My client complains of shin splints, yet in six months, she wants to do a three day walk averaging 20 miles a day. What can I do to help her?
Thank you for your question. Shin splints are something that should be discussed in some detail. Most people are under the wrong impression when it comes to shin splints. First, the name itself is misleading at best. What is a shin and where does it have a splint? The shin bone is otherwise known as the tibia and the splinting sensation is posterior tibialis tendonitis. Quite often shin splints are often a result of a weakness in the frontal plane stabilizers. In other words, the glute medius, among other muscles, cannot control femoral internal rotation at the hip at heel strike and allows undue rotational stress on the posterior tibialis. The posterior tibialis is one of those muscles that aren't discussed much in the flashy magazines because we cannot view this muscle. It is embedded between the tibia and fibula. We don't ever really want to hypertrophy this muscle, but we need to keep it strong. If ignored, it can cause an individual quite a bit of anguish and distain from being ignored. Another common signal that leads to shin splints is a lack of motion at the ankle joint, especially in dorsi flexion. The lack of motion is due to the soleus and gastrocnemius being tight from also being overloaded in this scenario.
Your client wants to walk continuously for hours during this three day walk. It may sound rather peculiar, but I would suggest she walk sideways for a while. What I mean is that she needs to work on her frontal stabilizers as mentioned above. One effective way of accomplishing this is to have her walk sideways with a light resistance tubing around her ankles. The slight resistance and the sideways walking will add increased load to the gluteus medius and help to turn that muscle on when she is walking straight ahead. I would also put her on fairly intensive stretching program that includes foam rolling and/or trigger point therapy on the entire posterior structure of the ankle. I can only assume that your client has been battling shin splints, or at least has had signs of them for a long time. The posterior musculature has built up deposits of waste inside the muscle tissue.
These deposits must be broken up before normal elasticity can be restored to that region. Some people can get relief from the foam roller and it tends to be a little less painful. If that doesn't do the trick, I would suggest her seeing a deep tissue or trigger point specialist to release those muscles. The trainer must also focus on strengthening the frontal plane musculature. After the release has occurred and the glutes have been strengthened, it is up to the trainer to train the client in a multi-planar environment and try to engrain a more efficient moving pattern. This is done by having the client concentrate on dorsi flexing the ankle before each heel strike to ensure the load is dispersed throughout the kenetic chain rather than all into the posterior ankle complex. These little suggestions should ensure her ability to complete the walk without any major issues. You mentioned you had six months until the expected date. That should be plenty of time to see significant changes.