Diagnosed

I ran road half marathons on a Saturday and Sunday in mid-February. In spite of running both races at a conservative training pace, I found myself limping about the next Monday. My left leg wasn’t able to bear weight properly. If there was anything I could describe as “pain,” it would be a dull ache that feels like it comes from inside the bone near shin. I’ve run more than 26 miles (clearly!) in a single weekend before so the volume was nothing new and was not the problem. My trusty Asics road shoes (with stability features) have much less than 300 miles on them. They were not the problem. I didn’t fall or otherwise injure myself during either race. That was not the problem.

In order to not mess up my Spring “A” race (DoubleTop 100K), I took an entire week off from running when I realized that there was a problem. I tried a short 2 mile run the week before DoubleTop and felt OK after. However, I decided to continue to play things conservatively and not run again. I went to see my sports massage therapist for a session. I went to see a chiropractor who performed an adjustment seemed to help. He also scanned my feet and recommended orthotics due to my very low arches and severe overpronation.

I ran the race (in my neutral trail shoes) feeling absolutely fine. I was shuffling around in the days after the race, but only because I ran 62+ miles. I wasn’t limping around like before. I took it very easy the week after the race and stuck to walking and the upright bike for recovery. One week later, I felt great and jumped back into training with an easy paced 4-mile trail run. I wore a brand new pair of my road shoes just in case my older shoes were the source of my pain. I felt fine during the run. The next day? Limping. I tried to run again and my left leg didn’t feel 100% but it felt fine after I warmed up on the treadmill. The next day? Limping again.

I decided to get fitted for a different pair of shoes because maybe, just maybe, it was the shoes. Maybe the stability of the Asics GT-2150s was no longer working for me. After consulting with Kena at Big Peach and running in 10 different pairs of shoes, I left with a cute pair of Brooks Ravenna 3s. This shoe has a little bit less stability than my Asics. Based on observation of my running gait, the thought was that maybe I was a bit overstabilized in the sturdier Asics.

I did a mid-week 6 miler in my new shoes that night with my local BGR group. I shuffled/limped along for a mile or so, but felt fine once I got going. My last two miles were very strong. But I noticed that when I stopped running, it took a mighty effort to get started running again. My stride would be all kinds of messed up until for .25 mile or so. The dull ache returned the next day and I resolved to take yet another break. I had a higher mileage weekend planned (30 miles), so I skipped my next two workouts. My left leg felt better for my Saturday 10-miler and even though I split the run up into an AM 4 miler and a PM 6 miler, I felt good.

On Sunday, I headed up to Red Top Mountain for a 20-mile trail run. After a walking warmup in the parking lot, I headed to the Campground trail and tried to transition into a jog. I couldn’t do it. What’s more is that even walking now hurt. I was shuffling along at a 18 min/mile walking pace and this wasn’t a particularly hilly section of trail. I limped back to my car in defeat after 1 very slow mile of walking.

I decided to make a mid-week appointment with a runner-focused doctor at Emory Sports Medicine Clinic. After an interminable wait (really docs, get it together!), I finally saw the doctor. They asked a bunch of questions and did a lot of poking, prodding, and range of motion stuff with my ankle and foot. The diagnosis: Medial Tibial Stress Syndrome or MTSS or (one form of) Shin Splints.

Sigh. I almost wish I had something concrete like a stress fracture. Shin splints feels like such a nebulous diagnosis and the treatments/remedies are so individual and varied. I am thankful, however, that right now it is at a mild level. Nothing (usually) hurts when I walk, nothing is inflamed, nothing is sore. There is only a dull ache after running sometimes. I can (usually) run through it, but often choose to stop out of a desire not to break myself.

There are so many different possible causes for shin splints that I can’t even point to one thing as the trigger. I don’t feel overtrained. I think I ramped up my mileage properly from marathon to 50K to 50M to 100K the past year. I don’t run an excessive amount of mileage per week. In fact, I’m sure that I’m on the low end for an ultrarunner. I do meet some of the risk factors in that I participate in high-impact activities, that I overpronate and that I am nearly flat-footed.

Whatever the cause of this problem, my interest lies in finding a solution and fast. I can’t continue to train for one week and recover an entire other week. I want to run free without any issues. I want to run for 12 Hours at Operation Endurance next week (!) and not break myself for life. I am looking forward to having a great time at the SweetH20 50K in late-April. I’m not interested in resting up for 6 weeks! I have to get it in now before I turn up pregnant and all the real trailrunning fun stops.

The plan right now is to follow traditional treatment for this problem. That includes physical therapy 2x a week for the next 3-4 weeks. I’ll also be getting some custom orthotics made as a longer term solution.

I also plan to do some things on my own that may help the situation:

- Learn good form: I registered for the April Good Form Running classes at Big Peach. I don’t think I heel strike anymore, but I kind of attempted to change my stride on my own. Maybe I did it wrong and caused this whole mess to begin with? It will be a hassle trying to attend a Sat class because The Mister always has to work. But I need to do this for my long-term success with distance running so I’ll work it out. My left foot is “mushy” when I walk due to overpronation according to the PT. My right foot is only marginally better. I can only imagine how this plays out when I run.

- Tape: The PT showed me a simple tape job for my tibialis that may help. I don’t have any orthotics right now. It may not help, but it shouldn’t hurt things. I’m going to use on all my runs.

- Lose Weight: I’ve been working on it and had some success (~4lbs) but I need to work harder and do more. It was honestly way easier to keep up motivation when I was 90lbs overweight than it is now that I’ve lost that weight but managed to put 15lbs back on.

- Ice: I must start icing after long runs. I don’t do this. I hate being uncomfortable, it blows my post-run high. I usually don’t have many muscle soreness issues so I didn’t feel the need to do the ice thing. It’s time to stop being a wuss. At the very least, I can wrap my legs in Arctic Ease because that isn’t uncomfortable.

- Warm up/Cool down: I need to spend more time warming up. In order to get a few minutes more sleep, I cut down on my workout time occasionally. A longer warmup and cooldown are the first things to go. No more. I’ve gotten better at stretching post-workout, but my calves are constantly tight. I can do more. Maybe I’ll start doing that runner’s yoga video I have again even though I loathe yoga.

Anyone had recurring shin splints? What worked for you to resolve them?

P.S. This is going to cost a grip to fix between regular doctor visits, physical therapy, and custom orthotics. I have a High Deductible Health Plan with a $2500 deductible of which I’ve met a whopping $500. I do make regular pre-tax contributions to my FSA account for medical stuff but not enough to meet my full deductible. I did when I was pregnant because I knew I was going to be going to the doctor a lot. I didn’t this year because the only time I usually go to the doctor is for routine stuff which is covered 100% before deductible. I can’t change my pre-tax deductions until Sept. This is when having a HDHP really sucks. You either put aside a lot of money and don’t use it (it rolls over) or you put away the bare minimum and have to come up with $1500 to pay for bills out of pocket. Huge sigh. I’m considering getting The Mister to just add me to his regular insurance policy when it comes up for renewal. I have a great job but I work for a very small company that makes a lot of medical claims and we automatically get sky high rates. It sucks.

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5 Responses to Diagnosed

  1. Ernise says:

    I totally feel you on that nebulous diagnosis. I went to the Doctor yesterday for a constant dull pain in my left leg and it’s shin splints as well. Rest was my diagnosis. I’ve already taken a week and a half off, but will continue to do so for the next 2 weeks with the hopes of it being better.

    I think mine were from doing stairs one afternoon for speedwork back in February. Since then, I’ve had that dull pain in both legs. The 1-1/2 week break healed one leg, but not the other. Since I don’t have any big events planned, I’m okay with resting. I’m going to focus more on weights and some pool work.

    Yeah, I kind of felt like an idiot at the doctor’s because I wasn’t in acute pain. My range of motion or whatever was good. I just know what can happen when I start running! Taking a week or two off helped but as soon as I ran again under certain conditions, it started back up. NOT running is just not an option that I want to accept right now.

  2. TNT Coach Ken says:

    Wow, I’ve had a few runners get diagnosed and we just shut it down……..

    Ugh! I know that is an option but I worry that I would stop running for 6 weeks, “cure” the problem, and then just get them again. There has to be some reason that I’m getting them and I need to figure it out.

  3. Kara says:

    Shin splints sound really painful! I’ve never had them, but I do think ice baths are really useful…just not fun. :) Hope you’re feeling better soon!

    I’ve never had any injury in 5 years until now! I suppose I should count myself lucky.

  4. K. Rock says:

    Aww I know you are hating this. I didnt think there was a thing that could stop you! But alas it is shin splints. It could definitely be worse though so I am glad this is something you can recover from. You’ll be better in no time.
    I guess I should be glad that this is my first real injury. I’m going to fix it!

  5. Shin splints are what sidelined me from running anymore because I ignored the problem until I developed a severe case. I know suspending your training right now might seem like the worst thing, but it could save your legs in the long run (pun intended). :-)

    I didn’t know that was the reason you stopped running!

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