Achilles Tendonitis is a very common injury among runners of all abilities. A University of Wisconsin Study of track injuries reported that during a 17 year period, tendonitis accounted for nearly 9% of reported injuries. It is an inflammation of the band of tissue that connects calf muscles at the back of the lower leg to your heel bone.
I suffered through this injury for over a year until I was properly diagnosed and treated. It really slowed my training, so my goal with this article is to share the symptoms, risk factors, treatment options and best prevention strategies so you can prevent achilles tendonitis from slowing your training.
I don’t recommend self diagnosis of any sporting injury because every injury is different in some way and each requires specific assessment and treatment. If you suspect you may have achilles tendonitis, I urge you to get it properly diagnosed by a trained and certified medical expert. It would be irresponsible of me as a certified coach to attempt to manage your injury in an article.
Use the following information for guidance only. Although I provide much researched details along with a logical and effective rehab program recommendations, I am not a qualified medical professional, so I encourage athletes to seek professional medical opinion for diagnosis and to confirm treatment protocol for any injuries.
Symptoms & Warning Signs
Achilles Tendonitis is often characterized as an overuse injury. The tendon may be painful to touch or move. The area may be swollen and warm. You may have trouble standing up on one toe. You may also have trouble finding shoes that fit comfortably.
Photo by Jenny Hill on Unsplash
For most athletes, the injury starts as mild discomfort or ache in the back of the leg or above the heel, typically experienced at the beginning of a run. Tenderness, stiffness or the ache may just be in the morning, but often improves with mild activity. However, as the injury persists untreated or more typically untreated properly, the pain becomes more severe and continues after prolonged running (especially on hills), stair climbing or sprinting.
As the pain persists and if left untreated, where the athlete continues to train, the tendon gets weaker, making it more vulnerable to a tear (rupture). This a painful injury that usually requires surgical repair. This is why if you experience persistent pain around the Achilles tendon and it’s affecting your running gait, you need to seek professional medical attention. Do this before the pain becomes too severe or the achilles tendon becomes torn (ruptured).
Achilles tendonitis typically has two causes. One is muscular and the other structural. It’s more common as you age, because the structure of the Achilles tendon weakens with age, which can make it more susceptible to the injury.
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The structural cause of achilles tendonitis is weakness in ankles and feet. Excessive pronation (rolling inward on the foot when walking or running) turned out to be the primary factor for my injury. A naturally flat arch in your foot can put more strain on the Achilles tendon. Other structural causes include chronic ankle instability or a recurrent “giving way” or rolling of the ankle.
Also runners with a slight leg-length discrepancy, can cause the body to compensate and put soft-tissue structures like the Achilles tendon more vulnerable to a tear.
The muscular cause is short, inflexible (tight) calf muscles which can develop over time with runners who don’t perform regular stretching & strengthening exercises. There are two large muscles in the calf. When they are strong and stretched out, they create the power needed to push off with the foot or go up on the toes. However, if the calves are short and inflexible, the achilles tendon will then attempt to compensate for the limited range of the calf muscle, so any strain from footstrike to takeoff will be absorbed by the tendon.
In my experience, it’s common for runners to have tight calf muscles, so as you can see below, calf stretches is one of the primary focuses for rehab and prevention.
Other risk factors for achilles tendonitis include:
-Athletes new to running or just starting on a training program.
-Sudden drastic (more than 15% per week) increases in weekly mileage.
-Sudden increases in speed work or hill training
-Wearing high heels regularly can shorten the Achilles tendon, making it more prone to injury
-Prior history of achilles injuries
-Old (worn-out) or improper running shoes (shoes that don’t offer sufficient heal support or stability)
Photo by Daniel von Appen on Unsplash
-Weakness in the hips & glutes
-Poor biomechanics (form or gait), which is often the result of structural or muscular issues discussed above.
The bottomline is that there’s many risk factors that contribute to achilles tendonitis. Typically it’s a combination of these factors that result in the onset of the injury.
A physician should diagnose the cause of the pain. This is very important. Although this is a comprehensive article, it should only be used as a reference. Do not use the contents of this article to self diagnose your injury.
A doctor’s diagnosis will come from a combination of a physical exam, the patient’s history (filling out a questionnaire) and if necessary, diagnostic tests. The tendon will be very tender when palpating (feeling) or squeezing it from the sides. There may be a nodule or lump felt in the middle of the tendon.
Another test is the “calf-squeeze” where they test the integrity of the Achilles tendon. The doctor may also ask the patient to do a series of exercises such as hops, jumps or leg lifts. They want to understand the level of activity-related pain, as well as exactly where the pain occurs.
Besides the clinical exam, the doctor will ask questions of the patient to ensure all details of the injury are understood.
For example, patients may describe pain as sharp versus dull, intermittent versus constant, and mild or severe. What makes the patient better or worse, such as whether the pain increases with activity. There will also be questions about his or her recent sports involvement, including any changes to the training schedule, surface or type of sport being played. Patients should expect to report past injuries and/or inflammations of the Achilles tendon, including when and how they occurred, if they recurred, and what treatments were used or have been recently used.
Lastly, the patient will be asked to describe any changes in the Achilles tendon area, such as increasing pain at the bony prominence at the back of the heel, swelling, tenderness, redness, or loss of strength or range of motion.
X-rays aren’t typically used in diagnosis of tendonitis, instead they can be used to help diagnose if there’s any bone problems. However, an MRI or Ultrasound scan can determine the extent of the injury and indicate a precise diagnosis
The main treatments for Achilles tendinitis DO NOT involve surgery. However, it is important to remember that it may take at least 2 to 3 months for injury to properly heal. Although most athlete’s don’t want to hear it, they will need to temporarily decrease or stop any activity that causes pain. If they can do so without pain and if their physican gives the “go-ahead” the athlete may be able to continue run or walk on smooth, soft & flat surfaces. I would definitely recommend avoiding hills & speed activity.
Different therapy options can get you back to the trails and running healthy. Typically a doctor or physical therapist will recommend any number of the following nonsurgical activities:
To fight the pain, oral nonsteroidal anti-inflammatory medications may be prescribed to reduce pain and ease swelling. People with asthma, kidney disease, or liver disease should first check with a doctor. Steroid injections, like Cortisone, can reduce tendon swelling, but they don’t cure the problem. In my research, I found a number of sources indicate concerns that taking these kind of shots were associated with a greater risk of tendon rupture. Remember, managing the pain is only the initial part of the treatment. The ultimate goal should be to address the root cause and prevent recurrence.
Other pain management strategies involve elevating the foot and keeping it raised above the level of the heart to help reduce swelling. An icing program involves applying ice to the Achilles tendon area for 15 to 20 minutes, 2 to 3 times per day. Remove the ice if the injured area gets numb.
Alternatively, runners can switch to low impact activities such as biking, eliptical, swimming, rowing machines or other activities that put less stress on the Achilles tendon.
Once the pain is managed, physical therapy and shoewear modification the most typical treatments for patients with tendon inflammation and early degeneration. For overweight runners or runners who pronate or have bio mechanical risk factors, high stability running shoes will help to prevent the injury from recurring. If you’re not sure what shoes are high stability, ask the experts at your local specialty running store. I while back, I wrote a detailed article about how to pick the right running shoes.
One of the treatments that my physical therapist tried in order to allow me to run a race, was heel lifts. These moved my foot away from the back of the shoe. Unfortunately, it only helped for about half the race, before the pain returned and became unbearable.
One unproven treatment option is with platelet-rich plasma (PRP) injections. I don’t have any experience with this treatment, but during my research for this post, it was identified as an option. However, a recent study couldn’t conclude that this was a viable protocal to treat the injury.
If the above treatments DO NOT improve symptoms, you may need surgery to remove inflamed tissue and abnormal areas of the tendon. If there is a bone spur irritating the tendon, surgery can be used to remove the spur. These options are rare, but I wanted to point them out.
In most cases, lifestyle changes help improve symptoms. However, it’s important to remember that symptoms may return if you DO NOT limit activities (risk factors) that cause pain or if you correct bio mechanical risk factors, including stabilizing the foot, strengthening weak supporting muscles and correcting short calf muscles.
This is exactly what happened to me years ago. I would rest, ice, change to a more stable shoe and attempt to strengthen my calf muscles, but the root cause for me was a combination of pronation, weak glutes and hips and my footstrike was mostly on my heal (as opposed to fore or mid foot).
It’s really important that you ultimately understand which risk factors are causing your Achilles tendinitis. Left unproperly treated, the injury may make you more likely to have an Achilles rupture. This condition will cause a sharp pain that feels as if you have been hit in the back of the heel with a stick and surgical repair will be necessary.
Prevention is by far the best way to avoid potentially major problems with Achilles tendon pain. It is far better to complete a program of 10 – 15 minutes of stretches & exercises a few times per week than have 2-3 months out of training or risk an Achilles rupture.
Below are stretching exercises that would be perscribed by your health care provider or physical therapist. they should be done under the supervision of a physical therapist, at least initially, because they could damage the Achilles tendon if they’re not done correctly:
Gentle calf stretching exercises can help stretch the muscles and aid recovery
There are a number of exercises you can do to stretch your Achilles tendon. Here are some of the most popular:
Calf Stretch: Place your hands on a wall with one leg straight and the heel to the ground. Place the other leg, with the knee bent, in front of the straight leg and push your hips toward the wall. Stretch your calf to the point where you feel a strong pull but no pain. Do not let your heels come off the ground. Hold the position for 10 seconds, then relax. Repeat 20 times on each foot in a slow controlled manner.
Sitting Heel Raises
Sit on a chair and raise your toes up as high as you can without pain. Slowly lower your heels. Do this 20 times a day. You can make it harder by pressing down on your thighs or holding a weight on your thighs.
Bilateral Heel Drop
Stand at the edge of a stair or a raised platform that is stable. Put the front part of each foot on the stair. This position allows your heel to move up and down without hitting the stair. Hold on to a railing or support to help your balance.
Slowly lift your heels off the ground and slowly lower your heels to the lowest point possible. Be sure to do this in a controlled manner 20 times. You can also do this starting on the floor rather than the stair.
Exercises to keep your calf muscles strong and flexible will help reduce the risk for tendinitis. Overusing a weak or tight Achilles tendon makes you more likely to develop tendinitis. As long as the leading risk factors (as diagnosed by a medical professional) are addressed, performing eccentric strengthening exercises is one of the best ways to ensure that a full recovery can be achieved.
Farmer’s Walk on Toes – watch video or follow instructions below
Grab a pair of heavy dumbbells and hold them at your sides at arm’s length. Raise your heels and walk forward (or in a circle) for 60 seconds. Be sure to stand as tall as you can and stick your chest out. Choose the heaviest pair of dumbbells that allows you to perform the exercise without breaking form for 60 seconds.
Single-Leg Standing Dumbbell
Grab a dumbbell in your right hand and stand on a step, block or 25-pound weight plate. Cross your left foot behind your right ankle and balance yourself on the ball of your right foot, with your right heel on the floor or hanging off a step. Put your left hand on something stable—a wall or weight rack, for instance. Lift your right heel as high as you can. Pause, then lower and repeat. Complete the prescribed number of reps with your right leg, then do the same number with your left (holding the dumbbell in your left hand).
Straight-Leg Calf Stretch
Stand about 2 feet in front of a wall in a staggered stance, right foot in front of your left. Place your hands on the wall and lean against it. Shift your weight to your back foot until you feel a stretch in your calf. Hold this stretch for 30 seconds on each side, then repeat twice for a total of three sets. Perform this routine daily, and up to three times a day.
Foam Roller – Calf Roll
Place a foam roller under your right ankle, with your right leg straight. Cross your left leg over your right ankle. Put your hands flat on the floor for support and keep your back naturally arched. Roll your body forward until the roller reaches the back of your right knee. Then roll back and forth. Repeat with the roller under your left calf. (If this is too hard, perform the movement with both legs on the roller.)
Foam rolling can be a great tool for recovery, but I would caution that it doesn’t always work immediately, especially with really tight calf muscles. It’s not unusual for tight muscles to take a few weeks to release as long as you’re consistently rolling.
Regular Prevention Program
1. Intelligently increase your distance and intensity – Many runners get impatient and make sudden increases in distance or time, especially if they’re falling behind with their scheduled training. Schedule your program then be disciplined enough to execute it. Very often tendonitis is caused by a sudden increase in load or force. If you do have a hard session(hills, intensity), no problem- but it’s very important that you choose to rest the next day or perform a low impact session the following day.
2. Introduce changes gradually. Be careful with hill sessions, change of running shoes or change of terrain.
If you go from road running to off road- or vis versa- the altered terrain can cause tweaks in the Achilles tendon.
If you feel tweak or a strain, revise your training immediately and do not try to push through. It is better to have one week off then to attempt to push thru, make the injury worse and require 2-3 months off of training due to injury. Also, if you get new running shoes, I recommend walking in them first and slowly increasing the distance and intensity for 7-10 days to allow your body to adjust & to break in the shoes.
3. Always complete a proper warm up and cool down. This includes after run/training stretches. Even though you may be pressed for time. It’s essential to stretch after your run. Just take 3-5 minutes to slowly stretch out your calf muscles, achilles, hamstrings, IT band and lower back. If you’re in the habit of performing these stretches, you’ll likely prevent recurring injuries.
4. Regularly perform foam rolling. Calf, quad and lower back muscles tend to get very tight. Sometimes stretching is not enough. I highly recommend foam rolling at least 2-3 times per week to prevent tight and knotted muscles. Rolling out the calf muscles will help prevent your Achilles tendons from getting get injured.
5. Regularly complete strength training. Especially the exercises listed above.
6. Get a sports massage – These can really help preventing injuries. Massages enhance flexibility, help to improve blood flow in muscles and tendons and a can help heal little tweaks in muscles and tendons quickly before they become problems. During marathon training, if you can afford one and have the time, it’s ideal to get a sports massage monthly.
7. Gait analysis – How you run is VERY important in the prevention and treatment of Achilles tendon pain. In most cases, runners with Achilles tendon pain have poor running mechanics. They over pronate, they have weak hip muscles and have very tight hamstrings and calf muscles.
Top Prevention Tip:
Get your gait analyzed – this is VERY important. I suffered for over a year with this injury before a sports therapist video taped me on a treadmill. He reviewed my gait in slow motion & confirmed that I was pronating. He also identified some issues with my stride. I had been running for 30 years and didn’t think I was a pronator, but it turned out that I had developed this condition which was ultimately affecting my achilles.
There’s a lot you can find out from a video analysis, I highly recommend this solution. You will be amazed at all the ways you can improve. For me, this was the best way to prevent injury and also dramatically improve your running speed.
Shin splints are a common injury for runners. They can also be known as medial tibial stress syndrome (MTSS). Symptoms include pain in the front of your lower leg and at times along the inside of the lower leg, next to the shin bone (tibia). Because shin splints are very common and often discourage new runners from continuing to train, I have put together this comprehensive resource which not only explains symptoms and causes of shin splints, but most important, treatment and prevention.
Self diagnosis of any sporting injury is dangerous. Every injury is different in some way and each requires specific assessment and treatment. It would be irresponsible of me as a certified coach to attempt to manage your injury in an article. So use the following information for guidance. Although I provide much researched details along with a logical and effective rehab program, I encourage athletes to seek professional medical opinion for diagnosis and to confirm treatment protocol for any injuries.
The role of the shin bone during running is to help absorb and dissipate the impact generated with each foot fall. Shin splints are generally an overuse injury that occur when too much stress is put on the tibia or when the muscles next to and around the tibia are overworked. In healthy runners, the stress a bone experiences after a long, hard run is not a problem and doesn’t result in shin pain. However, in less experienced runners or athletes who have a muscle imbalance with weak shin muscles and underdeveloped hip abductors & calves, the shin bone has not yet adapted to the stresses of a high-impact activity like running.
Unfortunately, shin splints often recur with many runners who aren’t able to address their overall weaknesses. This is because, many resources on how to get rid of shin splints (even from trusted medical sources) don’t address the root cause of the problem.
Risk factors for shin splints
The biggest risk factors for shin splints is a rapid increase in mileage or intensity of your running activities, such as a big increase in mileage or over-training on hills or hard/uneven surfaces. However, in order for these risk factors to lead to shin splints a pre-existing muscle imbalance between quads and hamstrings or weak shin muscles and underdeveloped hip abductors & calves will often lead to shin splints. Other factors include inadequate footwear, poor bio-mechanics such as over-pronation, flat feet or high arches. Each of these risk factors contributes shin splints.
In a recent study of high school runners, a significant relationship was found between Body Mass Index, internal hip rotation angle and shin splints in females, and between limited single leg raise and stress fractures in males. This would support the need for strengthening and stretching exercises which are discussed below.
Symptoms of shin splints
Shin splints result in pain in the front of the outer leg below the knee. Typically this pain is located on the outer edge of the mid region of the leg next to the shinbone (tibia). In my experience dealing with runner’s with shin splints, they complain about discomfort in an area of their leg that’s anywhere from 4-6 inches in length (as opposed to a stress fracture which is typically pain in a much smaller area). Oftentimes, the pain the runner is experiencing is at the beginning of the workout, then gradually lessens, but then can reappear at the end of the training session. Most people describe shin splint discomfort as a dull ache at first. However, as the trauma continues, it’s not uncommon for the pain to become so unbearable that it causes the athlete to stop their workout altogether.
There are many articles regarding treatment of shin splints. The aim of most “traditional” treatment methods involved rest & ice, which typically reduced the pain. Medical studies of shin splints have attempted to confirm the most effective treatment, but no study is conclusive.
The proper progression of treatment and along with a planned exercise program will help alleviate the pain and most important prevent shin splints from recurring. First, I strongly suggest getting a diagnosis from a medical professional. We must confirm that the trauma is actually due to shin splints and not a stress fracture. There’s a big difference between the two injuries, especially in the treatment and length of recovery.
Assuming that the injury is shin splints, first order of business is to minimize the pain.
Rest – avoid activities that cause the pain or discomfort. However, don’t give up on all physical activity. Try low impact exercises like elliptical, swimming or stationary bike.
Ice – apply ice packs to the affected shin for 20 minutes at a time 2-3 times per day.
If the pain persists when you’re not engaged in physical activity, consider taking an over-the-counter pain reliever of your choice. Discuss your best options with a medical professional.
Use of KT Tape
KT Tape can help treat shin splints by relaxing associated muscles, relieving pressure on tissue to reduce pain, and increasing circulation. Although I haven’t tried KT Tape as a means to minimize shin splints, you can follow the directions in this KT Tape video
In parallel to the above pain relieving regime, preventing shin splints involves a program of stretching and strengthening.
Best Prevention Strategy
Improving calf strength, abductor strength and strengthening shin & hip muscles are the best approach to preventing shin splints. The calves are the largest muscle group in the lower leg, when we strengthen them along with hips and shin muscles, we help stabilize the tibia with each impact.
Regularly stretch your calves and hamstrings.
Use the stretching routine below to help avoid tight muscles in your leg that can put you at greater risk for shin splints and other lower leg injuries.
Avoid sudden increases in physical activity.
Gradually increase your weekly mileage & the intensity of your workouts. The rule of thumb for most runner’s is to limit weekly mileage increases to 10%. More experienced runners can increase by slightly more, but it’s always best to err on the conservative side.
It’s also very important to ensure proper recovery after long & hard runs. This not only includes spreading out days between hard activities, but also completing alternate forms of exercise (like elliptical, stationary bike and swimming). It’s also really important to run slow on your easy days. Bottomline, getting sufficient rest will ensure proper recovery and help to avoid injuries.
Run on softer surfaces whenever possible.
This tip isn’t just for runners that are experiencing shin splints. It’s a good idea to try to minimize running too often on hard surfaces, such as concrete (sidewalks & bike paths). These hard surfaces over time will increase the amount of force that your bones and muscles have to absorb which can cause muscle fatigue and overuse and ultimately possibly result in shin splints.
Choose soft surfaces like dirt, grass and synthetic tracks. Make it a goal to go for a weekly run on a nice wooded trail to break up the monotony of running on surface streets. This will help to prevent your bones, muscles, tendons and joints from having to absorb so much shock.
Complete exercises that will strengthen your foot, ankles and the arch of your foot.
The arch of your foot forms by the time you are 7 to 8 years old. Injury, age, and other health conditions can alter the structure of the arch; lack of physical activity can actually create weakness in the muscles of the foot, lower leg, thigh, and trunk. These changes can affect your lower leg and is often why beginner runners experience shin splints.
Strengthening your feet is important. An excellent exercise is using your toes to pull a towel on the floor closer to your foot while sitting. This helps to strengthen the arch muscles. Stronger arch muscles ensure the arch works more effectively.
Foot orthotics (ie, arch supports) may be prescribed by your doctor or physical therapist if you pronate or require additional support for low arches. Alternatively, orthotics help with high arches by helping the foot absorb more shock and decrease stress.The use of orthotics should be prescribed by a medical professional.
Strengthen your hip muscles.
Strengthening your hip muscles will help your legs absorb more of the shock and pressure during running. Below are some excellent exercises that will help.
Ensure you are wearing running shoes that are right for you.
Shoes that don’t fit right or that lack proper features can contribute to shin splints. Speak with your physical therapist about the right shoe features for you. I also recommend rotating your running shoes. One strategy is to rotate your shoes. This means having 2 pair of the same or slightly different shoes and use them each 3 – 4 times per week.
It’s essential to regularly replace worn running shoes. Typically replacement is recommended every 350 to 500 miles (560 to 800 kilometers). You can find a detailed article discussing how to buy new running shoes. It’s a quick, but informative read that will help you get the appropriate shoes to accommodate your gait and size.
Maintain a healthy body weight.
Increased body weight, being overweight, or obesity can lead to a higher risk of shin splints. Even if you if you run or exercise regularly, you should still regularly consume a well balanced diet. You can find some suggestions about How To Improve Your Diet Right Now.
Have your running technique analyzed and corrected by a physical therapist.
Incorrect running, jumping, and landing techniques can cause shin splints. Your physical therapist can help you understand how to improve your exercise technique to avoid shin splint pain. Your physical therapist also can check to see which muscles are tight or weak, and teach you how to stretch and strengthen them.
Physical therapists can observe how a person moves, determine how their body reacts, and then establish a program of care for prevention, recovery, and progression of desired activity.
A formal video analysis of your running technique can help to identify movement patterns that can contribute to shin splints or other injuries. In many cases, a slight change in your running can help decrease your risk.
How to Prevent Shin Splints Routine
So now that we know all this information about the cause of shin splints, it’s essential to develop a routine to prevent them. Below is a recommended strength training program. The exercises shown will strengthen and stabilize your legs, ankles, hips and core. They will help prepare your legs and body to deal with the high-impact of running.
Start by lying on your side, legs stacked on top of each other with your knees bent at around 45 degrees and pulled slightly behind you.
Put your bottom hand under your ear to support your head or along the floor and use the upper hand to push into the ground right in front of your chest.
Keep your heels together, slowly open and close your upper knee up and down. Switch sides and repeat, opening out the opposite leg for the same amount of reps.
Clams help to maintain hip flexibility and provide knee stability. The small controlled movements activate all the small muscle groups in your glutes and inner legs to improve strength and range of motion without any impact.
Stand approximately 18 inches from a wall with both feet shoulder-width apart, toes pointed inward.
Press your pelvis to the wall, adjusting the distance from the wall and the angle of the toes to gain the best stretch of the soleus muscle. Keep your heels on the floor.
Hold stretch for 15 – 30 seconds and repeat.
Get on all fours with your hands under shoulders and knees under hips.
Keep right knee bent 90 degrees, flex right foot and lift knee to hip level.
Lower knee without touching floor and lift again. Complete 15 reps.
Switch legs and repeat.
Standing Calf Stretch
Stand, facing a wall with one leg extended backward, foot planted on the ground. The other leg, flexed at the knee, has the foot planted on the ground straight down from the hip. Arms are extended forward at upper chest height, shoulder width apart. Hands are placed on the wall.
Press gently into the wall and gradually press your heel of the extended leg into the floor. A stretch should be felt through the length of the calf muscle.
Stretch statically for 15-30 seconds, repeat multiple times and then switch legs after every rep.
Runners with either neutral or underpronoted biomechanics often suffer from tight calf muscles. This stretch will help to alleviate the pain associated with recurring calf injuries. This stretch will also help to prevent calf injuries by keeping the calf muscle supple.
Hip & Glute on Ground
Thrust Hip Up, Point Toe Forward & Hold for 5 seconds
This exercise helps to improve glute strength
Standing Heel Raise with Eccentric
Stand with both feet on a step with the heels off the step. Hands are pressed against the wall in front.
Raise up onto your toes of both feet to full extension
Lower gradually to full extension (dorsiflexed).
This exercise both shortens the calf muscle and then lengthens it. Including an eccentric (or negative) component adds value to the the calf. Performing exercises with an eccentric component actually shortens the time it takes to heal an injury.
If you’re currently experiencing shin splints or they have plagued you in the past, incorporate the above routine into your training two to three times per week. Now you’ll be targeting the real cause of your shin pain rather than strengthening a muscle that really doesn’t contribute to the injury.
Zimmermann WO, Helmhout PH, Beutler A. Prevention and treatment of exercise related leg pain in young soldiers; a review of the literature and current practice in the Dutch Armed Forces. J R Army Med Corps. 2017;163(2):94–103. Free Article.
Yagi S, Muneta T, Sekiya I. Incidence and risk factors for medial tibial stress syndrome and tibial stress fracture in high school runners. Knee Surg Sports Traumatol Arthrosc.2013;21(3):556–563. Article Summary in PubMed.
Authored by Andrea Avruskin PT, DPT.
Claude T Moorman III, ScientificAmerican.com/article/what-cause-shin-splints. May, 2004.
Last week, I presented a video and discussed the difference between shin splints and stress fractures. That video reviews in detail the differences, which is really important because the treatment is so different and it’s possible for shin splints to lead to a stress fracture if not treated properly.
One of the root causes of shin splints is a muscle imbalance in leg with calf muscles being much stronger than muscles that surround the shin (tibia). Because these muscles are under developed with beginner runners and athletes like weight lifters who try to run, shin splints are very common.
The following video provides 3 easy exercises that should be regularly completed to help prevent shin splints.
Other strategies to help prevent shin splints include:
1) Avoid or at least minimize running on hard surfaces, instead opt for softer surfaces like crushed gravel or well worn dirt trails. 2) Run in shoes that aren’t worn down. The general rule of thumb is to replace running shoes between 350 – 500 miles. Take a look at the soles and if they’re showing signs of wear, replace your shoes. Even if the soles aren’t worn down, the inserts inside will be after about 350 – 500 (tops). 3) Give yourself enough time to recover from long and/or hard workouts. Go easy and try to stay on softer surfaces after putting a lot of stress on your legs. 4) Stay at a healthy weight. This will also help avoid or minimize many other running related injuries to the knees, hips, back, etc.
The following video is a short view, but I’m sure you’ll find it to be very informative with exercises you can start doing immediately.
Shin splints are very common with beginner runners. Both shin splints and stress fractures are considered overuse injuries. They are both very painful, but the treatment protocol for these injuries are very different.
A shin splint is an inflammation of the tissue running along the shin bone, whereas a stress fracture is a very small crack or group of cracks that form in the bone itself. Typically, a stress fracture shows itself as pain in a specific location along your shin. Shin splints tend to hurt as you rub your finger/thumb along the shin. Often, shin splints hurt a lot when you wake up, whereas a stress fracture won’t.
This video goes into great detail discussing the differences between both injuries. The treatment of a stress fracture and start with a boot. Non impact exercise may be allowed (bike, eliptical, swimming). I strongly recommend consulting with your Doctor for a full recovery plan.
My youngest son experienced a stress fracture last year. He was not able to run for 10 weeks.
Have you heard of training by feel, running with your inner GPS or simply training without a GPS watch? They’re basically the same, but I had never tried this strategy myself, until the last 5+ months. Last Sunday, I crossed the finish line of the Vancouver Lake Half Marathon and I saw the finishing time of my run for the first time since last September. In this article, I will briefly tell you what I learned, how I trained and the results of my race.
Training With a GPS Watch or Electronic Stopwatch
Since 2010, I’ve religiously tracked every run that I completed outside. I uploaded runs to my Garmin Connect, Polar Flow or Strava Accounts. Prior to 2010, I used a simple digital stop watch (traditional Casio) and documented the results in a log book. I was never obsessed with my times, but I would compare similar workouts from year-to-year.The GPS watch was merely to ensure I was following the assigned workout paces. I wasn’t typically concerned about distances, since I’ve been running in/around my town for the last 19 years, I know the approximate distances.
Running By Feel
In Matt Fitzgerald’s book: RUN – the mind-body method of running by feel, he provides numerous reasons to ditch the gadgets and listen to our body. The biggest reason to run by feel, as opposed to increasing/decreasing your pace mid run, based on what you see on your GPS watch, is that how you feel during runs is the most reliable indicator of how well the training process is going. Many who run without a GPS watch claim that it reduces performance pressure and can help prevent injury, because when they make adjustments to their pace based on how they feel, they’re not over-extending themselves. Instead, they’re actually working within a smart, yet challenging, training zone.
So, if you feel good during a run, you’re likely fit. In general, the more fit you are, the better you will typically feel during your runs. Now, I understand that if one was running slow, they may feel good, but that doesn’t mean that they’re fit. So, let’s assume you need to be running at what is a fairly quick pace (within your abilities) and then determine how you feel. Ultimately, the only way to get fit is to work hard, which likely means you’ll end up suffering through some workouts.
Remove the Watch To Create A Positive Mindset and Momentum
Momentum in running, occurs primarily in training and can take the form of a period of improving fitness. In many articles and interviews, it’s apparent that even the most confident athletes know that they do not have complete control over every situation. They are aware that their success often depends on the situation shaping itself to their benefit. Why not remove the watch from the equation and simply run by feel where you can create both a positive mindset and momentum.
In my experience, with runners I coach, the most effective way to manage their fitness/fatigue balance is to tell them to pay attention to how they feel. When they don’t feel good, regardless of the time/pace on their watch, we must must determine whether it’s because of lack of fitness or excessive fatigue. If it’s lack of fitness, we can correct this with more hard work. However, excessive fatigue should be corrected by more rest, which also could mean simply slowing the pace of the workout and upcoming workouts.
Another term for running by feel is “using your inner GPS.” Some coaches, like McMillan, have written extensively about calibrating your inner GPS, so I won’t get into the details in this post. It’s important to understand that inner GPS training or running by feel should not take the place of traditional time/distance-based training. At least not until you have a lot of experience running by feel. I recommend that if you want to run a time like 1hr 59 minutes for ½ marathon, you better know exactly that pace.
Heart Rate Monitor
If you don’t feel completely comfortable about ditching a gadget, an alternative to using a GPS watch is using a heart rate monitor. You’ll still need the watch, but you can just adjust it so you only see your heart rate. One could make a sound argument that this is technically running by feel. Instead of running at preassigned paces that you monitor with your watch, when you train with a heart rate monitor, you simply adjust your pace by keeping your heart rate within a specified zone. This is why this is also referred to as zone training. I discuss how to train using a heart rate monitor in an article I wrote a few years ago.
My 5 Month Challenge of Training without a watch
What started out as just running my base/easy mileage without the watch, soon turned into 5+ months of not tracking my times or pacing for any training run. The majority of my runs were on the road, some were on hotel treadmills. Typically the treadmill runs were 4 – 5 miles at an easy/conversation pace (low 7s) and an elevation of 1.5 – 2 degrees. Duration of my treadmill runs were 30 – 40 minutes. Over the first 3 months I usually ran 18 – 30 miles per week at an easy or conversation pace. I don’t know for sure the pace of any runs, but for the last 5+ years, I’ve been able to easily complete 6 mile runs between 46 – 48 minutes.
To a large extent, due to my many years of experience of being a long distance runner, my inner GPS has been calibrated. I’m confident that I was probably running the majority of my runs at 7:45 – 8:15/mile pace. As you can see below, I also completed a few faster/tempo paced runs of 5-6 miles. On a weekly basis I would also get to the track to complete strides to keep my legs moving faster.
Since last September, while I completed my base or foundation training, I also performed 2 – 3 different CrossFit workouts per week. The CrossFit consisted of 45 minute High Intensity Interval Training (HIIT) with a variety of challenging body weight exercises. I also regularly completed a 45 minute routine where I would rotate between 1 minute on a stationary bike at a controlled to vigorous pace with 1 minute of body weight, BOSU and/or barbell exercises. The key to these workouts was the variety and intensity. They were supervised by a personal trainer in a group setting at my health club. My goal was to get stronger, build an injury resistant body and reduce the pounding on my legs while completing aerobic exercise.
Increasing the Intensity as the Race Gets Closer
Two months out from the ½ marathon, I started to gradually increase my weekly long run from 7 to 12 miles. I also increased the intensity of 1-2 runs per week. All the while, I never used a GPS watch. Following are some of the workouts that I completed: Training started in September. During Weeks 1-4, I continued with base training (conversation pace runs of 4 – 7 miles) and cross-fit training.
Week 5 of 10 8 miles at easy/conversation pace (CP) Fartlek 3 other easy/CP runs of 4 – 6 miles (1 day w/ strides)
Week 6 10 miles at CP 4 mile Tempo (at ½ Marathon Pace (MP)) 3 x CP runs of 4 – 6 miles (1 day w/ strides)
Week 7 11 miles at CP (last 2 miles at ½ MP) 6 mile Tempo (at ½ MP) 3 x CP runs (1 day w/ strides)
Week 8 12 miles at CP (last 3 at ½ MP) Track Workout – 4 x 1600M at 10k Pace 3 x CP (1 day w/ strides)
Week 9 10 miles at easy pace (last 3 miles at ½ MP) Track Workout – Ladder (400M, 800M, 2 x 1200M, 800M, 400M at 5k pace) 3 x Easy Runs
Week 10 9 miles at easy pace (last 4.5 at ½ MP) 4 x CP 4-6 miles (2 days w/ strides)
Race Day – February 24th
Because I didn’t train too hard for this race, I wasn’t sure what kind of time to expect. The last ½ marathon I completed (2 years ago) was 1:27:45. I figured anything around 1:30 (6:55/mile pace) would be great. With almost ideal conditions of 35 degrees, overcast and no wind, I positioned myself at the start, slightly behind some runners who were projecting finish times of 1:25 – 1:28 (6:30 – 6:45/mile pace).
My strategy wasn’t to try to keep up with the faster runners. Instead, I wanted to keep them within range (gradually let them get 3-4 minutes in front of me). Turns out, this is exactly how the race played out. There were no splits given at any point, so I only knew my time as I approached the finish. My finish time was 1:30:25.
After the race I spoke with others who had run near me and told them that I had not used a watch for the last 5 months. Overwhelmingly, the response was positive and a few thought “how liberating.”
It really was liberating to train without a watch. However, I think I would use a watch for longer runs & track workouts if I was really concerned about achieving a goal time. The key to being successful when you’re not training with a watch is to be honest with yourself and push during the hard workouts and of course during the race. I knew I was getting fit when I was able to comfortably push the last 4.5 miles of my 9 mile run the Sunday before the race.
Due to some tough weather in January, I condensed the timing of the strength & track workouts (typically they start 8 weeks out), I never worried about splits during any of these harder runs. My goal was to self calibrate what I thought were 5k, 10k, ½ and full Marathon paces during each of the tougher workouts. During each one I always felt like I could have gone further or completed another interval at the desired pace. This doesn’t mean that I wasn’t running fast enough, because I felt fatigued.
I’m certain I could have run faster in the race if I had a 6 or 8 mile split. Also, if I included more strength and interval workouts in my schedule, I would have benefited. I also believe that if I had used a GPS watch during the race, I would have pushed the pace a bit more during the middle and end to get under 1:30.
If you’re interested in joining me, I can put together either a custom training plan or I can personally coach you. Either program will be specific to your goals and athletic abilities. Just click on the links for details.