When people find out you’re a runner, one of the first things you probably hear is something along the lines of, “Better take care of your knees!” It’s quite the misconception that every runner will have knee issues at some point; and actually knee injuries aren’t the injury runners experience most.
That isn’t to say knee injuries don’t happen. In fact, chiropractor Marc Taczanowski a certified strength and conditioning specialist, with experience in sports medicine, injury prevention and management at True Sport Care, says they are some of the more common injuries experienced. “Common injuries in running include, but are not limited to, iliotibial band (ITB) syndrome, patellar tracking issues, runner’s knee, Achilles tendinosis and plantar fasciitis,” he explains.
IT’S NOT WHAT YOU’D THINK
According to a 2012 article in the journal Sports Health, the most common injury in distance runners is actually medial tibial stress syndrome (MTSS) or shin splints.
“Between 37–56% of recreational runners who steadily train and participate in a long-distance run periodically will sustain a running-related injury each year,” authors Robert A. Gallo, MD, Michael Plakke, MS, and Matthew L. Silvis, MD, note. While most injuries involve the knee, their article cites a specific study of 2,000 running-related injuries, which found the most common leg injury is medial tibial stress syndrome, making up 4.9% of injuries.
In fact, in another article in the journal Current Reviews in Musculoskeletal Medicine, authors R. Michael Galbraith and Mark E. Lavallee add that shin splints are “one of the most common causes of exertional leg pain in athletes.”
According to Taczanowski, there are actually three different types of shin splints, named for their geographical location in the leg: anterior, lateral and medial.
READ MORE > A RUNNER’S GUIDE TO INJURY PREVENTION
“The most common is the medial, which leads to a medial tibial stress syndrome,” he notes. “The muscle that causes most of this issue is the tibialis posterior muscle. We usually find that it is either weak and tight or strong and tight. In both cases, a weakness must be identified to correct the issue.”
The good news is shin splints aren’t a threatening injury and aren’t likely to end a runner’s career. Though it is often noted that shin splints are understudied — which is surprising due to their commonality — treatment doesn’t involve surgery or inpatient stays. Once you receive a diagnosis, often there will be exercises and additional therapy prescribed that will not only heal your injury, but also work to strengthen your entire leg.
When it comes to diagnosing shin splints, Taczanowski says the identification process is actually simple. Treatment can be more difficult, because it involves identifying the underlying problem, which often is not the shin itself.
“Correcting shin splints takes the keen eye of a good detective,” he explains. “The weakness that we typically detect reside in either the tibialis posterior itself, the piriformis or the adductors on the affected leg.”
When it comes to treating shin splints, it can be natural to think that, as with most injuries, it came on due to overuse. In fact, Gallo, Plakke and Silvis found injury rates increase significantly when a runner’s weekly mileage extends beyond 40 miles. However, it is actually the underuse of muscles that causes real problems, and Taczanowski explains why.
“With every diagnosed overuse, we find an underperforming, weak, underused muscle,” confirms Taczanowski. “What is typically prescribed for an overuse? Rest. Is it successful? Rarely. Here is why: If we rested our overused muscle, but never strengthened the underused muscle, what actually changed? The answer is nothing.”
It is because of this that besides the usual rest and ice prescribed for injuries during their onset, runners should actually focus on strengthening the surrounding muscles to reduce any imbalances. In their article, Galbraith and Lavallee note that the knees and ankles should be examined, and that muscle imbalance and inflexibility — “specifically tightness of the triceps surae” — is commonly found in runners dealing with shin splints. By addressing these other factors and reducing the stress to the shins, runners can prevent recurrence.
“So how do we fix it and fix it permanently? We address that underused structure and strengthen it,” concludes Taczanowski. “Once balanced, the muscle that was doing too much has less of a load placed on it and the overuse — in this case, shin splints — corrects.”