Another Shin splints question...sorry

[Canuck Physio]

Hello, i know that shin splints have been brought up many times on this forum as are there streams of information about them across the entire internet. However i have hit a brick wall with what else i could possibly do now.

It all started a year ago when i began to get the pain on the inside of my shins so visited my doctor who told me that my problem with my shins was due to me having slightly flat feet so got me to get some insoles.
This is only a band-aid solution, they will not correct the biomechanical problem you have.
He said this would aid with my shins and also with my knees (i go through fases of getting really bad pain in my knees which gets worse when i do less with them i.e if they stay bent for a while like in a car they get very painful) Un suprisingly however the pain didnt subside.
No it probably won't, although it may settle at times, the problem is at either the knee, or in combination with the ankle which is more likely the source of the problems.
I then took 8 weeks out to give them time to heal so that i was ready for football when i got to uni. The pain came back straight away, i carried on playing through the pain until it got so unbearable.
Taking that time off probably just helped make the muscle fascia tighter and tighter. Most sprinters and runners think that stretching calf muscles is just “pushing” against a wall for a few minutes or doing a few bent heel stretches before they set off. Dead wrong!
. The calf muscles surrounding the ankle joints are used constantly in such a small explosive range of motion (the extension of the ankle in the propulsive phase of the leg stride generates a force greater than 4 times your body weight). The muscle fascia of the soleus and gastrocnemius becomes tighter and tighter so that conventional stretching does not correct this problem.

I saw the doctor down here who has been untter useless and has asked me what i thought need be done. I had an xray to make sure it wasnt stress fractures. then i went to a pediatrist who said my feet wernt too flat n supports wernt neccessary but the ones i had could help slightly.
Most likely again, a band-aid solution
So i went to a private physio who gave me accupuncture, hurt immensely and made them worse.
Accupuncture!!!? For what?
He then gave me a series of stretches to do along with simply doing calf raises and said that after 8 weeks of this i would be able to start playing football again. After one game the pain was back again.
Suspect so.
I am now really at a loss and dont know what to do. my football is seriously suffering as is my fitness. The shin pain is so bad all i can do to keep fit is cycling or rowing which for some reason doesnt seem to be helping me keep in shape, and compared to how i was before the pain when i was runnig at least 7 km a day i am really out of shape.
Here is one suggestion, take away the strain and repetitive forces from your lower limb for a while. Try to get into a pool.
If anyone has any ideas on what i could do next i would be very much appreciated, i was considering as to whether getting my legs extremely strong and doing lots of stretches would help. I really need to be back to full fitness come pre-season in september, i have come to terms that its not going to be a quick fix any more.
I would be worried about going all out with your calves, as you have not really identified a problem in and of itself. It seems that you are missing the arches in your foot based on what you have said. Ideally you would need a combination of strengthening, stretching, massage, and cryotherapy to really make this problem go away. And it would take a few weeks. I would recommend maintaining your fitness in the pool with under-water sprints. Do you have access to physio?

mike

As above regards

[crazy4958]

Thank you very much for your help, yes i do have what i believe are quite falllen arches as did my doctor however the paediatrist didnt believe it was bad enough for specialist insoles. As it stands i was visiting a private physio which was costing me £30 a visit, and as you are questioning him putting needles along the painful area of my shins its seems stupid that i was paying so much, also as a student this was something i couldnt afford so am waiting on my doctor to get back to me as i was hoping to get reffered to a physio on the nhs. As with stretches, strengthening excercises and cryotherapy what do you suggest? I now have plenty of time on my hands and have until july before i go away on holiday (would like to get back into shape by then) then i have all summer afterwards as well to really make sure i am 100% for the start of football. Would shin supports help at all, like the compression shin supports?

[Canuck Physio]

Providing a cookie cutter knee/ankle program for yourself is not unlike the average gym-goer opening up to a certain page in a magazine and following a bodybuilding program. Without the personal one on one attention analyzing form, range of movement, appropriate tempo, cadence, weight selection many gym-goers suffer from years of diminishing returns for all their hard efforts in the gym. For those reasons most therapists on this board are hesitant to provide specific therapy over the web. I would recommend you chase your doctor for some NHS physio (hopefully a sports physio), and tell them your concerns and what you have received previously. You need to be adamant that you do not want acupuncture for a biomechanical joint problem. Ask them to test the tension in your lower limb muscles, assess your posture, and assess soft tissue (the myofascia). ALSO most importantly have them assess yourself with your training footwear on as you complete specific movements such as those that you complete on field. This is vital in ascertaining over-activity, under-activity and form of movements to determine exactly which muscles may be shortened, or over-active during activity, and which muscles may be lengthened, and under-active during the activity. Take this information with yourself and have them provide you a closely monitored specific program that will help you get back to match fitness.

[cptnsausage]

Just as a quick additional to this - A lot of the time Flat feet are indeed the cause of such problems and I've found certainly that it is misdiagnosed (as fallen arches) and mismanaged in the vast majority of cases. Most Flat feet problems are not fallen arches but are simply due to an everted calcaneous an as such have the secondary effect of causing the longitudinal arch of the foot to disappear. Now Knowing that I find it scary that for almost every flatfoot problem is simply to prescribe arch supports - unless u happen to be uber flexible then the arch supports will simply cause pain and in some extreme cases can compound the problem further and cause damage - this is because a simple arch support in the case of an everted calcaneous will recreate your arch but will do absolutely nothing for the heel problem, which means your foot is being twisted further out of alignment (forefoot will end up in excess suppination with the calcaneous still everted = pain and damage)

Now taking that into account the answer is quite simple. I believe that in your case you would benefit from a pair of insoles with medial wedges added to the heel (3/4 length with MINIMAL arch support and probs about 10-15 degrees of medial wedging at the heels) this will essentially treat the cause and not the symptom. I not only speak as an orthotist who see's this just about every day but also as a patient! - my doctor tried for years to fix me flat feet with arch supports etc but all it did was cause pain and like yourself i found that particularly when I was active i got pain in my shins (sometimes my knees as well - Im Very flat footed lol) - After i finished my degree and started working i made myself a pair of insoles similar to what I've suggested for you and the pain has pretty much disappeared - even during sports etc. Thats just my suggestion based on the info you have given us but I'd strongly reccomend as others have that you get a full assessment first - the fast way to tell if u have everted calcaneous' is to stand straight with your back to a mirror - if the line of the back of your foot where the achilles tendon runs splays outwards at your heel then its a positive test and the problem is definitely not a fallen arch and is an everted calcaneous.

I agree with whats been said here 100% that you need to treat the biomechanical problem and not just try to get rid of the pain, and the above is how I'd go about it as an Orthotist but i know a vast number of podiatrists who treat numerous patients using the same rationalle with great success so it might be worth giving it a try in your case.

hope that maybe gives u another option to explore - although theres not a lot of literature on this particular subject but I will be happy to answer any questions you have

[ASCook]

*snip* straight with your back to a mirror - if the line of the back of your foot where the achilles tendon runs splays outwards at your heel then its a positive test and the problem is definitely not a fallen arch and is an everted calcaneous. *snip*

I got positive for that test, and I've been having bilateral shin splints for almost 2 years now. I have custom orthodics, and they did 'help' but the problem is definitely still there.

The worst phase of my shin pain was last fall when I scored stress fractures in both left and right legs when running the 1.5 mile run test. After the orthodics, I can run about 3 to 4 miles with little pain. Any more, and I get pain that is very similar to DOMS since it sets in the second day off more than the first.

I am seeing a clueless physician and PT team, and they're the 3rd that I've seen over the past 2 years. Any suggestions?

The exercises they have me doing are the basic medial/lateral and dorsi/plantar rubberband exercises.