Elitetrack: Sport Training & Conditioning

All,
I am coaching a high school female athlete this year who, last year, had a stress fracture at the end of the season. She did the right things in the summer and was able to play soccer and start training on her own in the fall and winter. Because of this extra training, she is in fantastic shape and, in my opinion, she will be able to run sub-60 seconds in the 400m with the right training.

As her coach, though, I’m struggling with the right approach because yesterday she mentioned to me that she just started to feel the comings-on of shin splints in her previously stress fractured leg. She has already been taking 2 days a week off from training. Should I increase this rest? I’m afraid that if I back off too much, she will peak in a couple weeks and we still have 10 weeks to go in our season. She’s already running low 43 seconds in 300m, but struggles hard during the last 100m and the type of training that I know of to help with that may be too much for her leg. Help! Any ideas?

Thanks,
Cody

The #1 issue with shin problems is proper footwear.  If she was fine in soccer and in the early winter, are her shoes getting worn?  If she needs new shoes, GET THE SAME ONES that she trained in successfully earlier in the year.  Did she buy different shoes recently?  Is she running on a different surface?

After the footwear issue has been ruled out, you have to make sure the muscles of her lower leg are in good condition.  When they are chronically tight they pull on the sheath that covers the tibia.  Prolonged stress in this manner can be a lead in to a stress fracture if it persists long enough.  Good stretching helps but good manual work is 10x better. 

Ideally you or someone need to be able to check her:
flexor digitorum longus (flexes the 4 small toes)- this muscle can be accessed just medial to the shin
tibialis posterior (inverts of the foot and plantarflexes the foot)- this muscle is beneath the soleus and gastroc
soleus
tibialis anterior

These are the main muscles that can yank on the bone covering.  If it sounds complicated, it’s really not.  You might be able to get a soft tissue guy to show you exactly what to do in 10 minutes.

When these muscles are tight they pull on the bone and don’t function optimally.  When they don’t function optimally, the foot will not be controlled properly leading to a breakdown of stability in the ankle region which leads to more stress upon the shin & foot.  It’s a vicious cycle.

http://books.google.com/books?id=g6eCsKTECssC&pg=PA437&lpg=PA437&dq=flexor+hallucis+longus+netter&source=web&ots=jF5Fghl5aF&sig=QUQjnl7kq__buyENchlU1_CW4Ek&hl=en#PPA422,M1
http://books.google.com/books?id=g6eCsKTECssC&pg=PA437&lpg=PA437&dq=flexor+hallucis+longus+netter&source=web&ots=jF5Fghl5aF&sig=QUQjnl7kq__buyENchlU1_CW4Ek&hl=en#PPA424,M1

I suppose you could also try taping or a compression sleeve.

Mortac8,
I do know that she purchased new shoes just before the season started. She has been working with a foot specialist that has been providing orthodics for her. You suggest using the same shoes as in the fall/winter, but what if the orthodic specifications have changed since then? She has been running on the same surfaces all year—track, turf, and grass, but she just starting using sprinting spikes which may be an issue as well.

Also, more generally, what are some shin splint reducing factors to look for when buying shoes?

Thanks,
Cody

Ok.  I’m sure the foot specialist is much more qualified than me.  I would listen to him regarding the footwear.  Just make sure he’s aware of footwear changes.  Does she have orthotics for her spikes too?

Generally any shoe that allows or promotes excessive pronation can be a biggie for shin problems.  I generally don’t like running shoes with super thick padding/soles because often the thick padding will wear to one side or the other just a little bit forcing the foot into the position that you don’t want. 

Usually if a certain piece of footwear is the problem, the athlete can tell just by changing shoes and doing some very light runs.

Is her shin pain on the inside or outside of the shin?

Mortac8,
Okay, I will do some research and run some things by her. Do you suggest any sort of training change for her? In my experience, once you get shin splints, they rarely go away, but because she has a history of a stress fracture, should I significantly change my training plan for her?

Cody

In the case that nothing helps you might need to change the training a bit.  Depending on her insurance, see if you can possibly get a freebie visit to a chiropractor who knows ART (active release) and pick his brain.

Mortac8,
To answer your question from a post or 2 back, her pain is on the inside of her shin, about 1/3 the way up to the knee starting at the ankle. Also, she describes the pain more as “tingling” than searing.

Cody

Thats where I get my shin splints.  Ice bath everyday (even if you dont feel it).  Definitely helps alot.  Running in spikes would strengthen the shins.  You can have her warm up/cool down in free’s which should also strengthen the shins.  Or, you can have her do shin strengthening exercises like plantarflex/dorsiflex walks and writing her name (with her foot) while sitting in a desk.  Due to my knowledge, what causes shin splints is not entirely known, I believe the best theory out there is that there is an imbalance of shin muscle strength (which those exercises should all help with).

we have had recent success with shin sleeves. i am no expert - but two of our chronic shin splint sufferers have had luck with mueller shin sleeves.

The best treatment for shin splints is preventing them before they ever happen by using appropriate and decent-condition footwear, strengthening the foot-ankle-lower limb complex, reducing impact when possible / beneficial by training on softer surfaces, and keeping stress reactions at bay by regular icing and soft tissue work if necessary.

Since reading this article: http://www.sportsinjurybulletin.com/archive/0161-shin-splints-treatment.htm about shin splint exercises last year, we have incorporated them into our daily workouts. This particular athlete has been doing them every day since the fall, has orthodics in her shoes, and has been icing regularly which cover the first 3 preventative treatment you mention. We could do better to train on softer surfaces other than the track, but the soccer turf is being used by the soccer team concurrently with our practices.