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How to Reduce the Risk of Shin Splints While Walking a Camino

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davebugg

A Pilgrimage is time I spend praying with my feet
Time of past OR future Camino
2019
I put this together a while back in a post to provide help to those who wish to minimize the risk of the unpleasantness of shin splints while on Camino. This has been edited with additional information. Keep in mind that this is a general overview, not a medical textbook. :)

There are different causes of shin splints including stress during exercise. Heavy and repetitive exercise may exacerbate deterioration to the cartilage and connective structures in your shins, which may be the beginning of potential problems. These conditions are often seen in athletes, but anyone can do exercises or activities that could create stresses to the shinbones, leading to swelling and pain in those connective tissues around it.

Exercise isn’t the only cause for shin splints. Having weak hip muscles, or out-of-shape core muscles can redirect high levels of stress to the shin.

Not properly warming up or cooling down, before and after exercise can do also create stresses to the lower leg structures. Certain foot issues, like flat feet, can impact shin problems, creating extra work loads to the lower legs. Issues with gait and motion control, like pronation or supination, can also be a factor.

Warm Up -- ALWAYS warm up prior to exercise and stretch well after exercise.
  • Walk at a slower pace at the beginning of each walk.
  • Then perform ankle circles: rotate ankle ten times in one direction, then ten times in opposite direction.
  • Next, do some toe points: point toes, then flex foot - ten times on each foot to get your muscles loosened up.
  • Do the ankle circles and toes points several times each day or write the alphabet in the air with your toes.

After Walking

Stretch your calves, shins, and Achilles tendon after every walk. Tight muscles make the shin work harder to lift your foot.

When Walking

Choose a good walking surface. Avoid concrete if possible. If you walk on a road with an obvious camber try to periodically, where it might be safe and appropriate, changing sides of the road. This helps to avoid putting too much stress on one leg. Again, only do this where it is safe to do so.

Additionally:
  1. Increase your mileage and speed gradually. Determine what your current baseline is for the number of miles/km you can comfortably walk in a day. The general rule of thumb is to increase mileage at a rate of 10% each week as you begin to increase your fitness levels.
  2. Be sure that you are not over striding.
    • Over striding occurs when you take longer steps to increase speed without running. Lengthen the stride in back, rather than in front, to improve power and efficiency in your stride. An overstriding walker has their front foot too far out in front of body. You want instead for your forward foot to contact the ground closer to your body.
    • Your stride should be longer behind your body, where your toe is pushing off, rather than out in front of your body. This is because your forward leg has no power, while your back leg is what is pushing you forward.
  3. Be Aware of Your Step Rate
    • Increasing your cadence or step rate will significantly reduce impact forces. Focus on striking beneath your center of mass and avoid stepping out in front of your body—this will also prevent over striding and braking—to lessen the load placed on the tibia.
Perform Exercises to Strengthen Calves and Shins

Studies demonstrate that bigger and stronger calf muscles have a lower risk of developing tibial stress fractures. Strong calf muscles also help reduce the risk of shin splints. It makes sense that strengthening your calves for distance walking on Camino will help walkers avoid both medical conditions.

Consider the following strength exercises to help strengthen those calves and the surrounding muscles to help prevent shin splints:

Calf Raises

Standing with your feet slightly apart, raise up onto your toes, pause for 2 seconds, and lower back down. Complete two sets of 15 repetitions.

Toe Walks

Standing on your tiptoes, walk forward 15 yards. Complete two sets of 15 yards.

Foot Pumps

Lie down with your legs straight out in front of your body and your toes pointed toward the sky. In a pumping motion, point your toes back towards your body and then back to the original position. Complete two sets of 20 repetitions.

Heel Drop

Standing on a stair or elevated platform, put your weight on your right foot while lowering your right heel past 90 degrees. Slowly raise back up and repeat before switching sides. Complete two sets of 10 repetitions on each side.

If you have shin pain, you may need to take a day or two of rest and start back more slowly.

Remember
: RICE -- Rest, Ice, Compression and Elevation.

Ibuprofen is often recommended for muscle and tissue inflammatory processes, including shin splints, because it blocks the action of the cyclooxygenase enzymes. This reduces prostaglandin levels which, in turn, can reduce the inflammatory process in shin splints. There may be health risks with this product, so it is best to seek advice from a health professional.


BE AWARE
-- There are a couple of related lower leg injuries which some folks may think are shin splints, but require medical intervention. Due to the risk of undiagnosed medical issues, do not self-diagnose shin splints.

Compartment Syndrome

Pain on the lower anterior may be compartment syndrome, a swelling of the muscles within the compartment. Increased pressure compromises the area's circulation and function of the tissues in that space. Symptoms include pain, unusual nerve sensations, and muscle weakness. This condition requires a physician's diagnosis and surgical decompression may be necessary.

Stress Fracture

Another cause of pain in the lower leg is a stress fracture. If you have a definite spot of sharp pain when you run your hand along your shin the pain may be a stress fracture. A horizontal rather than vertical line of pain is another indicator and stress fractures normally feel better in the morning after a night of rest. A bone scan is necessary for diagnosis.

Again, do not self diagnose. Recognizing what your symptoms are will help you to communicate with the doctor so that s/he can do a better job of determining the cause for the symptoms, and to then recommend the best course of treatment.
 
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Thanks Dave. Great advice.

Can I add - if the laces on your shoes or boots are too tight or in the wrong place (particularly the last one, before the tie), it can cause compression and irritation of the tendons.

Having something alternative to wear, like a pair of walking sandals, even if only for a short period of time, can help prevent or relieve repetitive strain injury.
 
Thanks for this great advice. I'll be heading out in 2 weeks and this was perfect timing for me to read.
 
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Be sure that you are not over striding.
  • Over striding occurs when you take longer steps to increase speed without running.
If you walk with someone taller, thus, longer stride, you will over-stride. Been there, done that, bought the T-shirt. Three things helped me walk thru shin-splints. Compression socks or ace bandage or tape at the shin-splint, rest, & Vitamin I (Ibuprofen).
 
Great advice, for local walks as well as Caminos, thank you! Starting today :)
fondly sandi
 
If you walk with someone taller, thus, longer stride, you will over-stride. Been there, done that, bought the T-shirt. Three things helped me walk thru shin-splints. Compression socks or ace bandage or tape at the shin-splint, rest, & Vitamin I (Ibuprofen).

This is a good example of how walking with another person could become problematic if the person with the faster pace is setting the lead, not the person who is slower.
 
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Consider this. You will be taking 35-45,000 steps per day. This is a lot of strain on the muscles that operate your foot.
Many people walk with their foot flat to the ground when bringing the foot forward for the next step. This requires tensing the muscles in your shin to keep the toes elevated. Fear of stubbing your toe will jave you doing this as well.
So, all day long, your shin muscles never relax or stretch. Bam! Shin splints.
I changed my walk (a conscious effort) so that I roll the foot from heel to toe and the toe is the last thing to leave the ground. Then keep the toe pointing down, bring the leg forward for the next step. This stretches and relaxes your shin muscles with each step.
Good luck.
 
I injured myself on the CF last summer, following the "conventional wisdom" to always keep my boots laced tight. Had to take extra days off to see a physical therapist in Burgos. I learned that my feet need freedom to move and started wearing my boots in loosely laced "comfy slipper" style. It has made all the difference ever since. I wish I had paid more attention to the messages my body was sending.
 
I put this together a while back in a post to provide help to those who wish to minimize the risk of the unpleasantness of shin splints while on Camino. This has been edited with additional information. Keep in mind that this is a general overview, not a medical textbook. :)

There are different causes of shin splints including stress during exercise. Heavy and repetitive exercise may exacerbate deterioration to the cartilage and connective structures in your shins, which may be the beginning of potential problems. These conditions are often seen in athletes, but anyone can do exercises or activities that could create stresses to the shinbones, leading to swelling and pain in those connective tissues around it.

Exercise isn’t the only cause for shin splints. Having weak hip muscles, or out-of-shape core muscles can redirect high levels of stress to the shin.

Not properly warming up or cooling down, before and after exercise can do also create stresses to the lower leg structures. Certain foot issues, like flat feet, can impact shin problems, creating extra work loads to the lower legs. Issues with gait and motion control, like pronation or supination, can also be a factor.

Warm Up -- ALWAYS warm up prior to exercise and stretch well after exercise.
  • Walk at a slower pace at the beginning of each walk.
  • Then perform ankle circles: rotate ankle ten times in one direction, then ten times in opposite direction.
  • Next, do some toe points: point toes, then flex foot - ten times on each foot to get your muscles loosened up.
  • Do the ankle circles and toes points several times each day or write the alphabet in the air with your toes.

After Walking

Stretch your calves, shins, and Achilles tendon after every walk. Tight muscles make the shin work harder to lift your foot.

When Walking

Choose a good walking surface. Avoid concrete if possible. If you walk on a road with an obvious camber try to periodically, where it might be safe and appropriate, changing sides of the road. This helps to avoid putting too much stress on one leg. Again, only do this where it is safe to do so.

Additionally:
  1. Increase your mileage and speed gradually. Determine what your current baseline is for the number of miles/km you can comfortably walk in a day. The general rule of thumb is to increase mileage at a rate of 10% each week as you begin to increase your fitness levels.
  2. Be sure that you are not over striding.
    • Over striding occurs when you take longer steps to increase speed without running. Lengthen the stride in back, rather than in front, to improve power and efficiency in your stride. An overstriding walker has their front foot too far out in front of body. You want instead for your forward foot to contact the ground closer to your body.
    • Your stride should be longer behind your body, where your toe is pushing off, rather than out in front of your body. This is because your forward leg has no power, while your back leg is what is pushing you forward.
  3. Be Aware of Your Step Rate
    • Increasing your cadence or step rate will significantly reduce impact forces. Focus on striking beneath your center of mass and avoid stepping out in front of your body—this will also prevent over striding and braking—to lessen the load placed on the tibia.
Perform Exercises to Strengthen Calves and Shins

Studies demonstrate that bigger and stronger calf muscles have a lower risk of developing tibial stress fractures. Strong calf muscles also help reduce the risk of shin splints. It makes sense that strengthening your calves for distance walking on Camino will help walkers avoid both medical conditions.

Consider the following strength exercises to help strengthen those calves and the surrounding muscles to help prevent shin splints:

Calf Raises

Standing with your feet slightly apart, raise up onto your toes, pause for 2 seconds, and lower back down. Complete two sets of 15 repetitions.

Toe Walks

Standing on your tiptoes, walk forward 15 yards. Complete two sets of 15 yards.

Foot Pumps

Lie down with your legs straight out in front of your body and your toes pointed toward the sky. In a pumping motion, point your toes back towards your body and then back to the original position. Complete two sets of 20 repetitions.

Heel Drop

Standing on a stair or elevated platform, put your weight on your right foot while lowering your right heel past 90 degrees. Slowly raise back up and repeat before switching sides. Complete two sets of 10 repetitions on each side.

If you have shin pain, you may need to take a day or two of rest and start back more slowly.

Remember
: RICE -- Rest, Ice, Compression and Elevation.

Ibuprofen is often recommended for muscle and tissue inflammatory processes, including shin splints, because it blocks the action of the cyclooxygenase enzymes. This reduces prostaglandin levels which, in turn, can reduce the inflammatory process in shin splints. There may be health risks with this product, so it is best to seek advice from a health professional.


BE AWARE
-- There are a couple of related lower leg injuries which some folks may think are shin splints, but require medical intervention. Due to the risk of undiagnosed medical issues, do not self-diagnose shin splints.

Compartment Syndrome

Pain on the lower anterior may be compartment syndrome, a swelling of the muscles within the compartment. Increased pressure compromises the area's circulation and function of the tissues in that space. Symptoms include pain, unusual nerve sensations, and muscle weakness. This condition requires a physician's diagnosis and surgical decompression may be necessary.

Stress Fracture

Another cause of pain in the lower leg is a stress fracture. If you have a definite spot of sharp pain when you run your hand along your shin the pain may be a stress fracture. A horizontal rather than vertical line of pain is another indicator and stress fractures normally feel better in the morning after a night of rest. A bone scan is necessary for diagnosis.

Again, do not self diagnose. Recognizing what your symptoms are will help you to communicate with the doctor so that s/he can do a better job of determining the cause for the symptoms, and to then recommend the best course of treatment.
Thanks Dave
There is also a body of evidence that lack of dydration causes the fascia around muscles to become brittle. The body robs areas of moisture when short of water to keep vital organs functioning including the heart and brain etc. brittle fascia causes pain in shins etc.
 
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Can you point to any of this evidence that shows its significance for walkers?
The chapter contains a lot more detail and was peer reviewed by a Sports Medicine Specialist whose focus is on minimising injury in athletes, including long distance walkers, marathon runners etc.

S Yates and D Hnatiuks book on Pilgrims Tips and Packing Lists also goes into this in detail on pages 42-43.
 

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Being an author does not make one a medical expert. There is plenty of hard evidence that our bodies need water. I don't think we can take it any further than that.

I have never seen any evidence that people who get tendonitis do so because they are dehydrated.
 
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Thanks Dave
There is also a body of evidence that lack of dydration causes the fascia around muscles to become brittle. The body robs areas of moisture when short of water to keep vital organs functioning including the heart and brain etc. brittle fascia causes pain in shins etc.

I have heard similar things mentioned as a vague hypothesis, but I have not seen anything definitive regarding this type of direct effect. I would be interested in any peer reviewed information you could point me to.
 
Hi Dave
please see several references below.
In addition the Sports Doctor who peer reviewed the Chapter assisted in simplifying some of the medical language. I don't claim to be an expert, rather to try and pass relevant Information.

The extract below is from "BackPacks, Boots & Blisters".

"I recently read another explanation in S. Yates and Daphne Hnatiuk’s Pilgrim Tips and Packing List: Camino de Santiago.
1647768757521.jpeg


On pages 42-43 they explain:

Water is also important for good functioning of your tendons, joints and ligaments. An orthopaedist on pilgrimage told the authors…This pain is not an inflammation of the tendons, joints or ligaments--they are simply thirsty….If your body does not have access to enough water it first tries to find the water it needs from somewhere in the body where it is not essential for survival, for example the production of the synovial fluid that surrounds the joints and certain parts of the muscles. It normally contains up to 94 percent water and thickens quickly from lack of water in the body….hence tendonitis.

I also found the following comments in support of this idea from Allyson Sunderman, DPT:

When you are dehydrated areas of the body that are not important for survival are deprived of water in order to supply the brain and other vital organs. As cartilage is not a vital organ the body begins to pull water out of it, dehydrating it. When the water content of cartilage drops it begins to lose its nice smooth, low-friction, and wear-resistant qualities allowing it to be damaged.

Imagine an old sponge… When the sponge is full of water it becomes soft and flexible. But, as it dries out it gets stiff and scratchy.
Once you damage cartilage it will not repair itself. You also feel your joints stiffen up due to the loss of the low-friction quality of cartilage. So, when you have that stiff achy feeling in your joints, ask yourself “have I drunk enough water (liquid) today?” This is why that stiff feeling is so common in the morning after we have slept ~8 hours without drinking anything. We essentially wake up every day with some level of dehydration.


Further information can be found here:

https://www.drdavidwilliams.com/relieve-joint-pain-with-good-old-fashioned-water/"

Happy to discuss further. I am currently walking in Tasmania so don't have access to all my research notes
Mark
 
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I am talking about tendonitis, not dehydration. Two different things. Tendonitis is a condition that, once it hits, is a camino killer and lasts for a long time - days and weeks, sometimes months. It is not cured by a glass of water or two.

I am glad you are enjoying a book about walking the camino.
 
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@happymarkos as someone who has walked more Caminos than the authors of the books you quote, I am in a position to peer review their works. I think that staying properly hydrated is important, but I have never seen any evidence that tendonitis and repetitive strain injury and stress fractures can all be avoided simply by drinking more water.

Simply repeating something does not make it true.

The forum has a policy of not allowing medical advice because we are not in a position to judge the qualifications or otherwise of members who post. This thread is a perfect example of that.
 
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