I recently had a visit from a 48-year-old, male runner who was complaining of a 4-week history of shin pain. He was training for the Berlin marathon, so was keen to be fit to resume training ASAP.
He described his symptoms as a constant, dull ache affecting the inside of the left shin bone, the pain had also been present at rest. When I examined him, the point of maximal tenderness was localised around the inside of the lower tibia (shin bone), which is consistent with Medial Tibial Stress Syndrome or ‘shin splints’. He had attended the hospital, and x-ray showed no evidence of a stress fracture.
With any running related injury, gait analysis plays a vital role in really getting to the bottom of, and understanding why, a certain condition has developed. As you can see from the stills of this gentleman’s gait analysis, there is quite a difference between when he is weight bearing on his right side to his left side.
Gait analysis showing normal hip level
Gait analysis showing crossover gait and contra-lateral hip drop
Firstly, look at where the left foot strikes the ground in relation to his centre of mass (CoM); the left foot crosses over the CoM, represented by the vertical yellow line. One of the many causes of MTSS, is known to be increased bending of the tibia during running; this type of cross-over gait will lead to increased bending forces affecting the tibia. Secondly, look at the level of his hips; when landing on the right foot, his hips stay fairly level, however, when landing on the left limb there is a large degree of hip drop on the right side. So, why is this happening? Well, in this case it was due a weakness in the Gluteus Medius muscle on the left hand side. During running, the Gluteus Medius reduces the internal rotation and adduction of the limb. Where there is a weakness, we generally see and increase in these movements, leading to the cross-over gait.
As well as reducing his mileage for a short period, I modified the insole of his left shoe with a basic wedge of material to reduce these increased bending forces. I also advised him a program of strengthening exercises for his Gluteus medius. After 4 weeks of using the modified insole and sticking to his exercise plan, he is now back on track to run the Berlin marathon in 2 weeks time.
This is just an example of why including a strengthening program into your training regime is vitally important to help reduce your chances of developing an overuse injury such as this. Research has shown that including some strength work in your training program can cut your chance of overuse injury by half!
If you have any questions, or would like more information on how I may be able to help your lower limb running injury, please get in touch.