Painful shins are common amongst runners, but in a lot of cases they are actually pretty straightforward to fix.

We’ve read a lot on the forums recently about shin splints and what we can do to sort them out. But what are shin splints?

The term shin splints is actually a bit generic. It’s a little like runner’s knee in that it covers a number of different specific types of pain, and that can initially be why it’s tricky to solve. The one thing we do know, though, is that it’s painful and can put us off running for a long time.

Right, before we go any further, I need to point out that if you’ve had painful shins for a long time and nothing seems to be helping, it’s time to go and see a medical professional. There‘s a chance that long-term pain in the shins can lead to more serious conditions that really needs to be investigated. Please be sensible and take responsibility for it, and if this sounds like you then get it looked at!

So, I’m moving on assuming that if you need to seek medical attention, you are going to do so. For the rest of us, here are some of the reasons we get shin splints:

• Lack of ankle mobility
• Shortened posterior muscles, particularly the calf muscles
• Muscular imbalance
• Lack of strength in the front of our shins (tibialis anterior)
• Poor running form
• Footwear

Shin splints are a classic overuse injury, and there can be many factors that lead to this very painful condition. At the bottom line though, it comes down to the fact that our shin muscles can’t handle the amount of repetitive force we are putting on them. This is why, even after taking a few weeks rest away from running, as soon as you start back the pain returns. If you think about it, what have you actually done to increase the resilience of the damaged muscle and connective tissue? Rest alone is not the answer.

All of the reasons listed above can be, and often are, inter-related. For example, having a severe forefoot strike combined with overstriding will put our foot into a steeply angled plantarflexion (toes pointing downwards). Over time this foot position will reset our nervous system’s range of motion and can also lead to the shortening of the muscles at the back such as the calf muscles. This, in turn, will have the effect of reducing strength in the front of the shins and making them less able to tolerate the force we are putting through them. One of the results of this lack of strength may be shin splints (not everyone suffers from shin splints so we can’t say it will happen).

Let’s now look at some of these factors in a little more detail.

I’m going to combine muscular imbalance and lack of strength together as they are so closely related. It’s very well understood in both practice and research that if there’s a difference in strength between our right and left sides, or even in the muscles on the same side but playing complementary roles, then trouble is often not far behind. Indeed, muscular imbalances are often a major cause of overuse injuries.

As we’ve just learned, multiple factors are frequently involved in shin splints, and sometimes it is difficult to pinpoint which came first. A lack of strength in our toes, feet, ankles and shin muscles (anterior compartment such as tibialis anterior, peroneus longus and extensor digitorum longus) can all contribute either directly or indirectly to shin splints. In a direct way, they simply don’t have the strength and resilience they need. Indirectly, they may force the muscles at the back to work harder, which then creates a dominance and a cycle of reducing the strength of the shin muscles. The end result being the same: they can’t tolerate the load and then they fatigue and breakdown too quickly. See this post on reducing tolerance as we get injured.

This also relates to an earlier post about ankle mobility, where we looked at why ankle mobility is important. As far as shin splints are concerned, if we don’t have the range of motion that we need at the ankle we will make compensations that could either place more force directly onto the shins, shorten those muscles at the back such as the calf muscles, and/or find other ways to get the necessary range of motion (such as turning the foot out) that then leads to improper movement and pain.

Ankle mobility is very important as it’s one of the shock absorption mechanisms we use during running.

Normally I steer clear of discussions on shoes because it often becomes murky and emotive and the truth is that research into shoe recommendations is very much lacking. However, you may be surprised to learn that certain types of shoes can contribute to painful shins. In particular, shoes with high heels. Whether these are high heeled work shoes, going out shoes, or even running shoes that have a large difference between the heel height and the toe height (heel drop or ramp).

Our feet are designed to have both the back (heel) and the front (toes) on a level plane. As soon as you lift one or the other up, we start to get problems.

Warning: Do NOT take this to mean you should rush out and buy a pair of flat minimalist running shoes – don’t! While in theory this would be a good thing, if you’ve been running in shoes with a high drop for a long time, your body has adapted to that position. Your nervous system has made alterations to the start and end range of motion. You will likely have lost some muscle length in the front of your shins. These can all be reset and rebuilt, but it takes time and it takes a sensible transition period.

So we can see that in all these cases, it all leads back to a resulting lack of strength in those muscles down the front of your shins. How this lack of strength came about can take some time to unravel, and this is where our gait analysis services are invaluable.

But there is some stuff you can be doing yourselves to fix shin splints.

The first thing to do is look at what you may be doing to put pressure on those shins or shortening your calf muscles. Here are some things to have a think about:

• Are you wearing high heeled shoes? Bear in mind, that infrequent wear may be worse than regular wear because you don’t adapt properly. That’s not to say that regular wear is good, but at least you do get a chance to adapt.
• Do your running shoes have a large difference between the heel and toe height? If so, you may want to look at transitioning progressively to a shoe with a lower heel drop. But, make sure you do this in increments. If your current shoes are 12mm drop, next go to 10mm. Then when you are ready to replace those, go to 8mm, then 6mm and then may be 4mm. You may find that at 6mm or 8mm you don’t need to go any further – everyone is different. The important thing is to transition progressively.
• What’s your posture like? Do you stand swaying backwards from your ankles? This will effectively put you in a toes down position and keep your calf muscles shortened and over time rob your shins of strength.
• How’s your ankle mobility? Can you stand with your toes 7cm from a wall, keep your heel on the ground while pushing your knee forward to touch the wall? If your heel doesn’t lift then great. If it does, you need to do some ankle work. You can use this same test as the exercise to help get more mobility. 3 sets of 12 on each foot 3 times per week for 3 or 4 weeks.
• How‘s your running form? Do you land right on your forefoot while reaching your leg out in front of you? This is commonly seen in combination with a prancing or bouncing style of walking and running.

Review all of the above and start to make the necessary corrections. Remember, these things take time. Also be aware that if you change your running style, you’ll be moving those loading forces somewhere else. So, you had better be thinking about building strength into those areas otherwise they may suffer as a result.

As you’re doing the corrective stuff above, you can also start to build up the the strength of your shin muscles (anterior compartment). This’ll be the topic of the next blog post.

The post Shin Splints – Causes of shin pain in runners appeared first on RunTeach.

Most specialist running shops now offer a gait analysis service. Many charge a low fee and if you go on to buy a pair of shoes from them, they take the cost of the gait analysis off. This essentially gives you a gait analysis for free!

So you would be forgiven for being confused when specialist running companies such as ours, charge anywhere from £60 to £120 for a gait analysis service. What gives?

Well, not all is how it appears. The simplest way to highlight the difference is to point out that the running shops are using a very basic gait analysis as a sales tool to encourage you to buy a pair of shoes from them.

That’s not to say that this basic service isn’t of value or that the staff in the running shops aren’t knowledgeable – many of them are experts in their field with a wealth of experience. However, they are doing it for one reason and one reason only. You need to decide why you want to get gait analysis:

1. To be recommended a pair of shoes that may work with how you run today but offers you nothing else.
2. To identify current injury causes, improve your running and reduce your future injury risk.

If it is number 1, then the basic gait analysis from a shoe shop may be good enough. But please don’t think it will highlight areas for you to work on to improve your running or reduce your risk of future injury. Even if you are told that you have an issue (such as overpronating), you are highly unlikely to be told why this is the case and what you can do to fix it. Rather, you will be recommended a pair of shoes that will compensate for this apparent overpronation. But two things to keep in mind:

1. Your shoes can’t fix how you run, but YOU can!
2. Research has shown that misprescribing motion control shoes can cause a higher rate of injury

In 2009, a review of the available research concluded that “the prescription of shoe type to distance runners is not evidence based” (Richards et al, 2009). So to a certain extent, prescribing a particular type of shoe is purely based on what the manufacturers have told the shoe shops and not what any clinical research may say.

In addition, the gait analysis from the shoe shop will generally only either look at your feet, or at best from the knees down. Gait analysis from a professional looks at your entire body – running is actually a very complex set of coordinated (or not!) movements that involves far more than just feet and knees!

This is all a bit like continually putting sticky tape over a sticky plaster to keep it stuck over a blister that you get from shoes being too small. Wouldn’t it be better to get a pair of shoes that didn’t give you blisters?

And that bring me to the gait analysis service a specialist in running, like us, offers…

Why would you want to spend up to £120 on this type of service? It’s a lot of money, so you’ll be wanting value for that. OK, here’s why:

• According to recent research, up to 80% of runners will suffer a running related injury in every 12 month period.
• The average amount of time these injuries last is 8 weeks.
• Almost all of these injuries are preventable.
• Many of us spend at least £40 per session with a sports physio to help with these injuries. Our fully comprehensive RunTest assessment is only £79.
• A lot of the work physios do in their session is pain relief and soft tissue work. While a very valuable part of the process and absolutely necessary, the onus is often on you to find out why the injury happened (or keeps happening). In many cases, you are just sticking a plaster on a recurring wound rather than solving the problem at source.

The real, tangible benefits to you are:

• You find out what is really going on.
• You save on physio costs because you can now get the issue(s) fixed at source.
• You have the choice to sort the issue(s) yourself with a deeper understanding, or work with the professionals to deal with the root cause and not just the symptoms.
• You miss fewer races and you’ll enjoy running them more. We all know that we have to book and pay for races so far in advance these days – do you really want injury to cost you your race fee as well as additional physio?

Summary

Gait analysis from a shoe shop is a sales tool for the purpose of choosing a pair of shoes, not improving your running or reducing your injury risk. Indeed, if you are prescribed an incorrect pair of shoes, you can actually increase your injury risk.

Gait analysis from a running professional such as RunTeach, is designed to help identify the cause of current injuries, reduce future injury risk and to improve your running performance.

If you would like to find out more about our gait analysis services, please click here.

If you would like to talk to us about how we can help you improve your running or with injury prevention, please contact us here.

The post What is Gait Analysis? appeared first on RunTeach.

Written by: Chris O’Brien

Choosing running shoes can be confusing. I saw this first hand recently (Sunday 25th Feb 2018), when I had the pleasure of working alongside the guys at Mizuno at the Triathlon Show London. We were carrying out running assessments using the dorsaVi sensor technology that we use at RunTeach.

Mizuno use the dorsaVi technology to highlight the differences in loading forces and left/right symmetry in different shoe types. They call this service the Mizuno Running Solution, and it works well to show these differences.

They then hope to prove that a new pair of Mizuno shoes are better (more efficient, more symmetrical, less impact force, etc) than the runner’s current pair of shoes. In most assessments, from what I saw, this was the case. In all 7 assessments that I carried out, I saw an improvement when the runner wore the Mizuno shoes. Some of this was probably because they were new shoes, but thsi is fine as it showed the runner it was time to change their shoes.

You may be thinking: “how does that help me?”. To answer that, we first need to look at the general shoe types, and go from there.

Shoe types

In general, there are 3 shoe types:

1. Neutral Shoes
2. Stability Shoes
3. Motion Control Shoes

Within the neutral category, we also have:

1. Maximalist (what we see as a standard running shoe)
2. Minimalist (simple shoe such as Vibram, Vivobarefoot, etc)

In reality, there is some crossover and within each category there are different levels of cushioning – even in minimalism, which may sound odd but is true. For now though, let’s just concentrate on standard running shoes. These are what most of us use. So, what do the main categories actually mean?

Neutral:

Whether they have a high level of cushioning or not, neutral shoes only provide minimal support, and generally allow your feet to move as nature intended. This means that your feet will naturally pronate (your arches flatten) as your foot goes through the gait cycle. More on this in a bit.

Stability:

These shoes tend to offer a medium level of support in order to limit the amount of pronation the foot can do. Typically this is done by having some form of higher density material near the arch of the shoe to limit the foot compression. Stability shoes tend to be prescribed for people with a moderate level of foot over pronation.

Motion Control:

This type of shoe offers the maximal amount of stability, and aims to significantly reduce the compression of the arch of the foot.

So how can I tell what I need?

And this is the million dollar question! It has become the norm for shoe retailers to offer a certain level of gait analysis in order to fit you for the right type of shoe from the categories above. But this has major flaws, not least because they tend to only look at your feet and not your whole body.

Some stores also use outdated and unproven tests such as the wet test. This involves the runner standing barefoot in some water to wet the soles of their feet, and then standing on a special piece of paper than will leave the watermarks. The test shows how the arches of the runner look (collapsed/flat, ‘normal’, high), and this is then supposed to help with shoe selection. The problem with this is that it is completely unfounded in the research, and all the latest research points to there being very little significant difference in the degrees of pronation due to arch height. There simply isn’t enough evidence to base shoe selection on a test like this.

At the Triathlon Show I heard people referring to themselves as over pronators, having flat feet, and many other terms that would justify them being put into either the stability or motion control categories. But is that right?

Well, no. What is now being discovered is that incorrect prescription of stability and motion control shoes can lead to higher injury rates. Stability and motion control shoes should only be recommended following a correct prescription. And by correct prescription, it is meant that there should be a very clear reason why a runner is told to wear anything other than a neutral shoe. Just because their foot over pronates is simply not a good enough reason, and here’s why… what is over pronation?

It is perfectly normal for our foot to pronate when we walk and run. We are all different, and the individuality of our foot structures means that we will pronate slightly differently from each other. In fact, we can have different degrees of pronation between our own two feet. Lets see what neutral, pronation and supination is:

The graphic above mentions a safe range and an unsafe range. However, the lack of robust research in this area doesn’t really help. Of the two most reliable studies, one found injury rates increased with over pronation, and one study found they didn’t. This means we can’t actually draw any conclusions from this at all.

So if the scientists can’t draw any conclusions, how can a running shoe assistant in your local store recommend you wear stability or motion control shoes from a quick visual assessment of just your feet? Answer: they can’t.

And there’s more. Over pronation itself may not even be the issue at all. It may be that it is excessively prolonged pronation that is the bad egg. That is, if your foot carries on in a pronated position after the mid stance of the gait cycle. See, your foot is designed to lock in a supinated position (see above) immediately before it strikes the ground. This is to provide a solid structure to land on. Then at foot strike, the foot unlocks and begins to supinate. By mid stance, it should start to decompress and make its way back to a supinated position, locked and ready for toe-off. But if the foot remains in a pronated position for too long after mid stance, it is argued that the tibia will be over-rotated and put under more stress than designed. It is this, some claim, that is the cause of the injuries.

To add more murk into the already muddying waters, there is an ongoing debate as to whether foot mechanics drive the mechanics higher up the chain (the knee and hip for example), or if it is the other way round. To explain a bit further….

It is claimed that over pronation causes the tibia (shin bone) to rotate inwards excessively (as seen with the prolonged pronation). This in turn will put stress on the knee joint, and further up the chain can have an affect on the hips, lower back and even the shoulders.

But hang on. Why can’t it be the other way round? Why can’t over or prolonged pronation be a symptom of something happening further up. Why can’t it start with the hips or knee, and end with the foot? Actually, in many cases this is what happens. The foot is being driven into an unnatural position because of something happening elsewhere on the body. If you are only looking at the feet, you are going to miss this crucial information, and this could have serious consequences as far as injury risk goes.

Help! I’m more confused than ever! How do I pick my shoes?

Well, the most recent discussions from the current experts in the biomechanics arena of running bring both good news and some not so good news. Let’s start with the not so good news:

There is no evidence at all that there is actually any reliable way to prescribe running shoes. This was found in 4 different studies between 2010 and 2015.

Here’s the good news…

Foot pronation is not associated with injury risk in novice runners wearing a neutral shoe: 1-year prospective cohort study. (Nielsen RO, Buist I, Parner ET, et al Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe: a 1-year prospective cohort study Br J Sports Med 2014;48:440-447.)

Pick a shoe that is comfortable for you as this is most likely to be the optimal shoe for you.

Once you find a shoe that is comfortable, get another pair! Some research has shown that rotating your shoes can provide up to a 39% reduction in the risk of injury. Now that’s a very good reason to go shopping!!!

Conclusion

OK, so perhaps not so conclusive. But hopefully this post has alerted you to be more aware when choosing shoes in a running shop. Just because the staff member has stuck you on a treadmill, looked at your feet (including video) and the recommended a shoe type, you shouldn’t feel that you need to go with that recommendation. This doesn’t mean they are necessarily wrong in their recommendation. And it is fair to say there are some great people doing these visual assessments – many have a lot of experience. But, this is a complex area that goes beyond just looking at someone’s feet.

First, look at what type of shoe you are currently wearing – neutral, stability, motion control. Have you had any pain while running in them. If not, either stick with that type of shoe (but of course feel free to choose a different brand or model) or if they are not a neutral shoe, perhaps it’s time to try a neutral shoe. Think about why you chose your current shoes and let that be a guide.

If you do have pain in your current shoes, then it’s time to find out why before you buy your next pair. As runners, we often cite incorrect footwear as our number one reason for injury, but often the problem is somewhere else. Footwear is usually quite far down the list.

Next, make sure you can go for some kind of run in the shoes, even in that’s on the treadmill or just on the street outside the shop. Most decent shops will let you do this. Are they comfortable? Let this be your lead on making a final decision. If you are unsure, try some different ones. Try on some different types (neutral, stability, motion control), even though you don’t think they are a good match. It is all feedback on how different shoes feel, and this in itself can be a good guide.

Personally, I would always like to see people start in a neutral shoe to see how it feels. If it doesn’t feel right, then go with your instinct on the other categories – just be careful about what you are being told.

Finally, if you do feel it is time to discover more about how you run we can help. If your current running style/technique is causing you problems or you want to get faster, we would love to welcome you to our offices for an in-depth running and movement assessment. You can even bring along a couple of different types of shoe so we can see how they affect the forces and symmetry as you run.

On a final note, I would like to say a huge thanks to the guys at Mizuno for welcoming me along. I would also like to say a big thank you to all the runners I assessed, and I trust you were happy with your shoe selections and the service you received from us all.

It is good to note that Mizuno’s best selling road shoe is their Wave Rider. This is their neutral shoe, so it shows that with Mizuno at least, runners aren’t being pushed into the more expensive stability and motion control shoes.

Neither RunTeach or I have any affiliate with Mizuno, nor do we earn any commission or other income from them.

The post Which running shoes are right for me? appeared first on RunTeach.