You don’t think about your shins until they hurt. And by then, you could be looking at some major downtime. A recent study found that it takes, on average, 71 days to rehab shin splints—that’s over two months on the bench.
Shin splints (the term for pain that occurs on the front, outer part of the lower leg) often occur when your legs are overworked. That’s sometimes due to a jump in mileage, and sometimes because your shins pick up the slack for body parts that are weak, says Susan Joy, M.D., a sports and exercise medicine physician with Cleveland Clinic Sports Health. Protect yourself by strengthening your feet, ankles, calves, and hips, which support your shins with these exercises. And if you are suffering from shin splint pain, scroll down for tips on how to alleviate it fast.
How to use this list: Perform each exercise below as demonstrated by Hollis Tuttle, certified personal trainer and run coach at Mile High Run Club in New York City. Perform 2 to 3 sets of 10 to 15 reps daily (but not before a run). You will need a step, a resistance band, and an exercise mat.
- 1. Toe Curl
- 2. Monster Walk
- 3. Heel Drop
- 4. Single-Legged Bridge
- 3 Easy Ways to Prevent Shin Splints
- SHIN SPLINT TREATMENT
- SHIN SPLINT PREVENTION
- It Could Be Tibialis Anterior Muscle Strain
- Symptoms of Tibialis Anterior Muscle Strain
- Causes of Tibialis Anterior Muscle Strain
- Treatments for Tibialis Anterior Muscle Strain
- Book A Physiotherapy Assessment for Shin Pain
- When walking makes your legs hurt
- Four conditions for leg pain causes that can affect you when walking
1. Toe Curl
Stand with feet hip-width apart and right foot on a towel. With the toes of your right foot, gather the towel and slowly pull it toward you. Return to start. Complete 10 to 15 reps then repeat with the other foot.
2. Monster Walk
Start standing with feet shoulder-width apart and place a resistance band around your thighs. You can use one long resistance band tied in a loop or a smaller circular band. Keep feet far enough apart to maintain tension on the band. Step forward with the left foot then the right foot. Then step to the left with left foot then the right foot. Step backward with the left foot then the right foot. Step right with the right foot then the left foot. (You basically walk in a square). Repeat going in the opposite direction.
3. Heel Drop
Stand with feet staggered on a step with right toes on the edge of the step. Shift your weight to your right leg and bed left knee to lower right heel down below the step. Return to starting position and complete 10 to 15 reps. Then repeat with your left leg.
4. Single-Legged Bridge
Lie faceup with your arms resting at sides, knees bent, and feet flat on the floor. Extend right leg straight out so that knees are in line. Squeeze glutes and engage left hamstring to lift your hips up off the floor. Complete 10 to 15 reps. Repeat on other side.
5. Point and Flex
Stand with hands on hips and shift weight to left leg as you lift right leg straight out in front of you. Flex toes toward shin then point toes away from shin. That’s one rep. Complete 10 to 15 reps then repeat on other leg.
6. Toe Walk
Start standing with feet together and arms at sides. Rise up onto toes. Step with right foot landing heel first, rolling onto midfoot, then through to the toes and lifting back up onto toes as you step with left foot. Continue to take 10 to 15 “rolling” steps then turn around and repeat back to start.
If you are experiencing shin splints, try these three tips to alleviate pain.
Massage With Ice
Freeze a paper cup filled with water, tear off the top edge of the cup, and massage with comfortable pressure along the inside of the shinbone for 10 to 15 minutes after running to reduce inflammation.
Add Arch Support
By “lifting” the arch with insoles, you take stress off of your lower legs. You don’t need to use these forever if you do strength work—think of insoles like a splint for your foot and remove them once you’re fully recovered. Try different options available at running specialty stores.
Stretch and Rest
Loosen up tight calves and Achilles tendons—both can contribute to shin splints. Reduce running mileage and do low-impact cross-training (biking, swimming, elliptical) instead. When you resume your training, ease in gradually. Too much too soon could cause a relapse.
All images: Julia Hembree Smith
For Fun: I enjoy all the outdoor activity opportunities Denver and Colorado have to offer. That’s what makes it such a joy to live here. Hiking, biking, skiing, climbing, fishing, game nights with friends and weightlifting are all valuable pass-times on the weekends. A good brew or some red wine are always great additions to a non-fiction novel. It’s just about finding the work-life balance we all seek.
Luke Sugg, PTA, Licensed Physical Therapy Assistant
Specialties: Functional Manual Therapy, Core first strategies
Treatment Philosophy: Luke thoroughly enjoys Physical Therapy and having the opportunity to heal patients ailments. He has first hand knowledge recovering from an injury with the help from Physical Therapy. Connecting with each individual, and promoting the highest human performance and enhancing overall body mobility, retraining movements to the entire body helping each patient get their quality of life back.
Education: Luke received his Associate’s of Occupational Science degree as a Physical Therapist Assistant in 2012 at PIMA Medical Institute in Denver, Colorado. He enjoys growing as a manual therapist through manual therapy courses through the Institute of Physical Art, looking towards pursuing FOC certification.
For Fun: Luke being a Colorado native from Boulder enjoys being outside and being involved in activities whether on water or land. He has a passion for baseball and all sports, loves being around the atmosphere that games have to offer. Go Buffs!
Kodi Barker, MT, Certified Therapeutic Massage Therapist
Specialties: Registered Massage Therapist with certifications in Neuromuscular Therapy, Cranial-Sacral Therapy, Lymphatic Drainage Massage, Pre-natal and Post-natal massage, Trigger point Therapy, Deep Tissue and Sports Massage
Treatment Philosophy: I believe that massage therapy can help improve overall wellness by relieving pain, improving ease of movement and relieving emotional stress. I create a personalized session for each individual, drawing from many different modalities of massage.
Education: My passion for improving wellness began with my own experiences dealing with the chronic pain of scoliosis as a teenager. Massage and physical therapy helped me avoid corrective surgery on my spine. After 10 years of working in the medical field, I realized my true passion was a more hands-on approach to wellness in the form of massage therapy. I received my Associates of Applied Science Degree in Massage Therapy in 2012 from the Colorado School of Healing Arts. I am certified in neuromuscular therapy, myofascial release, Cranial- sacral, lymphatic drainage, pre and postnatal massage. I have focused my continuing education on sports massage and structural integration.
For Fun: When not doing massage, I enjoy spending time with my daughter Paris and my family. My favorite pastimes are trail running, rollerblading, dancing and yoga. I enjoy trying new activities to challenge my mind and body, currently I am learning kickboxing and will be trying roller derby soon.
Christopher Snook, PT, DPT
Specialties: Doctorate Degree in Physical Therapy, Sports, Orthopedic and Post-Op Rehabilitation
Treatment Philosophy: Your body is capable of incredible things, including recovery. With the right stimuli, often a little time and guided work, we can get you back to doing what you love. Christopher is passionate about finding ways to build up his patients’ functional capacity and develop patient independence.
Education: Christopher attended The College of William and Mary in Virginia where he studied Kinesiology and Health Sciences and graduated in 2015. Afterwards he attended the University of North Florida to obtain his Doctorate in Physical Therapy in 2018. Since then he has been practicing physical therapy in Colorado, treating various orthopedic conditions and sports related injuries.
For Fun: You can often find Christopher hiking or skiing on the weekends while competing in various recreational sports throughout the week.
3 Easy Ways to Prevent Shin Splints
Shin splints, also known as medial tibial stress syndrome, are one of the most common injuries that runners and walkers encounter. In fact, studies suggest that upwards of 20% of runners experience shin splints. What’s more, research looking at naval recruits in basic training reported an incidence rate of shin splints as high as 35%.
When you think about gait biomechanics, it’s no wonder so many of us encounter this issue. Whether you’re running or walking, each time you step, you come down with more than twice the force of your own body weight. That process puts a whole lot of stress on your muscles, bones, joints and tendons. In particular, your tibia or shin bone bends or bows every time you strike the ground. The repetitive stress put on these bones can then result in pain known as shin splints.
The most common symptom is pain in the tibia during running or when you push on the bone. While this is uncomfortable, it’s not a season-ending injury if you address it promptly. If you ignore the issue, however, shin splints have the potential to develop into a tibial stress fracture, which could leave you on the bench for months. By understanding how to both treat and prevent the issue from materializing in the first place, you’re more likely to head off major problems down the road.
SHIN SPLINT TREATMENT
While the latest evidence regarding treatment of shin splints falls short of identifying specific treatment methods with overwhelming confidence, most experts agree that it is an injury caused by overloading the tibial bone. Indeed, it has been shown that individuals with a “below average activity history” who pick up running are 2.5 times more likely to experience shin splints. This is probably a result of their bones not being primed and strengthened for high-impact exercise. Those who have been running or walking regularly for many years have stronger bones that are better able to accept the impact forces associated with running and walking. Here’s an easy two-step plan to follow if you start experiencing shin splint symptoms:
1. CUT BACK ON IMPACT EXERCISE
Since shin splints are an overload injury, it is important to reduce the amount of high-impact exercise you’re doing in order to allow the tibia to heal. Swapping some of your running or walking workouts with biking or swimming can be a good way to help keep the injury from worsening while still maintaining fitness. If you’re having trouble healing, complete rest has also been suggested as an important treatment method.
2. ICE THE SHINS
Icing is also commonly recommended if you’re experiencing shin splints. This can not only help ease inflammation in the area, but it can also assist in reducing pain. You can either use an ice cup, running it up and down the tibia, or grab a couple of ice packs and put them on the affected area for at least 10 minutes twice a day.
SHIN SPLINT PREVENTION
Once you’ve successfully treated shin splints, it’s important to turn your efforts toward preventing them from reoccurring. Because many runners and walkers with less experience tend to encounter this injury more often, it’s important to tailor your exercise plan to your fitness level. Ease into a high-impact activity, such as running—it will go a long way in helping you skirt bone-related issues like shin splints. As far as mileage goes, follow the 10% rule—don’t increase your mileage by more than 10% from one week to the next. Here are some additional preventative measures you can take:
1. CONSIDER SWITCHING SHOES OR ADDING ORTHOTICS
You should also take your running or walking mechanics into consideration. In particular, research has linked over pronation to shin splints. This is likely a result of the considerable torque that is put on the lower leg when the foot strikes the ground and then excessively rolls inward. Shoes with built-in stability or orthotics may help reduce this type of unwanted motion. While the research regarding treatment is somewhat scant, there is evidence to show that insoles or orthotics can help prevent shin splints by reducing that inwards rolling motion.
READ MORE > WHAT TO KNOW ABOUT YOUR FEET WHEN BUYING RUNNING SHOES
2. BE AWARE OF YOUR STEP RATE
For runners, increasing your cadence or step rate will significantly reduce the impact forces associated with running. Focus on striking beneath your center of mass during running and avoid stepping out in front of your body—this will also prevent overstriding and braking—to lessen the load placed on the tibia.
3. DEVELOP MORE LOWER LEG STRENGTH
Additionally, studies demonstrate that runners with bigger and stronger calf muscles have a lower risk of developing tibial stress fractures. Since tibial stress fractures can be the result of shin splints that haven’t been addressed, it makes sense that strengthening your calves may also help runners and walkers avoid medial tibial stress syndrome.
Consider working the following strength exercises into your exercise routine to help strengthen those calves and the surrounding muscles in order to prevent shin splints:
Standing with your feet slightly apart, raise up onto your toes, pause for 2 seconds, and lower back down. Complete two sets of 15 repetitions.
Standing on your tiptoes, walk forward 15 yards. Complete two sets of 15 yards.
Lie down with your legs straight out in front of your body and your toes pointed toward the sky. In a pumping motion, point your toes back towards your body and then back to the original position. Complete two sets of 20 repetitions.
Standing on a stair or elevated platform, put your weight on your right foot while lowering your right heel past 90 degrees. Slowly raise back up and repeat before switching sides. Complete two sets of 10 repetitions on each side.
It Could Be Tibialis Anterior Muscle Strain
If you’re experiencing pain anywhere from the bottom half of your leg (also known as your shin) down to your big toe, it’s not only frustrating, but concerning, too.
Many people with pain in this area assume they have shin splints, but did you know that “shin splints” is often used as an umbrella term for any pain, strain, and inflammation involving muscles around the shin?
This means that there could be a number of specific conditions causing the pain you’re experiencing, including tibialis anterior muscle strain.
If you’re seeking medical care for your symptoms, find a physiotherapy clinic near you and book an assessment for shin pain today.
Symptoms of Tibialis Anterior Muscle Strain
If you’re suffering from tibialis anterior muscle strain, it’s common to feel pain anywhere from your knee down to your big toe.
You might notice these symptoms at the front of your lower leg, ankle, and/or foot:
- Pain – burning, cramping, or aching
- Tension or pressure
Flexing your foot upward towards your body, walking or running, climbing stairs, and even operating the gas and brake pedals while driving can cause these symptoms to appear or flare up.
These symptoms may come and go or be persistent, and they may worsen depending on your activity level and how much you have exercised your leg muscles that day.
Have you noticed symptoms of pain in your shin and feel concerned? Book an assessment with a physiotherapist near you today.
Causes of Tibialis Anterior Muscle Strain
Your lower leg has four compartments—each one is made up of tissue, nerves, muscle, tendon, and blood vessels.
The tibialis anterior muscle runs along the outside of the tibia, or shin bone, and connects to the bone just behind your big toe.
If you’re experiencing front of leg and shin pain, you may have caused trauma to the area or the muscle directly by:
- Increasing workout intensity or duration
- Striking the lower leg
- Running or jumping on hard surfaces
- Walking style, or gait
Are you worried about a recent injury causing shin pain? Book an assessment with a physiotherapist near you today.
Treatments for Tibialis Anterior Muscle Strain
If you’re experiencing pain, swelling, or weakness in the lower leg, ankle, or foot, you should practice RICE and seek an assessment from a qualified physiotherapist.
Your physiotherapist can offer you a customized treatment plan that can include:
- Activity modification
- Hot/cold therapy
- Joint mobilization
- Re-injury prevention
The use of orthotics may also be recommended to help address your gait and relieve unnecessary strain on your legs.
Book A Physiotherapy Assessment for Shin Pain
Although it can be tempting to try and walk it off, you may be doing further damage to your leg.
If you’re experiencing shin pain, book an assessment today so we can help you to get well and stay well!
When walking makes your legs hurt
Four conditions for leg pain causes that can affect you when walking
Updated: June 21, 2019Published: June, 2008
When walking is supposed to be good for you, why do you have to suffer with leg pains? And what causes the pain in your legs when walking? Fitness experts used to stress the benefits of heavy-duty aerobic exercise — the kind that makes you breathe hard and gets your heart going. But the message changed to moderation after a number of studies showed that physical activity that’s far less taxing is associated with lower rates of heart disease, some cancers, and several other illnesses — if it’s done regularly. Plain old walking usually tops the moderate-intensity exercise list because it’s easy, convenient, and free, and it requires minimal equipment — a comfortable pair of shoes.
The trouble is that walking isn’t so easy for everyone. Indeed, the leg pain is agony for many. And forget the “brisk” pace of three to four miles per hour advised for health and fitness.
With age — and occasionally without it — a number of conditions can result in leg pain after walking and make walking difficult. Some are very familiar, such as arthritis that makes knees and hips creaky; others, such as peripheral artery disease, aren’t.
This article looks at four nonarthritic conditions that cause leg pain and may affect walking, and some ways to treat and manage them — no need to limp and bear it!
Leg pain causes and conditions
We’re discussing these conditions that may cause leg pain separately, but people may have two or more of them at the same time, which complicates diagnosis and treatment.
1. Peripheral artery disease
Peripheral artery disease is a form of atherosclerosis, the same condition that leads to most strokes and heart attacks. Fat- and cholesterol-filled plaque narrows arteries, and blood clots can collect on the plaque, narrowing them further. In peripheral artery disease, the arteries affected by atherosclerosis tend to be the ones that supply the leg muscles. The risk factors are similar to those for heart disease and stroke: smoking, high cholesterol levels, high blood pressure, and especially diabetes.
The classic symptom is cramping, tight pain that’s felt in muscles “downstream” from the narrowed artery. It can occur in the buttocks, thigh, calf, or foot, but occurs most often in the calf. The pain tends to come on with walking, gets worse until the person stops walking, and goes away with rest. Similar to angina, the pain caused by peripheral artery disease comes from working muscle cells that are “starved” for oxygen because of obstructed blood flow. The medical jargon for this kind of pain is intermittent claudication, from the Latin claudicatio for limping. Many people with peripheral artery disease have other sorts of pain, though. Sometimes their legs are heavy, or they tire easily. And it’s common for people to cut back on their activity level without realizing it, which can mask the problem.
Signs of peripheral artery disease include a diminished pulse below the narrowed artery, scratches and bruises in the lower leg that won’t heal, and pale and cool skin. The diagnosis usually depends on the ankle-brachial index, which compares the blood pressure at the ankle to the blood pressure at the arm. They’re normally about the same, but if there’s a blockage in the leg, blood pressure will be lower in the ankle because of low blood flow.
Arteries narrowed by atherosclerosis leave leg muscles starved for oxygen.
Peripheral artery disease by itself can be serious and debilitating, but it may also serve as an important warning of even more serious trouble. Atherosclerosis in the legs often means there’s atherosclerosis elsewhere, and people with peripheral artery disease are six to seven times more likely to have a heart attack, stroke, or transient ischemic attack than people without it. A peripheral artery disease diagnosis should prompt a concerted effort to rein in cardiovascular disease risk factors.
Walking hurts, so a “just do it” attitude about exercise isn’t helpful. But researchers have found that tightly structured, supervised exercise programs can help people increase the amount they can walk before their leg pain kicks in. These programs usually involve walking ’til it hurts (which may be only for a few minutes), resting ’til the pain goes away, and then walking again. These walk-rest-walk sessions are most effective if people do them for about 30 minutes at least several days a week.
Low dose aspirin (75 mg to 81 mg) is often recommended to reduce the risk of heart attack and stroke. Clopidogrel (Plavix), another drug that makes blood clots less likely by making platelets less sticky, is an alternative for people with aspirin allergy. Cilostazol (Pletal) can help people walk longer distances without pain.
Serious cases of peripheral artery disease can cause leg pain even when the person isn’t walking. This “rest pain” most often occurs in the feet. Even more serious are cases when the condition leads to tissue death and gangrene.
If peripheral artery disease is serious, or isn’t improving with exercise and medication, doctors can reopen the blocked artery with angioplasty or use part of a blood vessel from elsewhere in the body to reroute circulation around the blockage. But the track record of these revascularization procedures is mixed, and some studies suggest that the results from a structured exercise program can be as good, or even better.
2. Chronic venous insufficiency
Like peripheral artery disease, chronic venous insufficiency is a condition of poor circulation, but it involves the veins and the blood’s return trip back to the heart and lungs.
Our arteries are springy and help push blood along, but our veins are relatively passive participants in circulation. Particularly in the legs, it’s the muscles surrounding the veins that provide the pumping power that drains the vessels near the surface of the skin and then push the blood up through the “deeper” vessels that travel toward the heart. Tiny valves inside the veins even out the pressure and keep the blood from flowing backward.
In people with chronic venous insufficiency, the valves are damaged, so blood tends to pool in the legs and feet instead of traveling “north” to the heart. It’s often a vicious cycle: if the valves aren’t working, pressure from the blood collecting in the veins increases, so the veins stretch out. As a result, the valves don’t close properly, so even more blood flows backward, adding pressure.
Symptoms include swelling, inflammation of the skin (dermatitis) and the connective tissue underneath (cellulitis), and ulcerated, open wounds on the bony “bumps” of the ankle. Legs may feel achy or heavy. And when people walk, they may feel a tight, “bursting” pain, most often in the groin or thigh. The leg pain will stop with rest but may take longer to ease up than the pain from peripheral artery disease.
Damaged valves in veins means blood may flow backward and accumulate in veins.
The symptoms from a mild case of chronic venous insufficiency can be helped by lying on your back and using a pillow to elevate your legs so blood flows downhill to the heart. If you’re sitting for long periods, pointing your toes up and down several times can flex the vein-pumping leg muscles.
More serious cases needed to be treated with compression stockings that squeeze harder at the ankle than at the knee. For the stockings to work, they must be much tighter than the “antiembolism” stockings people routinely wear in the hospital. But because they are so tight, people often have a hard time getting them on. Washing a new pair can help. Some people coat their skin with talcum powder or wear thin, regular stockings underneath. Devices called “wire donners” hold the stockings open so people can push a foot and leg into it.
There are no specific medicines to treat venous insufficiency. Surgical procedures have improved significantly over the years. Nowadays varicose vein therapy has moved very far away from the old-fashioned saphenous vein stripping. That procedure involved making an incision in the groin and leg, inserting a stripping device into the vein, and pulling the vein out of the body. It usually required general anesthesia, an overnight hospital stay and weeks of recovery.
Today, physicians usually close the vein permanently rather than remove it. They use one of several minimally invasive techniques, performed through catheters inserted into the veins under ultrasound guidance. These treatments are performed in outpatient settings under local anesthesia, and the patient can walk immediately after treatment.
3. Lumbar spinal stenosis
Stenosis (pronounced ste-NO-sis) is a medical term for any kind of narrowing. Spinal stenosis can occur anywhere along the spine as a result of the vertebrae, the disks between them, or their supporting structures impinging on the tube-like spinal canal that holds the spinal cord and the roots of the nerves that branch off of it. Pain comes from the mechanical pressure, and perhaps also from the pinching off of blood flow to nerves.
The lumbar region of the spine consists of the five large vertebrae that form the small of the back. When spinal stenosis occurs in the lumbar region, lower back pain can be a symptom but often it’s the legs that are affected. The pain can resemble the pain caused by peripheral artery disease: cramping tightness that increases with walking, although it’s often felt in the thigh rather than the calf. The legs may also feel weak and numb.
In the past, the leg pain caused by lumbar stenosis was called pseudoclaudication because it was unrelated to blocked arteries, and doctors didn’t understand that it could be caused by spinal problems. Now the preferred medical term seems to be neurogenic (which means originating from the nervous system) claudication.
Vertebrae, disks, and other parts of the spine impinge on the spinal cord and nerves branching off of it.
The diagnosis starts with discussion of symptoms and medical history. One important clue is whether the pain eases when the back is curved forward, or flexed. That posture tends to take pressure off the lumbar region, and it’s the reason some people with lumbar spinal stenosis find it easier to walk when leaning on a grocery cart or a walker.
An MRI or CT scan will often be ordered to confirm a diagnosis, but imaging studies shouldn’t be used to make one. Many people have spinal stenosis that shows up on an imaging study but doesn’t cause any symptoms.
Treatment usually begins with physical therapy and exercises aimed at strengthening back and abdominal muscles. Pain relievers may help. Growing numbers of older patients are getting corticosteroid injections into the spine, which worries some experts. Evidence that the shots are effective is mixed.
If the pain persists, surgery is an option. The most common procedure is a laminectomy, which involves cutting away part of a vertebra to create more space for the spinal cord and nerves. Bone spurs and portions of the disks and facet joints can also be removed to relieve pressure. Study results for surgery are murky. The majority of patients seem to feel better for the first year or so, but the advantage over a nonsurgical approach seems to wear off after several years. A second operation is sometimes needed. On the other hand, for some, surgery greatly reduces the pain and discomfort.
4. Diabetic neuropathy
People with diabetes are prone to nerve damage, or neuropathy. Exactly why is uncertain. High blood sugar levels may damage the tiny blood vessels that supply nerves, creating “nerve strokes”: nerves starved for oxygen (ischemic) because of damaged vessels. Diabetes may also deplete the body’s store of neurotrophic peptides, chemicals that normally repair and regenerate nervous tissue.
Blood vessels (shown in red) that supply nerve cells can be damaged by high blood sugar.
Diabetic neuropathy affects the upper and lower legs in different ways. In the upper leg, the pain from ischemic nerves can come on suddenly and be felt in just one leg. In the lower legs and feet, where it is more common, the symptoms are typically numbness or tingling, and are usually felt about equally in both legs. The numbness often dulls painful sensations, so sores on the feet go unnoticed and get worse. Diabetic neuropathy can make walking difficult, but leg pain may improve with exercise.
People with diabetes can reduce their chances of developing neuropathy by keeping their blood sugar down. It’s less certain that tight blood sugar control is helpful once nerves have been damaged. Still, it’s an important goal for many other reasons. Pain relievers, tricyclic antidepressants (amitriptyline, desipramine, duloxetine), and anticonvulsants (carbamazepine, gabapentin, pregabalin) are used to control the burning and tingling sensations from neuropathy.
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