I don’t know what I think I was going through a weird period of My Life um and within about a mile someone said you just cannot have that being cuz I didn’t have actually didn’t have headphones in oh my God you that guy so
Come I mean they were right they were right they were right but I like I like it as an idea and I think I think it’s great I’ve done it and it really helps like it’s a really useful little thing and I think that lots of people can Will
Imately think that that sounds quite intense like having to but it’s actually quite it becomes quite um meditative yeah almost that you kind of like find a Zone and you kind of sit in this little oh I’m just you know tapping it out and I think it’s a think would definitely
Make a big difference I think like obviously like 180 is like and obviously well Tom you tell say but it seems to be tighted as like the gold standard but for people who maybe have a slow CES it’s much faster than than a lot of people might think I think be like
Really this quick you know yeah what 180 is one of those ones where it’s it’s a little bit of a myth really um it our step rate our Cadence actually changes a bit with speed anyway so this idea of saying oh we just got to do 180 all the
Time because a very small group of elite Runners did it in one one study is not you know it also changes with things like how tall you are and things like that so this is why we always go with the Baseline with what the person has rather than just a sort of arbitrary
Number so we start with their Baseline yeah and then we increase 5 to 10% from there the other things that you can do now with the modern sports watch is you can actually set a Cadence kind of Target zone so you can say I want my
Cadence to be say 165 to 170 and then the watches will kick in their own metronome if you fall outside of that so if you if your step break drops but it it is hard you know because think about it you’re going to be increasing the
Amount of Cycles you have the amount of of times you’ve got to move your leg in a minute if you see what I mean so usually we don’t say right set set up your Metron name go do 10K with it it’s really hard to do that it’s usually
Better to begin little burst of 20 to 30 seconds when you remember during a run get used to it see how it feels see you know if you’re doing it fish Shin pain for example see if it helps your symptoms and then go from there really
In a sort of the wonderful world of prehab so we’ve got people listening who haven’t got any current got any Shin problems but they’re thinking oh I don’t want that that sounds rubbish what are the things that are there sort of you know standing against the wall and
Lifting your toes there sort of exercises like that you know like very focused on on on the things we’ve discussed already that can kind of like Aid in in sort of making sure that the shin is robust yeah I think I think it’s a good idea to do some strength work
Around the Foot and Ankle so you could just as you said you could you know stand with your back against the wall uh do some some lifts so lifting the toes uh up to work the muscles through the front of the shin you could add some
Weight into that so um people can use resistance band I know some people actually hook their foot into like a small kettle bell um so you can do that kind of thing to strengthen up that muscle if you want to um I personally think there’s probably a bit more
Mileage in strengthening up the calf the calf is a major shock absorber and manages a lot more weight than than those muscles around the front of the shin so you know if if I was thinking about like preventative exercises for this you know strengthening the calf the
Quads the glutes those big muscles that manage a lot of load would be good but really what’s key is planning your training and your recovery from that training because you could be super super strong you know in the gym four or five days a week lifting huge weights if
You suddenly go out and run more than the the body’s ready for it’s still likely to hurt so the shin is really one of those load like volume kind of problems most of the time where you would find when people come in they’ve as you say they can be as robust
Physically as they as they can be but but if they’ve gone from zero to 30 mile weeks or whatever that’s that’s really when the shin stuff kicks in yes yeah and often intensity is a piece of that puzzle too there’s a lot more stress on
The bone as we run faster so you you you know you often sees people yeah I’ve really pushed how much running I’m doing but I’m also doing two or three speed sessions a week and now my Shin’s really really sore um so it’s it’s trying to
Find out what they can manage and and that’s there this is where there’s a really big difference in management of these types of shin issues is that we don’t recommend running in pain that is a big difference like we we often say you can run with a bit of discomfort
With a tendon issue but if it’s a bony stress problem it doesn’t do well running with pain yeah because we’ve talked on this before it’s a sort of a pain scale and if something’s manageable and and if it is then that it’s okay because it’s not going to it’s not going
To increase the damage being done but with this with a bone related thing is actually this is a unfortunately for those who suffer from this this is a stop running sort of situation it is or it’s a reduce the running to painfree levels that’s the thing so you
Know if someone’s listening in and you know you know you’re pretty comfortable for 3K but after after that you start to feel some some Shin symptoms then it would be sensible to cut it back to to what feels painfree that’s the thing um they have tried one study said okay well
Runners can can keep going up to a four out of 10 pain as part of this this program in the research but it took him over a 100 days to build up they’re running to just 20 minutes yeah you know that’s over three months to get to 20
Minutes so and it’s what we see in clinic people keep running through these types of shin pain and it it just keeps it irritated to will’ll often either dial it right back to a pain-free level or we suggest a a rest period from running um sometimes it can be as little
As a couple of weeks to really settle the symptoms down um people can often cross train with non-impact stuff so they can cycle swim cross training in the gym row anything think painfree and then we retest them we make sure they’re not getting pain with with impact tests
Like jumping jogging on the spot hopping that kind of thing and then we gradually build them back up again and keep it pain free that’s that’s one of the key ways we manage these medial tibial stress syndromes um you know that pain around the inside of the shin does um
Does surface play a role Tom would you be more likely to to get shin pain shin splints if you running like purely on hard surfaces or would would a return to like if you were returning from it maybe running on soft surfaces start off might be something you’d recommend or is there
Not actually much evidence for that stuff there’s not a lot I think probably we could recommend treadmill over Road probably less going to be less stress on the on the shin uh bone when you’re running on a treadmill compared to when you run on the road and your step rate
Tends to be a bit High about 5% higher on a treadmill than it would be on the road anyway so but really what we we govern it by symptoms because you can always have a the I think he’ll be more comfortable on the grass or I think he’ll be more comfortable on the
Treadmill but we listen we got to listen to our Runners and see if they say oh I can’t do Road it’s really sore but treadmill is very comfortable that that’s what’s going to going to guide us um other things obviously running slower will help um because there’s less stress
On the shin there um running on the flat or or actually downhill has a little bit less stress this is a surprising one for people but downhill tends to be a little bit less stress for for the potentially we might get them to work on their stride width run a tiny little bit
Wider if that’s an issue for them there’ be lots of ways we’d adapt it to try and keep it painfree with that’s an interesting point Tom with with width because it’s really something we’ve never discussed we’ve always talked about Cadence and people sort of like whether they how they go through the
Gate cycle but the width of someone’s running gate that sounds like how how I mean as you you mentioned that knees brushing or sort of almost like an overlapping of where the feet cross in the M on that Center into line if you had a sort of line running down the body
Um how how do you go around sort of adjust getting someone to adjust that is that is that a muscular thing is that a physiological thing uh it’s more of a technique thing really and most of the changes we want to make to running gate actually focus on changing the technique
Itself the running gate doesn’t change that much in response to strength work for example you know so people might think oh well you know I need to strengthen my glutes to to help kind of this HIIT position but that doesn’t actually change the gate very much so
It’s simple stuff qu quite often when you watch someone run and they’re narrow what what you’ll see is that their their knees brush together as they’re running and and they just don’t notice it because it’s so normal for them so I would use a really simple cue like don’t
Let your knees touch while you’re running so that people just create a little space between the knees um you can suggest just running wider so focus on keeping a little bit more of space between your legs as you run but this takes a bit of practice and more so than
Increasing the step rate which most people get quite quickly most people overcompensate so they run really really wide to begin with and it’s very uncomfortable if you try it yourself it just yeah it looks and feels pretty horrible so it takes a bit of practice
Bit of feedback to kind of get to a level like yeah this this is what we’re aiming for here a little bit of space between the knees um but not no not running like you’ve just got off a horse yeah I did a lot of that actually cuz my
Right leg was very much acrossing the the midline right and it’s it took it did take a couple of months of actually trying to get it right yeah I mean you must be you’re fighting against Cadence is very much a manipulable thing Tom mentioned like the faster you go
Naturally your Cadence increases and you can do that but if you’re sort of fighting against the natural sort of like alignment of your body I guess in sort of yeah it was it was quite a trial mentally to sort of remind myself to do
It um CU look you now I it’s yeah the actually epitomy of efficient running form but because I would naturally think and it sounds like this is wrong that you know stuff like you know this kind of lateral um lateral movement like with a resistance band where you would do
Kind of like marching to the left or marching to the right where you’re moving your your leg away from the midline or like a lateral lunge yeah anything like that that kind of is moving the the body away from midline I would think oh maybe that’s actually
Helping create some kind of width when I run because I’m strengthening the muscles on the side of the glue but that’s not that doesn’t sound like that’s actually true maybe I should stop doing it I mean those great movements to do but the thing is running’s there’s a
Real skill element in running and it only seems to change from you know what we see in the research and clinical experience when you practice that skill so you could you can do lunges and glute strengthening and that’s really helpful you know if you strengthen up those
Shock absorbers that’s a good thing but it doesn’t seem to change how we run very much we have to kind of practice running and change that if we want to change it and you don’t have to you know people listening into this you don’t have to change your running gate to
Successfully overcome Shin pain you can as part of it because it can help reduce the stress on the shin but many people if they if they give this a chance to settle and then you know gradually build back up again they can do quite well um
But I think a good starting point is seeing someone to work out like what what is the issue you know as I said there’s there’s probably three main ones in this Shin region you know medial tibial stress syndrome stress fracture or or overload of tibialis anterior so
It’s trying work out which of those might it be or maybe something different and then planning around addressing that and and your needs really thank goodness for people like Tom because otherwise we just people we’ve been carrying on telling people that the bone was ripping away from their shins that was it like
You know we no we Public Service we’ve never said that but it’s um it’s really thank you Tom for joining us once again an incredibly informative uh re sort of like summary on on the shin and it’s what it’s you know it’s a very useful bit of Kit when you’re running the sh
Yeah you need that you do need them one tiny extra point I would add yeah if you’ve got pain in the front of your shin and it’s very pinpoint like in the front on the bone that needs to be checked out really quickly because there’s a certain type of bone stress
Injury we call an anterior stress fracture and those require very rapid investigation so if you’re listening into this and it’s it doesn’t feel like it’s around the inside or around the outside it’s more in the middle and it’s it’s on the bone get that checked out
Pretty quickly I would and that would be one that’s like you can put your finger on a very specific spot T more typically with with stress fractures of the shin there’re they are a specific spot that’s tender on the bone whereas with a medial tibial stress it’s quite spread out
Along the surface um but they they they do present in lots of different ways and it’s something that actually if you’ve got a stress fracture in that region quite often people need to be non-weight bearing for six to eight weeks on crutches so these are the kind of things
We want to be you know anybody listening in if you have any any symptoms in those regions just get it checked out most of the time with a good history and and a good examination we can say no it’s not that but it’s this is what you need to
Focus on um but those symptoms I wouldn’t just ignore and try and train through Tom thank you so much for your time coming on the rville podcast um great to have you back on I’m sure we we we haven’t covered all the injuries there’s more that we can cover still for
Sure there’s loads absolutely thank you once again for having me it’s been a real pleasure thank you Tom cheers Tom so that brings the end of this week Runners World podcast a huge thanks to our guest Tom goom and to you of course for listening I’m just typing Runners
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