Why Running/Jogging Sucks.  Sometimes...

     I would like to begin this article with a quote from legendary Anchor Man Ron Burgundy-"I believe it's pronounced jogging or yogging, it might be a soft 'j'. I'm not sure but apparently you just run for an extended period of time. It's supposed to be wild. ..."

I was inspired to write this article after trying to take Chomper for a walk on the seawall in English Bay but was thwarted by the Vancouver Half Marathon.  I am not angry that I had to move my walk back to the North Shore, but I feel as though I had a moment of inspiration to write about running when I saw a mixture of great looking athletes, fat people, and people whose knees touch when they run. 

     Let me be somewhat clear in a vague sense-Running or Yogging can be a great way to exercise and has many great health benefits when done with proper footwear and technique, but when done incorrectly you can be entering a world of pain!  Other than car accidents and yoga, running injuries account for the majority of my rehab hours with clients.  After a brief conversation with my sister in-law I felt that one of the most common injuries we see are shin splints (as she is suffering from them while training for a mini-triathlon).  Today's rant is peppered with useful shin splint facts taken from consultation with Andrea Engelmann (our in-house physio) and her trusty Marquette Physical Therapy course notes... the entertaining and/or offensive stuff is of course from me.    Before I move on, I want to explain why I dislike running for the average person: the repeated impact is punishing on the joints and if you don't have the stability and strength to support that pounding-you will get injured at some point!  Second, bad shoes-if your technique is crap please at least make sure to have good shoes!  For the average person that wears runners you are looking for a pair to last 4-6 months and for a runner I would guess more like 3.  Women-unless you run like a man, I would suggest you cycle or swim or hike-This may seem a little harsh and sexist, but the fact of the matter is-women are not structured the same as men from the hips down and the repeated impact is terrible for them.  (I'm not saying don't run if a bear is chasing you, but consider shortening the length of the run or adding in some sprint work to lessen the amount of foot contacts in your sessions).  If your knees touch -or come close to touching when you run- find a new hobby.   This is not a harsh gesture, it is just common sense.  You don't see a lot of structures resting atop two support beams that bend inward.  If you are heavy set or fat, find a new hobby or lessen the total volume till you reach your goal weight (walking, cycling or swimming).

The Dreaded Shin Splints:

• (I) There are four main diagnoses of shin splints, all of which are unpleasant and refer to pain in the lower leg region.
• 1. Anterior Tibialis Tendonitis
• 2. Posterior Tibialis Tendonitis
• 3. Stress Fracture of the Lower Leg
• 4. Anterior Compartment Syndrome

• (II) Both forms of Tendonitis can be discussed together and will follow this progression of symptoms:

Grade 1-Pain after running.

Grade 2 -Pain at beginning of run, pain goes away then comes back if the run is long enough.

Grade 3-Pain throughout entire run and does not go away.

Grade 4- Unable to run because of pain.

Grade 5-Pain with daily activities (walking, stairs etc.)

• (III) If you are experiencing any of the early signs, stop the activity and use the good ol' "RICE" principle. Rest, Ice (use a paper cup, fill it half with water, freeze it, rub it into shins in small circular fashion for 5-10mins or until numb. Compression-Try compression sleeves for relief (discontinue immediately if compression makes it worse or you get a compartment syndrome diagnosis) and finally Elevate-Raise your feet up to help drain the build-up of swelling. Outside of the 'RICE' principle, you should try calf stretches. Achilles tendon and calf tightness cause poor foot mechanics that are commonly linked to tendonitis and even stress fracture type tendonitis. You may also consider getting a new pair of shoes. When purchasing, tell the 16 year old that doesn't really care that you are looking for a shoe with good arch support and shock absorption at the heel.
• (IV) Both the posterior and anterior tibialis muscles help maintain the arch of the foot. Tendonitis or inflammation of the tendon, occurs with excessive repeated stress to the muscle attachment on the tibia (shin bone)-The two main causes:
• 1.) Poor alignment and mechanics of the foot/lower extremity.
• 2.) Excessive and/or rapid increase or change in training regime (location, duration, intensity).
• (V) Shin pain from stress fractures to the tibia or fibula (lower leg bones) occur from repetitive trauma on hard surfaces (running, jumping or too quick of an increase in training). The symptoms after a fracture are in some ways different than tendonitis:
• 1.) Pain with activity-If it does not go away with warm up, you should stop running.
• 2.) Pain free at rest, but pain with pressure on bony part of shin.
• 3.) Stress fractures appear best on a bone scan (if you want to catch it early) or on an X-Ray, 5-6 weeks after they first happened. Once discovered, 6-8 weeks of rest is typically required along with 'RICE'.
• (VI) Acute Anterior compartment syndrome is by far the most serious of the 4 diagnosis discussed. The muscles of the lower leg are bundled by a tough, fibrous covering called fascia into distinct compartments. With trauma (such as a kick to the shin), swelling can build up in the compartment, restricting blood flow to the muscles of the front lower leg and the foot. The pressure that causes the muscle to be starved of oxygen typically takes 2-48 hours after the trauma to build. The condition is characterized by:
• 1.) Trauma to the shin and extreme swelling.
• 2.) Extreme pain in anterior leg.
• 3.) Numbness and discoloration to the top of foot (pale, blue or ashy).

     If any of the above symptoms occur, it is a MEDICAL EMERGENCY requiring a surgical release of the fascia binding the compartment (fasciotomy).

• (VII) A chronic compartment syndrome, less serious in nature, can develop after a trauma to the shin because of the fascia undergoing changes that make it tougher and more fibrotic after injury. The more fibrotic fascia does not allow the normal amount of blood and oxygenation to occur to the front of the shin and foot muscles.
• 1.) Pain occurs with activity and keeps getting worse if activity continues.
• 2.) Symptoms disappear with rest.
• 3.) Numbness on superior aspect of foot (top).
• 4.) Swollen/taut anterior shin region.
• 5.) Numbness to top of foot and/or between 1^st and 2^nd toes.

     Depending on the severity and persistence of symptoms chronic compartment syndrome can be treated with rest and elevation (NO COMPRESSION!) or fasciotomy.

• (VIII) What can I do?

     If backing off/stopping training and 'RICE' have not worked, then you need to book in to see Andrea or Greg down at Level 10 Fitness Physiotherapy clinic (I never do shameless plugs-until now) or if you are not in the lower mainland, I guess any physio will do.

The physio will help by identifying the specific diagnosis, cause, strengthening, stretching and treatments required for your case of shin splints.  Your physio should do the following:

• 1.) Assess your foot and lower body mechanics static and with activity.
• 2.) Assess your shoes (bring the ones you run in, not your flippy floppies). There is a possibility you may need generic arch supports or prescription orthotics.
• 3.) At Level 10 we use treatments such as ART (active release therapy) and acupuncture.
• 4.) Give you appropriate stretching and strengthening exercises.
• 5.) Assess your training/training changes, provide guidance for your gradual return to activity, to prevent re-injury.

     If you have any questions regarding shin splints, please don't hesitate to contact Andrea at 604-985-8910 or at andrea@level10fitness.ca.  If you have questions or are offended about fat people running, or have a specific topic you would like to hear about, please contact Joe at joe@level10fitness.ca.

Ref. Dr. Simoneau, Guy, "Orthopedic Physical Therapy" Course Notes, Marquette University, copyright 2007.

     My Final Thoughts:  If you haven't figured it out, anything in the article that sounds smart came from Andrea and everything that didn't came from me.  I rely heavily on common sense in life and feel as though it has been good to me thus far.  It does not take a rocket surgeon to figure out that if you run with poor mechanics and are overweight with bad shoes and your knees touch-you may get hurt (I know this article is mainly about shin splints, but I feel it is necessary to touch on other potential injury concerns from this activity).  Do not get me wrong, running/yogging are great forms of exercise, but if you fall into one of the categories of people that I think should not run-consider trying something a little less impact based (swim, bike, hike etc).  If you are dead set on running, consider trying the following: Walk and run intervals (you make up for distance lost by walking by picking up the tempo when you run), Run and sprint ( you can shorten the distance by upping the intensity with a little sprint work).   I know some of you are wondering why sprinting? Isn't that pounding?  Why yes I say, but it is more bio-mechanically friendly as you are not striking the ground with your heel first like in running so the impact on the joints is lessened.    Finally, try running on grass or trails instead of the street or sea wall.  Fitness is something we try to preach as a lifestyle, so we must preserve our bodies as much as we can through smart and safe training practices.  It may not seem like a big deal running on pavement while you are young, but if you add up all the pounding and minutes over the weeks, months and years it will take its toll on your joints.  On a positive note, it was great to see how many people were out on a beautiful Sunday morning exercising,  I would just like to see us exercise smarter, not harder so you don't need to miss out on trainings because you are in physio all day!

     If you would like me touch on some alternatives to jogging, or to hear more about running or exercise related injuries, please don't hesitate to contact me.

Yours In Strength,

Joe McCullum