Shin Splints: Beyond Overtraining & Rest - Complete Guide
This episode of the Unreal Results Podcast is all about shin splints. I go beyond the standard causes of overtraining and talk about how biomechanics/running form, nutrition, and even the nervous system may actually be the culprits to shin pain. Dive deep into my multi-faceted approach to shin splints and help your clients, or even yourself, get over this common injury and return to pain-free movement.
Resources Mentioned In This Episode:
Episode 3: Swelling Reduction Protocol That Works Like Magic
Episode 8: Unlocking The Fibula
Episode 14: The Stories We Tell: A Lesson From My Compartment Syndrome
Episode 25: The Peripheral Heart
Episode 26: Sartorius B.I.G.
Episode 45: The Kidneys - Visceral Connection To Movement
Episode 52: Foot Pain Shocker: It Might Not Be Plantar Fasciitis
Matt McInnes Watson IG Profile
Blog Post - Revitalize Your Sole
Blog Post - Foot Massage & Mobilization
Considering the viscera as a source of musculoskeletal pain and dysfunction is a great way to ensure a more true whole-body approach to care, however, it can be a bit overwhelming on where to start, which is exactly why I created the Visceral Referral Cheat Sheet. This FREE download will help you to learn the most common visceral referral patterns affecting the musculoskeletal system. Download it at www.unrealresultspod.com
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Anna Hartman: Hey there, and welcome. I'm Anna Hartman, and this is Unreal Results, a podcast where I help you get better outcomes and gain the confidence that you can help anyone, even the most complex cases. Join me as I teach about the influence of the visceral organs and the nervous system on movement, pain, and injuries, all while shifting the paradigm of what whole body assessment and treatment really looks like.
I'm glad you're here. Let's dive in.
Hello, hello, and welcome to another episode of the Unreal Results podcast.
Welcome back. Um, my desk is a mess trying to fit the computer and this microphone all in the space. Challenging. Um, here we are. I've been home now for two weeks. It's been glorious. Um, it's going by way too fast because I'm only home for another two weeks and then hit the road again. But sheesh, the weather's been great.
First day of spring today. We've made it. We've made it through winter. I know maybe where you live Perhaps it still feels a lot more like winter than spring but uh That's also why I choose to not live in those places Uh, also maybe you're in a different hemisphere shout out southern hemisphere people and you're in the entirely opposite Season is us.
I sometimes wonder, I'm like, what a very Northern Hemisphere centric world we live in. That's my thought, but maybe it's just because I live here. And I'm like, is it annoying to those in the Southern Hemisphere who, like, follow along on social media and Things platforms like podcasts and they're like, you know, it's opposite for us and I try my best to not be like Oh the course in the spring the course in the fall realizing that that's only true for half of the world Um and use months, but man if it's not difficult, especially sometimes when I don't know what month I'll be launching a course in so i'm just like oh the course will be in the fall or the summer so Yeah I'm always curious, thoughtful, what my Southern Hemisphere friends, what thoughts go through their mind when they hear things like that.
Um, speaking of courses, just opened the doors to the June 15th and 16th course, LTAP Level 1 course in Washington D. C. Doors are open. Um, I expect it to be full because there's been a big interest in having a course in Washington DC, um, and on the East coast in general. So, um, already, so, um, I just announced it only really on social media and on to my wait list on yesterday and, uh, already four spots are taken.
So, um, We'll see. Um, obviously it's only three months away, so I apologize for the short notice is actually, um, the first time I'm doing a course in the summer. I normally just do one. See, here I go with the seasons again. I normally do one in the first quarter of the year and the last quarter of the year.
But due to popular demand of this first quarter of the year course, I've added an additional course. So the LTAP level one in person course will be offered three times this year. So in April in Phoenix, it is sold out. Um, I had to actually open up extra spots for a couple of people. So it's like oversold.
And then, um, June in Washington DC and then November we'll be back in San Diego. So yeah, it's super exciting. I'm glad that it I'm so happy to be doing a third course I love the in person. In person is like Perfect. What I love about the in person course though, is that, um, there is a hybrid component, there is some online learning that you do prior to coming to the course, and, um, that allows us to be the whole two days, like fully, basically hands on, there'll be like a short lecture, you know, orienting ourselves, like refocusing, um, reviewing the online modules, um, right at the beginning of the class on Saturday, and then.
The rest of the day, Saturday and all day Sundays. Totally hands on. So it's a super practical course with the goal of being, when you get back to your clinic or professional setting on Monday, you are like ready to go in real time with your clients and feel confident that you're going to like do it right and get good results.
So, um, really excited about that. We'll still be rolling out the certification for the LTAP to become a, um, certified LTAP provider. Uh, but that's not going to be until, um, probably the end of The second quarter, third quarter of the year. Um, you know, so more for the last courses. Um, obviously if you've already gone through the courses, you'll be eligible to add on the certification if that's something that you want.
Um, but yeah, exciting things coming up and, uh, still working on getting CEUs for people. Um, though I can't promise that, definitely not promising that for the April course. Um, yeah. Definitely not promising it for the June course, but that's my target. And, um, we'll make sure that the certification portion at least has some CEUs attached to it too, if possible.
Um, so that's it on the courses. It's kind of what's exciting about this week. Um, rehab's going well with my athlete. We're just trucking along and I was talking to his doctor yesterday and I was just like, you know, We have our goal. We seem to be on target for it. There's no way to know if it's gonna work out.
We just gotta take it day by day and The body will let us know if it's possible or not. So, you know, he's sort of like You can only control so many things and we're controlling what we can control and um, hoping the body responds in the way we want it to but um, we're not about forcing things around here and so We're not forcing it.
We're just Pushing the envelope and his body's responding great. So, um, super positive that um You know, I feel positive that we're doing the right things and we're on track to hopefully meet our goals. So Yeah, it's uh an accelerated accelerated rehab. I always tell the doctor cautiously aggressive so with that said, um, I was at a track meet this past weekend and Shout out Naval Academy Track and field team, um, was watching them compete at the Point Loma Nazarene university track meet here in San Diego.
And first of all, also shout out Point Loma for literally the best track views in America. It sits right on the top of Point Loma, which is like the piece of land that separates San Diego Bay from the ocean and Mission Bay. And so, um, it's right on a natural preserve called Sunset Cliffs. And so it's right on the ocean.
It's absolutely beautiful. Their track and their baseball field are right there. And wow, what a lucky, what a lucky school to, um, run and play sports for and just to attend, you know, undergrads, they all live on campus. They've literally got the best housing for college ever. So, um, yeah, it was great to be at track meet.
Beautiful day. There's nothing better sometimes than sitting at a track meet on a beautiful day. Top that off with a view of the ocean, like. Not, not, not arguing with that as a great day. It was, it was cool to see, um, competition and, um, yeah. Anyways, when I was there, one of the people there, he is a high school track coach, um, also happens to be one of the parents of one of the Naval Academy, uh, uh, athletes.
And he was talking to me. He asked me a question. trucked me down on the track when I was going to get something to drink. He asked me about shin splints and, um, basically asked me, he's like, Hey, is there any like new things, new discoveries, new treatments for shin splints? Because I coach high school track and he's like, for the most part, we manage them pretty well.
But then there's always a couple outliers that I can't figure it out. And I was like, actually, yeah, I do have an opinion on shin splints. Um, full disclosure though, uh, I don't see a lot of shin splints in my population of athletes. Number one, I have a small population of athletes. Uh, so I'm only going to see so many things.
Number two, they're all, um, elite professional athletes that, um, are well taking care of themselves well, as well as, um, don't really ever have a ton of, like, time off and, and, like, laps from training, so they never sort of get in a situation where they're gonna be overtrained. And I'd say the majority of shin splints, often, are from an overtraining error.
Or just, And maybe it's not an overtraining error, it's an undertraining or underprepared error, meaning that they haven't really done anything and then they go into their seasons and then they're doing, you know, they go from zero to, you know, nothing to like everything and then that's the overtraining error.
So it's not necessarily overtraining technically, it's that you're underprepared and now you're doing too much too soon and your body is barking at you. And so, um, I answered his question. You know, too, in the, in the perspective of like, if I did have an athlete that assuming they're coming to me because they've tried all the traditional things and nothing has helped.
These are the things I would consider. And actually, when I look back on athletes that I have. Helped with this over the years, some of the stubborn ones. I think if I would have known this information, perhaps I would have had a little bit better outcome with them. This also comes about a year ago. Um, one of my athletes agents, um, reached out to me about another one of his football players, um, who was a professional football player.
I am, I can't remember position, but I want to say it was a wide receiver, some sort of position. Um, like that, you know, like a more, um,
I don't even know what you want to call those positions, but like a little bit more dynamic of a position, move around a little bit more on the field. Um, but anyways, uh, his agent reached out to me because he was having this problem. He had actually bilateral shin splints. And no, like he wasn't getting any relief from, you know, anybody he was seeing really like the sports medicine team, um, on the team he was with, um, other professionals in the area, I guess it was like something that had, it's been like kind of chronic for him.
And so they were reaching out to me to see if I could consult with them. And then like, what, like what I would consider, like, what, what maybe are they missing? And so, um, This is also so that when I got the question on the track meet this weekend, I was like, actually, yeah, I just answered this question for someone not too long ago.
And I do have a lot, lot of thoughts on shin splints and let me share them with you. So shout out that coach. Thank you for the question. Reminded me that This would be a great episode of our podcast. So that's what we're doing today. We're talking about shin splints and, um, makes sense. We talked about plantar fasciitis last week.
So we're just moving up the leg from the plantar fascia and to shin splints. And, um, As usual, I have, like, this, like, brainstorm piece of paper to the side of me that I, like, write, um, all my thoughts, like, just how my brain works. And, um,
so let's dive in. So I already talked about one of the primary things with Shinsplint is overtraining or under prepared leading into a situation like overtraining. Um, part of that, too, in addition, um, especially for Some of my athletes, especially for the track athletes hate to like point fingers, but a lot of them are underfed and from a nutritional standpoint, maybe you're not getting all their nutritional needs, needs met, which in general, when you're not getting your nutritional means, needs met as an athlete, you're going to be more susceptible to a couple of things.
One, soft tissue injuries and pain. And then two, um, stress fractures and bone density type issues. Um, especially then too, when you look at females and adding them all the hormonal things, um, you know, with excessive exercise and under fueled athletes. So, um, so that's, you know, that's always kind of like a possibility of shin splints that it's actually a stress fracture to the tibia.
Um, That is something to rule out and then looking back to like if it is a stress fracture, looking at nutrition, are they getting enough calories, protein, vitamins, and minerals, uh, to support healthy bones and healthy soft tissue. Um,
overtraining also gets thrown into this category, right? Like, um, at the end of the day, like how much pounding is happening on these bones with In this too, this overtraining piece in this like stress fracture piece, um, and it's going to relate to another sort of factor that I have in shin splints too on the deceleration weakness is basically, um, you're running mechanics and your movement mechanics in terms of, are you adequately, are you moving within your fascial tensegrity system?
Like, are you eliciting an absorption of forces through the muscles and the fascia and elastic recoil through the fascia to be efficient with your, um, running mechanics. And so how this relates to it, when we can, can stay in this elastic recoil function, especially of our lower legs, you know, because our legs, lower legs are a built in spring for us.
So when we're developing, When we're developing in the womb, our limbs come out of the embryo, and then as the embryo is developing into a baby, so a fetus, and then into a baby, um, one of the last things that happens in our limb formation is our lower legs twist. not lower, sorry, our entire legs twist. The back of the leg becomes the front, the front becomes the back.
And so we have a built in spiral, a built in spring to our lower extremity. Um, this is part of what makes our walking so efficient is that we are relying on this built in spring action of the limb. This built in spring action of the limb is also amplified by one, our rotational pattern in our trunk, our bipedal rotational pattern, but then ultimately amplified by our fascia.
The quality that fascia has, um, is. this elastic recoil function that is able to store energy and release energy within the tissues, which then costs us very little from an economical standpoint of creating a muscular contraction to move the body, to locomote. So locomotion is actually a very low cost movement pattern because of this, um, stored potential kinetic energy sort of thing, right?
So there is a certain cadence of movement that will, um, target these tissues more than others. So we are actually more efficient, not out, not so much even out walking. I mean, walking is efficient, but we are most efficient at this elastic recoil at a running cadence of 175 to 185 beats per minute. And so oftentimes if I want to decrease the impact on joints and bones, I want to make sure that a lot of my training is in this It's 175 to 185 beats per minute.
When I'm training in that cadence, I have less impact into the joints and the bones and more into the fascia and the soft tissues. So for someone who is feeling when they run a lot of like bone pain or joint pain, it's helpful to kind of like, look like what is their cadence? And the cadence is interesting because as you clean up someone's running mechanics and get them to be striking on the area of their foot, that is like, better, more efficient, mechanically efficient to strike at, which is right behind the Met Hats, right, right behind the forefoot, not on the heels.
It actually sort of naturally puts you in this quicker cadence. And so, um, this too, why sometimes doing a lot of barefoot running work or barefoot movement stuff can be helpful in these scenarios. I think oftentimes people look at barefoot movement as a way to strengthen the foot, um, which. Can be possible, but when you're actually doing running it is a way to force us to that better foot strike position because a really painful thing is when you're barefoot to land on your heel because there's not a whole lot of Cushion there and so it hurts and so you you can't This is a, an example of you change the environment and it changes the movement pattern, take the shoes off, you create a little pain scenario and the body will avoid it.
The body avoids it by getting more up on top of yourself and striking at that, um, more flatter foot sort of, um, right behind the forefoot contact. So that's something to consider is like it, especially in the case of the person that's having a stress reaction That's creating the shin splint pain or you're suspecting they're on the Spectrum like they're on the path to that is like looking at their cadence looking at their mechanics from that standpoint now
another thing to consider is Well, and I guess we'll talk about it because I kind of already led into it with the foot thing. So another like standard approach to shin splints is, um, the assumption that the person's foot stability is lacking or their foot is weak. And so, um, people prescribe a lot of foot and ankle exercises for these people, which, um, Is, is not sometimes wrong, sometimes it can be, again, like a lack of stiffness in the foot, um, a lack of, in stiffness I mean like, um, fascial and muscular stiffness providing this like spring like action, not stiffness as in like limited mobility in the joint.
And so, um, you know, some foot strengthening can be helpful to, um, support that. This is also sometimes when it's counterintuitive to do a lot of barefoot stuff, because sometimes a lot of barefoot stuff is like, Too much of a load and it actually makes things worse And so it's always a happy medium when you take your shoes off to do barefoot Exercises just because your shoes are off and your barefoot doesn't make the exercise a foot strengthening exercise It makes it a barefoot exercise.
And then every exercise you do barefoot is not great, not always helpful. So this is always like, what is the intention behind the exercise? So oftentimes my athletes will be like, Oh, we should do our step ups or our split squats or our squats with our shoes off. So then not only are we getting the leg strength out of our exercise, but we're getting foot stability and foot strength too.
And I'm like, that's, it, it doesn't work that easy. And something's got to give, right? Like you are only as strong as your weakest link. You're only as strong as your weakest link. So if your intention with the exercise is foot strength, Then sure, take your shoe off, go barefoot, pay attention to how your foot is moving, and like really work on the intrinsic connection of the foot to the leg to the pelvis.
Now that means in order to do that, you might have to drop the load down or decrease the difficulty of the split squat, squat, or step up. So that means now that that split squat, squat, or step up. that you thought was killing two birds with one stone, right? Like doing leg strength and foot strength is now just a foot strength exercise.
Not so helpful on the leg strength thing. And so you have to decide when it's appropriate to help your foot out and give it, meet it where it's at and then strengthen your leg, right? If, if you had nothing but time on your side from a, um, Training preparation standpoint. Yes, of course you would do both at once because eventually your foot gets strong and then you can load the The movement and get the legs strong, but most of the people that I work with most of the athletes I work with, they have a timeline, they have a very distinct start of the season, then they need to be ready for.
And if we dick around and do everything barefoot, then I'm leaving a ton of strength opportunities on the ground on the on the, you know, on the table. And so it's like, Is that really the best way to strengthen the feet? Probably not. I should just insert exercises into their program that are going to help strengthen the foot and are just foot focused.
Can they be barefoot? Yes. Should they be barefoot? Yes. Always? No. Can you strengthen the foot with shoes on? Yeah. Um, But taking shoes off what it actually does with the more important powerful component of it is there's an opportunity to Improve sensory information to the foot and I've talked about this in many podcasts and I have a whole blog post on it So Joe, let's make sure to link those.
I think it's the rest posture podcast and then the Revitalize your soul blog post. Um I And also I just talked about it last week on the podcast with the plantar fasciitis podcast. Let's link that. Um, improving sensory information to the bottom of your foot, improving sensory information, period, is going to improve your motor output in your foot, in the leg.
in your movement, all of it. And so the benefit of doing some barefoot work for someone that's having shin splints is actually the sensory thing more, I would argue more than the strengthening thing. You get an improvement often of strength and postural dynamic alignment of the foot, but it is the body organizing itself differently based on the sensory information.
And so if you're including barefoot training in your, in your training or rehab for these athletes with shin splints, I would encourage the barefoot part to go find surfaces that are interesting for the foot. So not the carpet, not the hardwood floor of the clinic, not the concrete of the clinic, not the concrete of outside.
Something more interesting, the track. That's a little interesting. It's textured. The grass, super interesting. Plus you get that a benefit of grounding or earthing, um, you know, to refill our electrons in our body, like literally recharge our battery, um, and rehydrate our fascia. And then also, the sand at a track is great, right?
Just walking in the sand pit. Yeah, is it harder? Yes, because the earth is now moving. And so you're, you don't have the elastic recoil properties as well. Right? Because the surface is softer and so your muscles have to do more work to create locomotion. So that's strengthening, but also that sand is a little bit more interesting.
If there's rocks around the area, that is wonderful as long as it's not painful, right? Anything, any surface creates an interesting environment for the foot to touch and feel is going to be helpful. Even using our hands to touch and feel our feet or different type of, um, tools like, um, a spiky soft massage ball or a spiky Uh, uh, corrugated mat or a plastic rock mat.
Like, there's many, like, artificial tools that we can use, too, to give, um, the foot an interesting thing to feel. But the key is that it has to be comfortable and not painful. So, um, And with that sense, if there is some weakness in the foot, which there often is, um, just being barefoot is not going to strengthen it.
It needs to be targeted exercises specific to what they're working on. So one of my athletes, like very targeted, we're working very specifically on his posterior tibialis. It was sort of like the weakest link of everything. So we're doing very specific posterior tibialis based calf exercises. Um, Another one that is like chronically weak in people is the soleus and I talked about this on um, joe will link this episode to um, the soleus I talked about it twice.
One on the podcast, I talk about my experience with exertional compartment syndrome. And then also on the podcast about the soleus, which is called the peripheral heart. So that is another actress, another, um, muscle that needs to be targeted quite a bit. Um, and we're going to talk about that in a second separately, cause it has to do with a couple other things in relationship to shin splints too, but yeah, by all means, strengthen the foot, but do it.
With intention and do it with specificity. Don't just generalize any barefoot work being foot strengthening and like call it good, right? Like that's not how it works. And then also recognize that if there is a true weakness, then a lot of what they need, a lot of what the athlete needs in their day is support around that.
You meet the body where it is as you're gaining strength. You also probably would. Want to consider maybe an arch tape or an arch support or at least wearing shoes with a lot more of the higher Dynamic loaded stuff because again just barefoot doesn't make it
Sometimes barefoot makes it the worst thing. Counterproductive to a foot exercise. It actually makes things worse. So, not going into this blindly is really helpful. So, um, Those are helpful things when it comes to like the foot stability of the shin splint. Now, another thing that's really common, um, you know, or like traditionally thought of with shin splints is, you know, again, it kind of depends on what side the shin splints are on, but this, it can be both.
Let's not oversimplify things, but traditionally it's thought that shin splints that are more on the outside of your shin, like around the tibialis anterior or anterior compartment of the leg are related to not very good deceleration mechanics. Okay. Or just like a fatigue of the dorsiflexors, right? And so, you know, you're getting kind of like a little foot drop scenario.
And so theoretically, then that means we need to work on our deceleration. And deceleration is something that I think a lot of people don't work on. in general. I think, um, deceleration is a little bit misunderstood. I think one of the main things that's misunderstood about it is the role that the soleus plays in deceleration and in controlling the anterior tibial translation.
Most people think that strengthening in the soleus is just like a bent knee calf exercise. And, um, it is, but also just as powerful as, of a stimulus to the soleus is a straight leg calf exercise. But even more powerful to a soleus is, um, a deep squat or a deep lunge or decelerating. And so I actually think a lot of the things that we can do for soleus besides just the traditional strengthening like as a calf raise, which is helpful, I'm not saying to take those out, I'm actually probably saying to do more of them.
Um, but to let go of the thought process that the only way to target the soleus is seated calf raises or bent knee calf raises. It's just as active in straight leg calf raises. Um, so calf raises in general in any variation are going to be very helpful for the soleus. Um, but also, you know, making sure you're doing stuff that are introducing anterior translation of the tibia.
So full dorsiflexion, a deep squat, something I'm playing around with now, thanks to, um, A new friend and colleague that, um, I've been learning from and working with is, um, some deeper, like yielding type of eccentric, I don't, I don't love the term eccentric plumb eccentric loading because it's more than that, but it's like oscillating or yielding exercises into deeper ranges of motion that occur when we're needing to do plyometrics or to decelerate.
And, um, Not just doing like drop squats and not just doing like falling lunges into these deceleration patterns but going deep into the pattern and oscillating so The coach I'm learning this from is Matt McInnes Watson. He's I think on Instagram Joe will link it, um, on Instagram. It's Mcinnes at McInnes Watson.
His company is plus plyos and his yielding series is like, so good for this. Like I'm adding it in for my own body, but also for my athletes too. And I think it's just going to be so helpful for that soleus. Strength in particularly, among other things. And then it's like also you can't separate all the out the muscles like that.
So like as we're stimulating the soleus in those deep squat or deep split squat positions, like we're also getting the quads, we're also getting the hamstrings. We're also getting the rest of the lower leg muscles. So it's like everything, right? But the way I'm seeing it is like, oh, this is such a great opportunity to strengthen the soleus.
In the range of motion that the soleus, or not in the range of motion, but in the function that one, that the soleus is like really Built for, but under, under, under utilized or under understood if I can say under twice, I don't know, but anyways, um, the yielding series, I think it's going to be like super great for that.
Um, as a preparatory to, to everything, movement, plyometrics, string training, like all of it. Just getting like things like working on that dynamic deceleration. relationship to gravity. So that is a big part of it too. Um, in my opinion, you should do more of those and throw out Nordics. That's probably a whole nother podcast, but I hate Nordics.
Um, I think they're the worst thing to happen to my athletes. Um, so like, again, a little bit more intentional ways of working on. the mechanics of movement. So deceleration, weakness, overtraining, foot stability, poor cadence, um, impact. We talked about nutrition and now the little bit more out there. is, um, obviously, you know, I'm not going to not talk about the viscera and the nervous system specifically for shin splints.
The first thing that comes up in my brain is more neural than visceral, though we also know the visceral things are translated, are, are transcribed. Um, relayed or referred on neural things. So when there's a visceral thing, there's also a neural component to it. So from a visceral standpoint, it's sort of like very similar to the foot.
The medial side of the leg is going to be associated a little bit more with the urogenital organs and the lateral side of the leg is going to be a little bit more associated with the intestines. However, the proximal tib fib joint is, um, a witness to, um, Meaning that it's going, the mobility will be affected by the Euro genital organs as well.
So, uh, big urogenital organ connection here. So that's going to be like all the public. Bowl organs and as well as the kidneys which Joe another link the kidney episode I talked all about how the kidneys are intrinsically embedded in our movement and our locomotion because of their location and relationship embryologically, so Can't discount making sure there's not some sort of visceral referral causing some of these symptoms And then, um, the neural piece is going to be two fold.
There's going to be a central nervous system, central nervous system possibility, as well as a peripheral nervous system entrapment type of scenario. So, this peripheral nervous system entrapment also, Ultimately, and this is sort of like what I landed on with the coach is like, I think a lot of the, of the, of the difficult cases of shin splints that are like not figureoutable, I think are going to be in this category and a lot of them, I think of those people in that category, I think probably high percentage of them are probably going to be undiagnosed exertional compartment syndrome.
Maybe I'm biased because I feel this in my own body, but I've seen it in so many athletes, even my elite athletes who, you know, are just used to like having pain everywhere in their body. And they don't necessarily like call it something like for someone that doesn't have that, like above the neck ability to just like shut information off in their body, they would probably be like, my shins hurt, my legs hurt and be diagnosed with shin splints.
But exertional compartment syndrome, I think is very. common and misdiagnosed because it's hard to diagnose. And it's also like, people are like, what are we supposed to do to treat it besides a fasciectomy, right? Like a surgical thing. And, um, so it becomes like a vascular or neurovascular entrapment type of syndrome.
And so one of the things like to think about, like the chronicity of the shin splints. So in terms of like, what is the pattern of them? Does their shins hurt all the time? Or They're good until they start moving and then their shin, and then they, after a certain time, now their shins start hurting and then it gets worse and worse through practice.
Um, how long does it take for it to feel better? You know, how much rest does it take to like drop in baseline if there is a reduction of pain with rest? Like I would be suspicious of it If after practice like if it gets worse and worse and worse and Um, it takes a you know a good amount of hours after practice for them to feel better less pain and pressure and um Or if they complain of symptoms like a dead leg, sometimes after practice, this is also, um, maybe more indicative of it.
So it is interesting to play around with sort of like, start your workout and continue until you feel it and then rest and see if it gets better on that rest period. Maybe add in some soleus exercises. So the soleus, which seems a little counterintuitive, but the soleus, which will, if you go back to that old podcast, the peripheral heart, you'll understand that the soleus's job too, besides controlling anterior translation of the tibia, is It is a, it's called the peripheral heart because there is an actual venous plexus within the soleus itself that helps pump our blood and our fluid back up towards our heart.
And so sometimes if we have a soleus weakness, that pump action is very, very powerful. not optimized and so we have a little bit more tendency towards fluid getting stuck in our compartments and there's not a whole lot of space within the compartments of the lower leg and so when there is extra fluid in the area it starts to strangle the neurovascular supply there and it can be extremely painful.
Not to mention also make things look like from a strength standpoint you're weak because of that decreased neural flow in the nerves to the muscles, right? And so, you can, it can look like foot weakness, but it's from a nerve entrapment. So the other things that can be helpful for this besides the rest and the soleus, that's kind of almost also to kind of diagnose it.
Um, I already said strengthening the soleus, but also doing the swelling reduction protocol. So You know, Joe will link that episode to, um, probably the original one. There's like three, there's three swelling, um, podcasts over the life of the podcast, but, um, in general, um, supporting all of the main areas of the body that relate to our, um, fluid flow or vascular and lymphatic flow can be really helpful for this type of thing as well as possibly wearing compression socks during your training or after training to help that pump like mechanism like get the fluid out of your legs and prevent the fluid from being stagnant there.
And then, um, um, I used to have a favorite compression sock, but I don't really anymore. So really You just kind of buy a few and see which ones you like the best. But usually they're called over the calf OTC recovery compression socks. Um, and there's different pressure gradients. So I like a higher pressure, but I also have a tendency towards compartment syndrome, so, um, You know, take that as it may.
Uh, then the other one that has actually has been huge for me and um, some other people i've shared it with but sometimes when we have a chronic fluid balance problem it is again go going back to the nutritional piece like what's our mineral status like I electrolytes in it. And so I wasn't really like holding onto the water, I wasn't, my fluid balances were really messed up.
When I started adding in potassium to my life, about a year ago, now it's been a year. So many things in my body felt better, but 100%, the swelling in my legs went away. And as that has happened, It's gone away consistently, and I've added in some solely strengthening, but honestly not a ton. My exertional compartment syndrome symptoms have gotten way better.
And so I can't stress enough, um, especially for athletes who are sweating quite a bit, but then also because stress, chronic stress. depletes our minerals too. So it's not just sweating. It's chronic stress that depletes our minerals. So perhaps Um, with intention and clinicalness, right? Meaning you're paying attention to how you feel as you add in some of these things, adding in electrolytes like potassium, like magnesium, like sodium, and seeing if that sort of helps things too, that is a good indication.
So, one of the things that I always consider that there might be a, a type of, um, Compartment syndrome going on is if people are getting lines from their socks or their pants. If you have lines on your legs and dents, no matter how deep they are from socks or tights, pants, then you need to be suspicious that you might have a fluid flow issue.
Something's getting entrapped somewhere in the five key spots, you know, like thoracic duct, cisterna, chyli. anterior hips, adductor canal, tib fib joint, peripheral heart, the soleus area, or um, you have a fluid imbalance from a mineral like kidney standpoint. And do you see the overlap of all this, right?
What did I say the visceral piece could be? Your genital kidneys. What did I say that the soleus does? It does a lot. Helps us with our fluid support. It helps with deceleration anterior tibial translation. It helps with foot strength and stability. You see how there's overlap in a lot of these things. So, um, I, I think this could, for some people, be like multifactorial.
Um, Anyways, so a little bit too about, um, you know, that, that's all I have to say about the, um, vascular, neurovascular entrapment piece from a fluid standpoint. But then there's a neural entrapment piece from a, just like straight up peripheral or central nervous system entrapment standpoint. So central nervous system.
Especially, sometimes I think this with bilateral symptoms could be a disc herniation or stenosis compressing the nerve root. So, we need to rule out the spine for this kind of thing, as well as it could be a peripheral nerve entrapment. So, you know, on the inside of our leg, shin splints, it's going to be kind of related to the saphenous nerve.
And so, like, what, what's happening in that saphenous nerve? The saphenous nerve has a lot of chance for entrapment all along the border of the sartorius. And so that's something to consider. Um, I did, Joe, another link, did an episode on the saphenous. Um, and then also, um, on the outside of the legs, the anterior compartment is going to be back of the leg, it's going to be more tibial or common peroneal nerve entrapment possibilities
All right. I did a whole podcast, Joe, link it in the show notes, um, on the fibula and unlocking the fibula and, um, how important that is for mechanics. So another thing to consider, um, of what might be driving some of this pain, right? And so, if this feels like a lot of things to consider, that, this is, this is the life of assessing something, right?
We're trying to assess, like, which one of these things could it be? And in a very generic diagnosis, like, shin splints, right? That's a very generic term. It's like, what does shin splints mean? It's pain on the front of your leg. It could be medial tibial stress syndrome, could be lateral tibial stress syndrome, could be not a stress syndrome at all, right?
So don't just take the diagnosis and the label that's given as like how to proceed with treatment. You have to do a thorough evaluation, which can, should consider all these parts. Compartment syndrome, nutrition, minerals, fluid balance. Neural entrapment in the central nervous system, even at the cranium, in the peripheral nervous system.
Overtraining, undertraining, deceleration mechanics, cadence, loading of the fascia, or loading of the joints in the bones. Foot stability, foot sensory information, stability, what specifically needs strengthening, how you're going to strengthen it, and do you need to use some sort of brace to support it in the meantime.
So many pieces. Right? This is why also it's hard to do just as one practitioner, hard to do just as a coach, hard to do just as an athletic trainer, hard to do just as a physical therapist. Sometimes I need to pull in the track coach to help me on some of these pieces, but then also the track coach or whatever sport coach needs to pull in a healthcare professional in some of these pieces too to rule out all this other stuff.
And then sometimes I need to pull in a doctor. Do we need to get an MRI of their back? So Lots of, lots of things to consider, um, but a great conversation, right, of like looking at a little bit more big picture and remembering if you're treating something in the traditional, like, accepted, gold standard way of doing it and it's not getting better.
Don't just keep banging your head against the wall and doing the same thing over and over again. Look bigger. Consider all the other things that you could be missing and start to go there, right? You know, this is like, again, like the, like, kind of like the coach said in the beginning of the question last, this past weekend was like, he's like, I got a handful of kids that get shin spins.
I'm usually pretty good at managing 75 percent of them, but 25 percent of them, like, sometimes I just can't figure it out. Yeah. Because it's not always going to be the standard thing. So hopefully this was helpful. I went a little longer than I intended to, but, um, lots of different podcasts for you to kind of listen to, to get other different pieces of this.
So, um, let me know if you have questions and have a great day.
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