Shin Splints (Medial Tibial Stress Syndrome)

Medial tibial stress syndrome, (MTSS) or “shin splints”, is a common ailment that many runners experience, especially when returning from inactivity or after a rapid increase in mileage.

Symptoms
Typically, there is pain in the front portion of the shin above the ankle. Pain is usually present at the start of a run or exercise but may gradually improve. Stress fractures in the tibia The painful area involved in MTSS is usually 3 to 5 inches in length along the edge of the tibia. Pain that is concentration in a smaller area on the tibia or pain that continues to get worse with prolonged running may represent a stress fracture of the tibia. Shin pain that does not improve or continues to worsen should prompt a visit to your physician.

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Iliotibial Band Syndrome (ITBS)

The iliotibial band is a thick layer of tissue along the outer part of the leg that runs from the hip to the knee. Irritation can occur either in the hip or knee.

Symptoms
Pain at the outside part of the knee that is worse when bending the knee. Also may present as pain on the outside part of the hip over the greater trochanter.

Causes
Tightness in the iliotibial band is a common cause. Other causes include weakness in the muscles around the hip and buttocks (gluteus muscles), running on a sloped surface such as the beach or road or excessive pronation or rolling in of the foot.

Prevention & Treatment
Ice massage to the painful area for 10 to 15 minutes after workouts can decrease the pain. Stretching of the iliotibial band is an important component if the tendon is tight.

One stretch is to stand and cross your injured leg behind your uninjured leg and bend over to touch your toes.
A second stretch is to sit or lay on the floor with the legs out straight. Bending at the hip and knee, take the injured leg and cross it over the uninjured leg. Slowly extend at the knee to increase the stretch.

Strengthening the gluteus muscles is also important. Step lunges and leg squats can help increase gluteal muscle strength.

Achilles Tendinosis

Symptoms
Pain or swelling in the back of the calf, usually 2 to 3 inches above the back of the running shoe. The pain is typically worse when the heel strikes the ground or when pushing off from the ground on your toes.

A rupture of the Achilles can occur during a forceful push-off. Typically there is a “pop” or ripping sensation in the back of the calf, followed by pain and decreased movement of the ankle.

A suspected Achilles rupture requires evaluation by a sports medicine physician and may require surgery or prolonged immobilization in a cast or walking boot.

Causes
Common causes of Achilles tendinitis include: tight calf muscles, recent increase in running mileage or running up hills. Over-pronation (rolling in of the foot) as well as high foot arches (pes cavus) and flat feet (pes planus) can also cause Achilles tendinitis.

Prevention
Prevention includes proper stretching, slowly increasing your mileage and proper running shoe selection.

Treatment
Ice decreases inflammation, pain, and swelling. Apply ice for 10 to 15 minutes three to four times a day. Anti-inflammatory pain medications such as ibuprofen (Motrin or Advil) or naprosyn (Aleve or Naproxen) as directed by your physician.
Gentle range of motion and calf stretches can be helpful. Eccentric calf exercises can be helpful in recurrent cases.

These exercises are done by standing on a step or stairs with the toes on the step and the heels hanging off the step. Slowly lower your heel so that it drops below the step. You should feel a slight stretch in the calf. This movement is the eccentric or lengthening movement. Slowly return to the starting position. Repeat 10 to 15 times twice a day.