Plantar fasciitis is one of the most common causes of heel pain. It’s not unusual for people to manage their plantar fasciitis effectively, only to have their symptoms come back when they stop treatment. For this reason, it’s important to develop strategies to help prevent recurrence. This article will present the risk factors, diagnosis, treatment & a proven prevention program.
I’m not a trained medical professional, so please use the contents of this post as guidance. As a certified coach, I have used a network of medical professionals as resources for my injuries to whom I refer my local clients. If you’re experiencing any kind of pain that forces you to change your gait, then you should stop running and seek professional medical attention to properly diagnose, treat and prevent recurrence of your injury.
Similar to many other running injuries, Plantar Fasciitis is often an overuse injury. It’s described as a stabbing pain that usually occurs with someone’s first steps in the morning. As the athlete gets up and continues to move around, the pain normally decreases. However, it might return after long periods of standing or after rising from sitting.
The pain comes from inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia).
There are a number of factors believed to increase a person’s risk for developing plantar fasciitis. Plantar fasciitis is most common in, but not limited to runners. It’s often reported in athletes between the ages of 40 and 60, although anyone can get it. People who are overweight and those who wear shoes with inadequate support have an increased risk of plantar fasciitis. People who are overweight and run, can put extra stress on their plantar fascia.
The most common causes of plantar fasciitis are either structural (in the foot) or muscle/tendon weakness. For example, people who have problems with their arches, either overly flat feet or high-arched feet, could be more prone to developing plantar fasciitis.
The injury can be brought on by certain types of exercise. Activities that place a lot of stress on your heel and attached tissue — such as long-distance running, among other activities, can contribute to an earlier onset of plantar fasciitis. Occupations that keep you on your feet. Factory workers, teachers and others who spend most of their work hours walking or standing on hard surfaces may damage their plantar fascia.
Plantar fasciitis is typically aggravated by tight muscles in your feet and calves.
Wearing non-supportive footwear on hard, flat surfaces can put abnormal strain on the plantar fascia and can also lead to plantar fasciitis.
All of these risk factors can cause plantar fasciitis. Understanding which, if any risk factors you exhibit can help you prevent or minimize the effects of this injury.
You should AVOID self diagnosis of injuries. Plantar Fasciitis is not limited to the following symptoms. Instead, these are the most common symptoms reported by runners.
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The pain described by people suffering from plantar fasciitis is usually the worst with the first few steps after awakening, although it can also be triggered by long periods of standing or rising from sitting. The pain is usually worse after exercise, not during it.
Under normal circumstances, the plantar fascia acts like a shock-absorbing bowstring. It’s purpose is to support the arch in one’s foot. If tension and stress on that bowstring become too great, small tears can arise in the fascia. Repetitive stretching and tearing can cause the fascia to become irritated or inflamed.
Ignoring plantar fasciitis may result in chronic heel pain that hinders an athlete’s regular activities. If a runner changes the way they walk or run (their gait) to minimize plantar fasciitis pain, this might lead to foot, knee, hip or back problems. Bottomline, if you suspect you may have plantar fasciitis, seek positive diagnosis from a qualified medical professional.
Because heel pain may also be due to other causes, such as a stress fracture, tendonitis, arthritis, nerve irritation or in some rare cases, a cyst. It is important to have it properly diagnosed by a medical professional. A foot and ankle specialist is able to distinguish between all the possibilities and to determine the underlying source of your heel pain. Proper diagnosis will lead to correct treatment and hopefully speed recovery.
Accurate diagnosis begins with the athlete describing symptoms and discussing specifics of their injury. The doctor will examine the foot to pinpoint the source of the pain. The exam, along with the patient’s medical history, will help properly diagnose the condition. During the examination the doctor will look for areas of tenderness in the foot. While holding the affected foot, the doctor may bend the patient’s toes toward their shin and then press along the plantar fascia from the heel to forefoot.
A doctor may also order imaging tests so he or she can rule out any other causes of the pain, such as fractures or heel spurs.
Other imaging tests, such as magnetic resonance imaging (MRI) and ultrasound, are not routinely used to diagnose plantar fasciitis. In my research, an MRI scan only seemed to be used if the heel pain was not relieved by initial treatment methods.
After diagnosis, the first priority with plantar fasciitis as with other injuries is to treat the pain. There are a few options your doctor could try to ease the pain and reduce inflammation. In my experience & research, it’s often recommended to try a few therapies at the same time to resolve the issue as quickly as possible.
Nonsteroidal anti-inflammatory drugs (NSAIDs) will help reduce pain and inflammation of the plantar fascia. A doctor may prescribe multiple doses a day for several weeks.
Depending on the severity of the pain, decreasing or even stopping the activities that make the pain worse are typical first steps. It’s common for a doctor to direct an athlete to temporarily stop activities like running.
Other typical treatment options include rolling affected foot over a cold water bottle or ice for 20 minutes. This can be done 3 to 4 times a day. Putting an ice pack on your heel for 20 minutes several times a day helps reduce inflammation. Place a thin towel between the ice and your heel; do not apply ice directly to the skin.
Some people find that massage helps with symptoms. Focus on massaging the arch of the foot around the injured area. If surrounding muscles have become tense because of the pain, massage those areas as well.
Tip: Dealing with early morning Plantar Fasciitis pain provided by the Hanson’s:“If you run early and find it difficult until the plantar warms up (or loosens), I suggest putting the foot in the bath tub under running warm water & keep adjusting the temperature until it is as hot as you can stand. This (will) help the early run hobble.”
Exercises that stretch out the calf muscles help ease pain and assist with recovery. When you walk without shoes, you put undue strain and stress on your plantar fascia.
Wearing supportive shoes with extra cushioning and orthotics if prescribed by a medical professional can reduce pain, especially if the patient is frequently standing and walking. I wear and recommend custom orthotics that fit into my running shoe. Although orthotics are not for everyone, if prescribed, they help correct underlying structural abnormalities that contribute to plantar fasciitis. A cushioned shoe or insert reduces the underlying tension and microtrauma that’s causing pain with the plantar. Soft heel pads can also provide extra support, they are inexpensive and work by elevating and cushioning your heel.
Although medication, rest and ice often eliminate the pain, working with a physical therapist (PT) can address bio-mechanic, muscle weaknesses or imbalances that were actually the root causes of the injury. A Physical Therapist will help with strengthening and stretching exercises (discussed below) that can prevent injuries to the plantar fascia, achilles tendon, and also lower leg muscles.
Kinesiology tape, straps and splints
Although I could write multiple detailed posts about the use of tape, straps and splints. I’ll keep it simple here. I have experience with using tape to alleviate pain (either myself or athletes I coach). Tape can help, but it must be applied correctly to achieve it’s maximum benefit. Below are a few videos that may be of interest. Proper taping of the foot or use of straps help support the foot and reduce strain on the fascia. The tape & straps will allow your foot and ankle to move well. Before applying kinesiology tape to your foot, be sure to speak to your physical therapist or doctor to ensure you are applying it properly.
Wearing a night splint can help to maintain an extended stretch of the plantar fascia while sleeping. This may help reduce the morning pain experienced by some athletes. Remember that these devices help relieve the pain, but they don’t correct the root cause. The good news is that they won’t be needed once the pain is gone. As long as a regular preventative routine is implemented to address risk factors.
For those patients who don’t show progress after several months, a small percentage of patients may require surgery. From my research, the surgical option was rarely used and typically only considered after 12 months of aggressive nonsurgical treatment. A foot and ankle surgeon would discuss the surgical options with their patient and determine the most beneficial approach.
A few other treatment options are ultrasound, which is used to target and remove scar tissue. This procedure may allow the patient to get back to their regular routine much sooner than with surgery.
Stretches & Strengthening
Stretching exercises should create a pulling feeling. They should not cause pain. Ask your physical therapist or doctor which exercises will work best for you.
People can speed recovery, relieve pain and prevent recurrence with specific foot and calf stretches and exercises. Perform these exercises two or three times every day. Often, muscle tightness in the feet and calves can make the pain of plantar fasciitis worse. So, a good strategy is to gently stretch the plantar fascia, as well as the muscles around your foot and ankle. The more frequently you do this, the more you will improve foot flexibility, mobility and promote healing of the irritated fascia.
Calf stretch – Lean forward against a wall with one knee straight and the heel on the ground. Place the other leg in front, with the knee bent. To stretch the calf muscles and the heel cord, push your hips toward the wall in a controlled fashion. Hold the position for 10 seconds and relax. Repeat this exercise 20 times for each foot. A strong pull in the calf should be felt during the stretch.
Plantar fascia stretch – This stretch is performed in the seated position. Cross the affected foot over the knee of opposite leg. Grasp the toes of the painful foot and slowly pull them toward the body in a controlled fashion. If it is difficult for the patient to reach their foot, then wrap a towel around the big toe to help pull toes inward. Place the other hand along the plantar fascia. The fascia should feel like a tight band along the bottom of the foot when stretched. Hold the stretch for 10 seconds. Repeat it 20 times for each foot. This exercise is best done in the morning before standing or walking.
Placing a round object under the foot and roll it back and forth. This will help loosen up the foot muscles. People also use a rolling pin, golf or tennis ball or specialized foam roller for this.
Flexing the foot increases blood flow to the area and relieves tension in the calves, which can help with pain. This exercise uses a towel or elastic stretch band, which people can buy from sports stores or online.
Curling a hand towel or facecloth with the toes can stretch the foot and calf muscles. Try doing these stretches before walking or doing any other morning tasks.
Picking up a marble with the toes will flex and stretch the foot muscles. This exercise is tough, but highly effective.
If you’ve read through this whole article, you understand the pain resulting from plantar fasciitis and how frustrating and what a painful problem it is to manage. The upside is that there are steps you can take to help alleviate your symptoms, address the root causes of the injury and prevent it from returning. Regardless of the treatment you undergo for plantar fasciitis, you must address the underlying causes. Therefore, it’s important to continue with preventive measures which may include long term wearing of supportive shoes, regular stretching, strengthening and possibly using custom orthotic devices as discussed above.
I used many sources in my research for this article. I interviewed a Physical Therapist and numerous athletes who have suffered through plantar fasciitis. I also used articles from the following online sources.
Most IT band problems are caused by hip & glute weakness. Performing various strength exercises prevents the injury from occurring, However, to relieve the discomfort if you start to experience IT band pain, I have found that a regime of foam rolling, stretching and massage works well. My recommendation is to start a program of strengthening in parallel with the foam rolling, stretching & massage.
The strategy revealed in the following video is really for any athlete experiencing or wanting to prevent IT band syndrome. Follow along to work out the tightness and trigger points in the IT band, quad, glutes, hip and hamstrings. Static stretching of these areas after a massage can also help.
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.