Shin Splints

Shin splints strike terror into the hearts of everybody engaged in regular high-impact endurance activities.

Runners, walkers, devotees of high-impact aerobics, squash players, volleyballers, basketballers, gymnasts, and many others all have participants who push themselves beyond the ability of their body to absorb the constant impacts, recover, and repair itself.

This can lead to shin splints.

Tenosynovitis

Any repetitive movement taken to an extreme will cause a chronic injury. Undertaking repetitive exercise without having your body adapted to take the strains involved will cause pain and injury, just as repetitive keyboarding will cause arm and neck pain.

And yes, you can get tenosynovitis in your lower leg. Any of the lubricating sheaths around the ankles can become inflamed, causing pain when the tendon performs work, and a feeling a “grating” or “crackling” over the affected tendon.

Tenosynovitis can be caused by things as simple as tying your shoelaces too tightly, or incorrectly so that the tongue of your shoe rubs the tendons on the top of your foot. Or poorly chosen shoes can affect your lower leg muscles, causing excessive use of a particular muscle and its tendon.

The only cure is to stop the activities that cause the pain. Then see a sports doctor for specialist treatment. Believe me, these conditions will not just “go away” or clear up magically if you ignore them and soldier on thinking “no pain, no gain”.

If your shoes have uneven wear patterns we would advise that you have a biomechanical (biomechanics — people mechanics) assessment from a podiatrist (a foot specialist). A podiatrist may give you exercises to correct a postural imbalance, or they may make an “orthotic” insole for your shoe to correct a mechanical imbalance.

If you have tenosynovitis, you don’t have to stop everything and turn into a slob. You just have to rest from the activities that aggravate the injury, and switch to other activities until you fix the problem. Swimming is a possible alternative form of aerobic exercise, or circuit or weight exercise is an alternative form of muscle endurance exercise.

Stress fractures

The cause of stress fracture is a repetitive muscle pull, beyond the limits of the bone’s normal strength. These stress fractures always come on after a sudden change in type and intensity of activity.

For example, a runner may suddenly increase their distance or speed, or you may suddenly take up a new sport, or you may have had a lay-off and returned to exercise with too much enthusiasm.

Beginners in aerobics are especially likely to suffer from stress fractures, and the breaking point seems to be when you move to more than three high impact aerobic classes per week, or when you don’t build up slowly over several months with a variety of different class styles and instructors.

Compressive forces, such as those involved in running on hard surfaces or doing aerobics on hard surfaces, do not seem to contribute to this injury. Stress fractures happen because your lower leg muscles are so strong that they are continually pulling the fibula bone into and away from the bigger bone, the tibia.

It only takes a little too much extra strain to bend the fibula too much, causing it to crack or weaken, like bending a bit of wire backward and forward, backward and forward, until it suddenly snaps!

When it first happens, you’ll hardly notice it. You’ll feel a slight ache on the outside of your lower leg when you cool down after activity. This ache will disappear when you exercise, but over time it will gradually get worse until it hurts all the time. At this stage the fibula bone is starting to crack up, and it feels like someone is sticking hot wires into the bones of your leg. Yowch!

You must see a doctor, as you will need a bone scan to confirm a diagnosis of a stress fracture. It will not show up on an X-ray until it has already started healing and a small cloud of new bone can be seen forming around the site of the injury.

If you keep going with the same activities, you risk shattering the bone completely. If you know you have increased or changed a program based around repetitive movements, and you have pain and tenderness directly over the bone, then it’s a pretty good guess that you have a stress fracture. See a doctor.

Healing usually takes six weeks, during which time you should work with your doctor and a fitness specialist to develop an exercise plan that will not cause strain over the injured area. There are a multitude of things you should still be able to do safely, based around activities that can be performed without a major lower leg involvement, such as swimming or cycling.

When the fibula has not felt sore for a couple of weeks, then you can return to your normal activities, but take it easy this time. Start off slowly, progress gradually, and allow rest days between activities. If at any time you feel the pain recurring, then return to your alternative activities for a few days, then start all over again at a reduced intensity and duration.

If the bone hasn’t healed within three months, then go back to your doctor. You may need to be referred to an orthopedic (bone) specialist for further help with a cure.

Learn your lesson. Adhere to the exercise principle of progressive overload — never make any sudden increases in activities involving repetitive leg movements. Build up gradually, allowing your body to recover and get fitter at each stage.

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