Soothe your aching shins

Stay off the sideline and in the game. Our espnW physical therapists dish out cutting edge advice for avoiding (and quickly rehabbing) common sports-related injuries.

The injury: Shin splints. It's a bucket term for pain that flares up along or just behind the tibia, the large bone in the front of your lower leg. It was first described in 1913 by Dr. Charles P. Hutchins, a former Big Ten football coach, who called the nagging lower-leg ache "spike soreness." Hutchins said the soreness was the result of training while wearing track spikes and led to "lameness of the shin." Sounds harsh, but it's a fairly accurate description. Shin splints, as they're now known, aren't so much a distinct condition as a symptom of underlying trouble with the muscles, bones and connective tissues in your shins, most commonly:

• Inflammation. Irritated and inflamed muscles, tendons and/or the thin layer of tissue that covers the bone.

• Stress fractures. Tiny hairline fractures in the tibia.

• Medial tibial stress syndrome. The fascia covering the soleus (a deep calf muscle) becomes irritated along the tibia where the muscle attaches to the bone. This is often a precursor to a stress fracture.

Shin splints are extremely common, accounting for about 13 percent of all running injuries. They strike people in nearly any sport where there's running and impact on hard surfaces, especially basketball, racket sports and aerobics. Flat-footed athletes may be more prone to shin splints because their feet collapse and roll inward, stressing the muscles and tendons. New runners and athletes just starting a season are also susceptible, because they tend to ramp up their training before their muscles are ready.

What it really feels like

In the early stages, shin splints often present as a dull ache along the front of the lower leg. But they also can cause aches and pains on either side of the shinbone or deeper in the muscles. Your shins may also be swollen and tender to the touch. If you push through shin splints they can worsen, going from dull ache to sharp, showstopping pain. In some cases they hurt only when you're in motion. Other times they can cause constant nagging discomfort.

Who's been there

Though she really, really hates to admit it, ESPN's own injury analyst, Stephania Bell, was there -- big time. "I was an idiot," said Bell, who was working alongside a foot-and-ankle surgeon in Kansas City at the time. "I ran through the pain. On cement. In complete denial. I didn't want to admit that something was really wrong. But it got to the point where I would lie in bed and the sheets touching my shin would make me nearly squeal in pain. Walking hurt. It woke me up in the night." Finally, she gave up the ghost and got her shin checked: three stress fractures. "I ended up on crutches," she said.

Don't feel her pain

No matter the cause, shin-splint treatment starts with rest. "You have to let your legs heal while you address the underlying cause of the shin splints," Bell said. Here's what she recommends:

1. Cold front. Ice shin splints for 20 minutes three times a day for three days.

2. Anti-Inflammatories. If you can tolerate them, ibuprofen and other NSAIDs can ease the pain for the first few days.

3. Stretching. "Many people have limited ankle mobility and tight calves, which forces the tibial muscles to work overtime to pull the foot off the ground, placing a lot of stress on the front lower leg," Bell said.

Strengthen the muscles that support your ankles by stretching your calves and tibial muscles with these moves. Do them most days. (For more stretches, check out the video.)

    • Calf stretch. Stand facing a wall with your hands on the wall at about chest level. Place the leg to be stretched about one foot behind the other, both heels touching the floor. Gently lean into the wall, bending the front knee, until you feel a stretch in the calf of the back leg while keeping that leg straight. Hold 30 to 60 seconds. To stretch the deeper calf muscle, bring the feet slightly closer to each other and bend both knees. Switch legs.

    • Shin stretch. Stand tall and cross one leg over the other with the toes of the crossed leg pressed to the floor. Bend your straight leg and push the ankle of the crossed leg toward the floor, so you feel a stretch up your shin. Hold 30 to 60 seconds. Switch legs.

    • Eccentric calf raises. Hold onto a chair back or sturdy support and raise your heels to lift up onto your toes. Shift your weight onto the right foot and slowly lower down. Repeat 10 times. Switch feet.

    • Towel crunches. Sit with bare feet. With your right ankle plantar flexed (pressing toes downward), place your right foot on a towel. Use your toes to scrunch up the towel. Release. Repeat 25 times. Switch feet.

4. Massage. Get pain relief and speed your healing by breaking up muscle adhesions and boosting circulation through your lower-leg muscles. Firmly rub a tennis ball along the lower leg muscles, focusing on where it hurts, as well as deep into the calf.

5. Orthotics. Inserts that support your arch and prevent over-pronation may be helpful, especially if you have flat feet.

Keep them from coming back

Once you're pain free, keep shin splints at bay by continuing the stretching and strengthening exercises. Also baby those tibial muscles with these tips:

    • Replace those kicks. Buy new running or walking shoes every 300 to 500 miles.

    • Stay off the cement. Run on softer surfaces whenever possible.

    • Do a dynamic warm-up. Get your legs ready for action by starting your workout with some strides, leg swings and bounds.

    • Cross train. Mix in sports that place less stress on your lower legs, such as swimming and cycling.

    • Ramp up slowly. When starting a new activity like soccer or running, ramp up the volume gradually.

* -- This does not substitute for medical advice.

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