Bridget Snapp: Today on ClubHouse Gas, we are talking about Medial Tibial Stress Syndrome. Yeah I don’t know what that is either. Today, I am back with friend of the show, Dr. David Marshall, Director of Sports Medicine over at Children’s Health Care of Atlanta. Welcome back Dr. Marshall.
Dr. David Marshall: Thanks for having me.
Bridget Snapp: Thanks for being back. Alright, so I have been running a lot lately and my shin splint is killing me. Now, I am hearing this term all the time, shin splints, I don't even know, I mean how do I know if I have one? Help.
Dr. David Marshall: Yeah, that’s a very common ailment that we see amongst runners. There is a lot of things that can cause shin splints and a lot of things that you can do to try prevent it or treat them when you do get them. Firstly of all, I don't like the term shin splints. I think it's overused. It seems there are too many athletes, too many coaches, too many healthcare professionals using the term shin splints to name any ailment from the knee down to the ankle. Oh! If your leg hurts, it must be shin splints; but there is a very specific problem that causes the classic shin splints. I like to use the term Medial Tibial Stress Syndrome. It’s much more descriptive for the location of the pain and cause of the pain that causes the classic shin splints.
Bridget Snapp: People aren't going to overuse that word?
Dr. David Marshall: No, they are not. MTSS, it's a lot easier to say.
Bridget Snapp: Okay, so what are the some of these main symptoms?
Dr. David Marshall: Well, the main symptoms of shin splints is pain, it's usually pain with running. It is one of the classic examples of an overuse injury, where the training or the abuse of training on a part of your body out paces the body’s ability to heal itself, and that’s kind of how we train, that’s how we adapt the stresses, you breakdown your body, you stress it and then given it ample time to repair itself. When it does that, you can slowly, over a period of time, increase the stresses.
What happens with overuse injuries such as shin splints, the abusive training or the beating up on your body out paces the body's ability to catch up and as a result the tissue fails and that's what causes the pain. So the most common symptom is pain after exercise and sometimes during exercise.
Bridget Snapp: So you are sort of telling us about the shin splints, tell me more about exactly what happens though.
Dr. David Marshall: Oh! There is lot of talk as to what actually causes the shin splints but my understanding and my belief here is that little tiny microscopic muscles tears, believe it or not. On the inside edge of the shin bone which is the Tibia, that's the flat bone on the front of your leg, the one that you are banging on the steps all the time if you try to go up too fast and miss. That's called the Tibia. And the inside or the back edge, or the medial edge of the Tibia about half to two-thirds of the way down, there is a muscle, one of your calf muscles called the Soleus that attaches to the shaft of that bone.
Next time you guys have turkey legs or drumsticks or chicken wings, you notice that the meat doesn’t attach just to the end of the bones, there is that deep layer of meat that attaches to the shaft of the bone, peel that little, that deep layer of meat away very slowly and you see those little tiny fibers, those little tiny microscopic muscles as they attach to the bone, that’s where shin splints occur.
So if you run too much, if those muscles are too tight, if you run on the wrong terrains, or poor shoes, those little tiny muscles will start to peel away from the bone and that's what causes the pain. So it's the little tiny muscles fibers, they get peeled away or teared microscopically from the bone.
Risk factors for shin splints. Number one, pure mileage, pure volume. If you start off running too much and you increase your mileage too quickly, that can overstress your body even though you have perfect shoes and perfect technique and perfect terrain, too many miles can certainly cause it.
Other biomechanical issues are flat fleet. Sometimes pronation, if you stand and your arches collapse, that puts a lot more pressure, a lot more weight or stress on the inside edge of those legs exactly where that muscle attaches. So the kids -- the pronators, or the runners that collapse their arches somewhat, they can be at an increased risk of shin splints.
Bridget Snapp: What do you think about the special shoes for those?
Dr. David Marshall: Well, there are special shoes and there shoes for pronators. If you go to a good running shoe counters, there is a lot of them in Atlanta. Fleet Feet, Phidippides, Big Peach Running, even places like Foot Solutions, or New Balance, so those people know shoes and they know the needs of different feet. So if you go to a place like that and they deem you with a pronator, there will be certain shoes or different lines of shoes that you need to buy. If you buy a shoe for a supinator, which is the opposite or buy a shoe for the neutral foot, you might be doing yourself a disservice.
Bridget Snapp: So how do you know what kind of shoe do you need?
Dr. David Marshall: I would go to a -- again, a good running shoe company where the people that are there not just to sell you shoes, but to say you the right kind of shoes. So some of these places will have evaluations, they might have you run on the treadmill, they might have you stand on a computerized platform that determines where your foot needs the pressure, where it needs the support, where it doesn't, and then they will help, that computer will help determine what type of shoe or what type of extra insert that you need to put in your shoe if that's the case.
Bridget Snapp: Okay. So you said increasing your workout too quickly, wearing the wrong shoes, what are some of the other?
Dr. David Marshall: Yeah, you can look at the surface that you run on. A very hard concrete asphalt type surfaces compared to a rubberized cushion track at the high schools, a wood ship, or a grass cross county course, those are better than the hard surfaces. Even the treadmills, the treadmills nowadays have cushion, shock observing decks which are designed to decrease the stress going through your legs when you hit.
Look at the terrain that you run on, also the inclines. Here in Atlanta, sometimes neighborhoods and place where we run are very hilly. So running up inclines and down declines could increase stress on your legs as well. So try to keep your running on a level ground with a nice surface and good properly fitting shoes. Look at the mileage on the shoes too.
We recommend that shoes should have about 350-400 miles on them. If you start getting over that, then it's time to get new shoes and some of the kids that run, 30-40 miles a week, it might be two-and-half to three months, and they have to go back and spend another $120 on a pair of running shoes, so it can get pretty expensive with certain doctor's visits.
Bridget Snapp: Right, money well spent. Okay, so say, our viewers are tunning in, it's too late, they already do have the shin splints, what do they do?
Dr. David Marshall: Well, the first thing I do is back off on your training. Very rarely does an athlete have to stop all training. There is a term that we like to use called, cross-training. Even though we are going to really back off on their mileage on the road, they can still cross-train, they can still put in the same aerobic workout but in much less stressful workout such as a stationary bike, an elliptical machine, rowing machines, even swimming, those are all good aerobic workouts that cause much less stress on the shin.
You got to ice it. I like ice cup massage. You can take some Styrofoam coffee cups and fill them to the very tippy top of water and freeze them and then peel back an inch of the paper around the rim of the cup. Then you have this nice little frozen snow like a push-up pop that we still enjoy and you can do some massage down all along that painful area. I think that's more effective than just putting ice bag on the sore spot.
Bridget Snapp: Now how do you know when it's time to get back to your regular workout?
Dr. David Marshall: Well, I think when the pain subsides, you don't have any more pain at rest, you don't have anymore pain with these lesser impact workouts, then it's -- I think it's okay to go and get back on the road. I would really cut it back, maybe do about a third of what you normally would do and see what happens. If that reproduces the pain, back up, or back off some more. If you can tolerate that, then every week increase about 10%, that's the ramp up that we typically recommend. No more than 10% mileage per week. If you do more than that, you are really putting your bones at risk.
When an athlete comes at second week of cross country, she says, I have a shin splints, that's a tough one to treat because they are early in the season, they don't want to stop, they need to continue to train and a lot of times mild to moderate shin splints isn't bad enough to make them stop but it is bad enough to nag them and bother them the entire season. So really what they need is an off season. They need a good 4-6 week period where we can really back off on the mileage and sometimes that's not always possible.
Bridget Snapp: Well, Dr. Marshall, thanks for teaching us about Medial Tibial Stress Syndrome.
Dr. David Marshall: Shin splints.
Bridget Snapp: Alright, that works. Thank you so much for all you do to help the kids.
David Marshall: My pleasure!
Bridget Snapp: Alright, and thank you for watching this edition of ClubHouse Gas. We will see you next time.
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