23 replies to this topic

[omy005]

G'day all, I did the 2012 Twilight 1/2 Marathon a few days ago and after finishing the race I had a pain on the inside of my leg just above my ankle that made me limp a bit walking back to the car. The next day it was quite sore at work when walking around. I didn't feel and thing particularly painful during the race. This was the longest/fastest I have run in my Huarache type shoes, but by a distance of 2km only and not time. I've been minimalist shoe running for over seven months now also with minimal shoes, sandals and completely barefoot.

After a bit of self diagnosis and web searching I'm pretty sure its a shin splint with pain in the same area as the image below. I've not ever had shin splint problems before and I thought they came on slowly after a longer period of time. I'm off to the physio in a few weeks time to have it checked out professionally. So my question is can one get a shin splint problem from just one run? If so what would be the sudden cause?

Andrew

[maryclaire]

I think the term "shin splints" is a generic term for any shin-type injury.  In my case, I had a medial tibial stress reaction - and, as you stated, it came on over time.  However the buildup to injury was so gradual that I barely noticed it.  It started with a feeling of tightness in the calf during and after running.  Eventually, the muscle was pulling on the bone to such a point that a stress fracture was the next step if I had not stopped when I did (in the end I stopped because the pain did not let me run anymore - not because I was smart enough to recognise the warning signs).

Perhaps in your situation, as you stated that the injury came on after one race in which you really did nothing new, you've got some sort of acute inflammation that may settle with rest.  I am always wary of soreness after a race - even if it wasn't run at top effort - as I think the simple fact that it is a "race" adds an element to the run which may play out as greater risk of injury.

[Ponytail]

Be thankful if it is just a medial stress reaction, which it probably is if you've heeded warning early.  I was experiencing pain along my shin which would abate as my runs progressed for some time.  Then I ran a 30k after not having run more than 20k (due to the recent pain) for months - I had run 30k plenty of times in the past so had no real respect for that distance.  After that, my longer runs resulted in barely being able to walk for the next 24 hours.  I would rest for a week and the next time I ran the residual pain would almost cripple me.  When I finally admitted defeat, I had a nuclear bone scan which confirmed a stress fracture (4 weeks in an ugly moon boot).  If I ever had an inkling of shin pain again, I would take heed and rest immediately.  And by the way, don't wait weeks to see the physio, because time is precious when it comes to running.

[omy005]

Thanks for the replies and info. I went for a 10km run yesterday and the pain came back again about halfway through the run and lingered for quit a while afterwards. I still don't understand how this can come on after just one effort with no other signs beforehand? Can one get a stress fracture so suddenly? I feel my Gold Coast Marathon plans may be shot. Although I can still walk OK so my Oxfam 100km still looks good. As for the length of time to see the physio, She is the only barefoot friendly one I could find and she's on leave for two weeks.

Andrew

[Emrun]

Shin injuries are a many and varied thing and as MC pointed out really is just a generic term for a variety of pains in that area.  The correct terminology I believe is Medial Tibial Stress Syndrome.

Sadly I can also report that a stress fracture can occur that quickly and seemingly without warning.  I've had 3 bouts of tibial stressies, the first came with a warning, I stubbornly ran through a persistent case of MTSS for weeks until I could barely walk.  This resulted in fairly lengthy lay off.  The second and third times around were seemingly a case of I was fine one day and the next, bang, stress fracture.  The most recent being acquired about 20km into a 30km trail run in Sept last year.  I was traveling along fine and then out of the blue that old familiar pain started up.  I finished the run because it was either run back or walk back, no sag wagon in a trail race, but that was it for 7 weeks.

I generally stay off shin splint/stress fracture threads these days because I've grown weary of discussing the injury and find people going through it the first time are in denial (as I was the first time!).  Also we are only fellow travellers, not medical experts.  

There is only one way to diagnose a stressie and that is via medical imaging, anything else is just guess work.  Unless you've had a few and just know.  Although threre is one little self test you can try, run your thumb quite firmly along the medial bone, as per the photo you posted, MTSS and stressies cause a thickening of the lining of the bone, you can feel the lumpiness down the bone.  Maybe not so easy to pick up as a novice but your physio should.  If you have this it's a good thing to get to know, it's part of understanding your body and how it reacts.

My doctors advice has always been, if it hurts at the start, stop! If it starts hurting in the middle take the quickest route home, then stop!

You can try and tough it out, make bargains with whichever deity you make bargains with, say "just one more run, see how it goes" or you could rest up now, discover cross training, see a sports doctor and deal with what ever the diagnosis is.  .

And take it from me, there is life after a stress fracture, heck, there is life after three :-)

All the best.

[sportsphysio]

Emrun, on 23 March 2012 - 02:40 PM, said:

Shin injuries are a many and varied thing and as MC pointed out really is just a generic term for a variety of pains in that area.  The correct terminology I believe is Medial Tibial Stress Syndrome.

Emrun, you're correct about the term "shin splints" being generic and used as an umbrella term for MTSS as well as some other conditions, including tibial periostitis. It tends to be referred to as shin splints as these conditions often co-exist. Hopefully a medical professional doesn't refer to it by the generic term though; it's like your mechanic telling you that you have a "vroom vroom" problem with your car.

omy005, on 21 March 2012 - 02:46 PM, said:

After a bit of self diagnosis and web searching I'm pretty sure its a shin splint with pain in the same area as the image below. I've not ever had shin splint problems before and I thought they came on slowly after a longer period of time. I'm off to the physio in a few weeks time to have it checked out professionally. So my question is can one get a shin splint problem from just one run? If so what would be the sudden cause?

Andrew

Andrew

Google may have let you down here. While the presentation of tibial stress problems can appear after just one run (not "caused" by one run, usually brewing without causing symptoms up until that point), the presentation of pain doesn't refer as far down into the foot as the photo indicates. That area of pain is often associated with tendon problems and may be caused by uncontrolled pronation. Not pointing the finger at the minimalist footwear but it may be partially at fault given the short period of time that you've been at it.

Good luck with the physio visit

SP

[omy005]

Emrun, on 23 March 2012 - 02:40 PM, said:

.
Sadly I can also report that a stress fracture can occur that quickly and seemingly without warning.

I dug out my Lore Of Running by Noaks and the above is repeated in there as well. (Paraphrased), 3 steps to diagnosing a stess fracture of the tibia, "the injury is usually of quite sudden onset, no history of trauma, mild warning symptoms". I also failed the "hop test" and thirdly "tenderness localized to the bone, even with gentle pressure"

sportsphysio, on 23 March 2012 - 08:13 PM, said:

Google may have let you down here. While the presentation of tibial stress problems can appear after just one run (not "caused" by one run, usually brewing without causing symptoms up until that point), the presentation of pain doesn't refer as far down into the foot as the photo indicates. That area of pain is often associated with tendon problems and may be caused by uncontrolled pronation. Not pointing the finger at the minimalist footwear but it may be partially at fault given the short period of time that you've been at it.

The pain is very intense just above my ankle bone (calcaneum?) if i put pressure directly on the bone with my thumb. So maybe not the tendon as you say?

As for the minimalist footwear, I don't know, I felt very comfortable with them, but did prefer completely barefoot, as the sandals even though they are only 4mm still took away a lot of the "feel" of the surface underfoot. But I knew I couldn't go for 21.1 completely bare.

This is all very depressing to hear, but one has to hear it though, else I'll be in a world of hurt. Noaks suggests 6 to 12 weeks of rest, although deep water running has been indicated to keep ones fitness up whilst allowing a fracture to heal.

Andrew

[Emrun]

Don't be too depressed, it's a blow that's for certain, but they heal and you get back, trust me.

Hopefully you won't find yourself on a seemingly never ending cycle, my Doc and I have explored everything and nada, I am strength training now as a last effort to beat this thing.

Deep water running does help, and you can do it barefoot ;-) I always found it helpful to have a plan and approach it with the same discipline as training, have a look here, this plan has served me well over the years, the link is about 2/3rds down http://pfitzinger.co...rts/water.shtml

If you have a bike or access to one then use that too, combined with the DWR it will help keep you fit.  Even if it's a exercise bike that's hired or borrowed from a friend it all helps.

Don't let people bring you down with "ugh that must be so boring" because it beats the hell out of doing nothing.

6-12 weeks is a wide range, the rule of thumb tends to be the lower down in the body the quicker the healing, ie a metatarsal may take 6 weeks, a femoral neck up to 12.

All the best, before you know it you'll be healed and wonder what all the fuss was about.

[maryclaire]

omy005, on 23 March 2012 - 10:16 PM, said:

I also failed the "hop test" an

ahh - the ol' "hop test" - brings tears to my eyes just recalling the pain of it!!!

Honestly, as the others have pointed out, patience is key in all injuries - and particulalry in a bone-related injury.  So just face the reality of your situation but don't let it get you down.  As Emruns said, plan a strategy of how you will deal with this.  Doing this will at least make you feel pro-active in all of this rather than a victim.  I found a long layoff due to injury taught me some much-needed lessons in patience and humility.  It also re-shifted my focus from purely running to developing strength in other areas that would support my running, when my body was eventually able to return to it.

I personally found that setting myself little targets through my rehab to be of huge mental benefit - as simply "not running" can seem such a black hole at times.  Instead, I'd celebrate small victories such as passing the hop test or being able to roll the calf out on a foam roller without bringing tears to my eyes.  It took a long time to pass the hop test but when I did, it was a great feeling because I knew that running again was simply a matter of when, not if.

However I think I am jumping the gun here as you need a solid diagnosis before you can even begin to strategise your rehab.  Good luck.

[omy005]

Emrun, on 24 March 2012 - 06:03 AM, said:

If you have a bike or access to one then use that too, combined with the DWR it will help keep you fit.

I usually cycle to work already, hopefully I can still do that.

maryclaire, on 24 March 2012 - 03:47 PM, said:

So just face the reality of your situation but don't let it get you down.

I'm facing it alright. All I can think about is what runs I'm "missing". Tempo last Thursday, Park Run this morning, Cross Country this afternoon and my long Sunday one.

maryclaire, on 24 March 2012 - 03:47 PM, said:

However I think I am jumping the gun here as you need a solid diagnosis before you can even begin to strategise your rehab.  Good luck.

True, It can't come quick enough, another week to wait.

Andrew

[maryclaire]

I am a bit spooked because today,towrds the end of an easy run along my usual route and distance in my Vibrams, I got a pain EXACTLY the same as you've described.  It came on suddenly and in the same location.  I immediately went home and RICED. THe pain has stayed with me all day (a busy day spent working frantically on my feet) but is easing off a bit now.  I am hoping that whatever ails you is not contagious!

Last time I had a medial tibial stress reaction it was higher up - more like 2/3 up the inside of the lower leg, and the tender spot was in a very specific location.  So i am hoping that PhysioAdvisor is correct in indicating that your diagram is more likely a tendon issue.  Whilst still potentially nasty, it is a lot better than a stressie!

[sportsphysio]

PhysioAdvisor? Hmmm, close.

MC

The reason I mentioned that the pain in the diagram was more reminiscent of a tendon problem is based on how far down it extends. Bone stress problems will give pain over the tibial area but it won't extend down past the ankle. Pain, if isolated over the tibia, could be any numbner of problems (including bone stress).

As it's the first time that your problem appeared and it was on a regular run (ie. not going further or harder than before), just RICE it and try another run in a day or two. If it's still sore or getting worse after a week or so, have it checked out by a good running physio (there are plenty of Melbourne-based sports physios on Coolrunning).

While I've got the soapbox going, it might be a good time to mention the detrimental effects of assuming the worst. As maryclaire mentioned above, don't assume anything until it's been properly assessed. I've seen a number of runners in the last month or so who have been going through regular bouts of shin pain, assumed it was bone probs, and took some time off. Every return to running flares it back up again, and so the cycle goes. Whatever the initial cause was, the rest periods have led to weakness, leading to more problems and pain. An early assessment would have saved the escalation and secondary problems.

For info on how to minimise the detrimental effects of a rest period while still giving injuries a chance to settle, see To rest or not to rest...

maryclaire, hope this tweak passes quickly, good luck

[omy005]



sportsphysio, on 27 March 2012 - 05:14 PM, said:

While I've got the soapbox going, it might be a good time to mention the detrimental effects of assuming the worst. As maryclaire mentioned above, don't assume anything until it's been properly assessed.

For info on how to minimise the detrimental effects of a rest period while still giving injuries a chance to settle, see To rest or not to rest... maryclaire, hope this tweak passes quickly, good luck

Thanks for this info and link, I think it may very well apply to me. After not doing any running for several days I did a 37km walk (in my Salomon XT Wings) for my Oxfam 100 training and my leg became sore again but not quite in the same spot, it extended down below my ankle and around toward my achilles more. After resting another couple of days I did my interval session which only lasts about 45min. This I did barefoot and I only have a very slight pain there now. Hopefully the physio can make the correct diagnosis so I can take the best action for recovery.

Andrew

[Runforthehills]

omy005,

I have had a few lower leg/ ankle problems over the last 3-4 months. The most recent being a posterior tendon problem degenerating into plantar fasciitis.
The treatment plan my physio suggested was rest from running, lots of stretching particularly calf muscles and the tendon running along the under side of the arch up to the big toe and more regular wearing of my orthotics (I pronate on both legs).

The information you provided suggests, and I'm only basing this on my recent experience, a posterior tendon issue.

My leg problems are slowly going away. I am able to run/ walk now but nothing more than 40-60 mins and on alternate days.

It is such a frustrating process not being able to run the like I could pre injury but I can still run.

Get a treatment plan from a physio and stick to it.

All the best

[sportsphysio]

Runforthehills, on 28 March 2012 - 12:40 PM, said:

My leg problems are slowly going away. I am able to run/ walk now but nothing more than 40-60 mins and on alternate days.

It is such a frustrating process not being able to run the like I could pre injury but I can still run.

RFTH

This illustrates my point about rest breaks. You did the right thing by having it checked out and following medical advice so I am in no way having a go at you. And not knowing your condition specifically, I'm not saying that rest breaks were inappropriate in your case.

Too often I see rest breaks used as the first approach to any running problem. There are some conditions where this is appropriate (eg. stress fractures) but many conditions including plantarfasciitis and tendinopathies may be successfully managed without rest from running. If the initial attempt to continue running doesn't work, the next step should be relative rest (eg. reduced running + cross training rather than stopping running). The last stage may be complete rest but the adverse effects of not running often leads to a gradual recovery of strength, fitness and endurance.

Remember, rest breaks make problems feel better but most healing needs some degree of load and many causes need some degree of exercise. If reduced pain is your goal, rest works. However if running is your goal....

[maryclaire]

Sportsphysio - sorry for calling you the wrong name!  

After my spouting off about my own experience with MTSS above, I am now humbly accepting that my experience is not the ONLY one.  A bone scan reveals a stress reaction/early stage shin splints in the area outlined above, with pain and swelling appearing in the one run, without any warning signs at all.  I am now on rest for at least 2 weeks - and Comrades training is now at a standstill.

Edit:  Just found this article - it seems sensible in terms of matching the injury to goals and outcomes.  I just hope mine is a "low risk/low grade" injury!

http://www.agoodgrou...ures_return.pdf

Edited by maryclaire, 29 March 2012 - 02:06 PM.

[Waggyb]

I have shin issues as well. Has anyone had dry needling and had any luck with it? And if so who would you recommend? I hope it works...

[maryclaire]

Waggyb, on 30 March 2012 - 10:29 PM, said:

I have shin issues as well. Has anyone had dry needling and had any luck with it? And if so who would you recommend? I hope it works...

Last time I had MTSS I saw a Chinese Orthopedic quack.  He is trained in both Western and Chinese medicine.  He did some serious acupuncture - pain was unbelieveable - and I swear the needle nearly touched the bone! (also left a mark that lasted for nearly a year!).  But it did make a huge difference to my recovery.  He also used cupping on the shins.  This was all over a course of several visits - and of course, rest would have seen me heal also, so I really can't say just how much the recovery time was helped along by his treatement.  He is on the corner of Malvern rd and St Kilda Rd.  If you are interested, PM me and I will dig out his details.

[Quill]

I had the exact-same problem in the exact-same areas and your schematic of the line of pain is, well, exactly where mine extended when I had posterior shin splits. I haven't the time to read all the responses above so this might be repeating inforation but it's down the the tibialis posterior, which attaches to the upper third of the tibia. The tendon which arises does a funky hook turn around your medial malleolus and terminates in a fan-like arrangement of tendons which work to support and stabilise your arch. The TP also works to control pronation.

I'll never forget the feeling of that tendon slinging around my ankle bone in its inflamed sleeve of grittiness. It was pretty far from fun. Heel lifts while concentrating on 'pulling' my arch up fixed it. That and rest.

Hope this helps.

[omy005]

G'day all, a quick update. I have been continuing on with my interval and tempo training as normal and done another 30km walk (with about 10km of down hill running) also did several cross country races. I hardly have any pain now in my leg so I don't really know what was going on or why it doesn't hurt much any more. Off to the physio tomorrow to find out.

Andrew

[Ponytail]

My experience with a stress fracture is that they don't always follow the rule of thumb!  I had extensively researched on "Google" the signs and symptoms and had, catagorically, ruled it out.  The tap test was fine, the hop test was fine, the vertical versus horizantal pain coincided with a stress reaction, rather than a stress fracture.  I managed to fool the physios until the podiatrist I was seeing sent me for a nuclear scan that confirmed the worst!  I am all the better for it, because, if it hadn't been confirmed and diagnosed, I would be still be flogging that dead horse.  I now realise that self-diagnosis is no substitute for the (although costly) professional confirmation!

[omy005]

I had my physio appointment yesterday (Lucy at Revive, Ashgrove) and she seemed to think it was a stress reaction as the pain has nearly all gone even though I've continued my training. This would be different for a stress fracture. Did some flexibility tests of the ankle and hip, watched me on the treadmill for 10min or so running barefoot and gave me a list of plyometric exercised to do. I did my interval session this morning without any pain during or now in my leg so all seems good. I think she sort of implied that a stress reaction is not necessarily a bad thing as its the body's way of saying "ease off a bit" and then the bone will become stronger in the long term.

Andrew

[maryclaire]

That's great news.  I have to admit that I am flummoxed by her comments however.  My understanding (based only on experience and discussions with Physios - I have no qualifications myself) is that a stress reaction is the precursor to a stress fracture.  Continuing to load it up will only take it further along the injury continuum; rest is the only answer.  As you have not rested and your symptoms have eased up, I'd have thought it was something else?   Regardless - you are back to running and pain free so that is awesome news.  I am nearly there - walk/run in short bursts over the next week and then is all is good back into training the following week.  Touching wood, crossing fingers etc etc.

[omy005]

maryclaire, on 04 April 2012 - 02:57 PM, said:

a stress reaction is the precursor to a stress fracture.  Continuing to load it up will only take it further along the injury continuum

She did say this, but the key word is "load". A bit like what sportsphysio was saying in earlier postings I think about not resting.

maryclaire, on 04 April 2012 - 02:57 PM, said:

.  As you have not rested and your symptoms have eased up

I have eased up quite a lot compared to what I was doing before the injury, basically only doing 2 runs with any intensity during the week, my intervals and tempo both of which the high load elements are about 20min long. The others are more like a shuffle than a run at 6 to 7min pace. And I haven't done any long runs at all.

I hope your recovery goes well also.

Andrew