What causes shin splints and tips on how to run pain free

What causes shin splints and tips on how to run pain free

When I started to increase my running in preparation for next years Brathay Windermere marathon (read blog here) I had an old and unwelcome friend return once more, shin splints.  

Shin splints is a term often overused in connection with any pain in or around the shin and is a poorly understood term. In the physio world we call shin splints medial tibial stress syndrome (MTSS) doesn't exactly roll off the tongue and so probably not surprisingly shin splints is still used more commonly.   

The problem arises when a chronic repetitive bending force is applied to the shin bone (tibia) and is very common in runners especially those that have rapidly increased their mileage, speed or running frequency. This causes a stress reaction within the outer layer of the bone and can be very painful.  

Other causes of medial shin pain can also include overload of a muscle/tendon on the inside of your shin (Tibialis Posterior).   

Both of these conditions are usually triggered by a rapid increase in training load however certain characteristics of your running technique are thought to increase your risk of developing medial shin pain.  

So I decided to turn the analytical spotlight on myself (something physios are notoriously reluctant to do) and did some filming of my running technique on the treadmill and whilst running overground.

So the most noticeable thing from looking at me from behind was that I had a tendency to land quite far on the outside of my heel on both feet. This means my foot has got a long way to travel in order for my foot to get flat (in physio speak we would call this an increased pronation excursion angle). Now over pronation has long been unfairly demonized as the cause of most running related injuries however my foot is not rolling in excessively it's just it's got a long way to travel in a short space of time. This can cause increased force to be applied to the inside of the shin bone and means the muscles on the inside if the shin work a lot harder both of which can lead to medial shin pain.

The other noticeable thing from the video is that I start to roll my foot outwards before I have fully pushed off through my foot.

In fact it looks like I don't push off through my big toe at all, this leads to a less efficient push off part of my running cycle (in physio speak we call this low gear propulsion). This might also help to explain why my calf muscles feel so tight and fatigued after a run.

The fix in the end was rather simple I used the running cue of thinking about pushing off through my big toe. This helped reduce my shin pain really quickly and after practising this cue over the last 3 weeks it feels much more natural, my 5 km and 10 km times have dropped and my calf feel much more comfortable even after longer runs. 

If your struggling with medial shin pain the 1st thing you need to do is get it checked out by a qualified health professional who has experience of treating runners. Call our reception on 01539 725220 or ​book online here.  

If you want to read more about our RunFit running assessment and retraining packages and how they can help you run pain free or improve your performance click here. 

Richard’s case of festival shoulder

Spending a weekend in a tent, ankle deep in mud, in a field somewhere in North Yorkshire left me with several things.

  • a strong desire to buy a camper-van
  • a debilitating lack of sleep
  • a very sore and painful shoulder

Now this could have been brought on by some over-energetic dad dancing whilst raving into the early hours of the morning. But instead I think it was caused by a combination of lifting and carrying all our camping gear from the car to the campsite, holding my sleeping 3.5 yr old daughter for an hour whilst watching a band and then carrying all our gear back through thick mud to the car.

I woke up on Monday with a really painful and stiff shoulder wondering whether I’d be able to ride my bike to work never mind spend all day treating patients. I knew I needed to get my shoulder moving and after some Ibuprofen and paracetamol I could start to exercise and move it which helped to further reduce the pain.

I continue to be amazed at the ability of the human body to heal itself as long as we put it in the right environment to allow it to do so. Fortunately the following week I was on holiday camping with my family and a combination of early nights, being able to run every other day and relaxing on the beach not having to worry about work in combination with a few strengthening exercises allowed it completely settle.

We see a lot of people with shoulder pain with a similar story, instead of a festival shoulder it might be a 1st good gardening weekend of the year shoulder or a I’ve been painting ceilings for 3 days shoulder. Basically if we expose our shoulders to a level of activity and strain that they are not used to too quickly and don’t give the muscles and soft tissues time to adapt to this new level of load it’s going to get sore.

So the take home message is to try an pace yourself and introduce any new activities at a gradual rate to allow your body to adapt and in my case make sure we pack a lot less stuff next time we’re camping at a festival!

If your suffering from a painful shoulder and don’t know what to do about it call our reception team on 01539 725220 and find out how we can help. You an also book online by clicking here

Lisa’s hurting hamstring

Some of you will already know Lisa our practice manager. A few months ago Lisa completed the Keswick to Barrow walk along with Kerry one of our physios. They did amazing raising loads of money for some worthwhile causes as well as being the fastest all female team to finish.  

During her training for the walk Lisa had increased her walking mileage a lot in a short period of time and started to get some pain in the back of her knee. This got worse after the walk and was starting to be painful during and after a run.   

Now Lisa identifies herself as a runner it's part of who she is, part of her DNA. She loves running, and I mean really loves it, so much so she just carried on despite the pain. Sound Familiar? 

She even did the Grasmere gallop a 10km trail run a few weeks after the walk but found her knee pain was worse than ever after. It got so bad she even had to stop running, now. Now what do you call a runner who can't run?

A "ner"!!  

Now the funny thing is Lisa works in a physio clinic, she is surrounded every day by expert physios with loads of experience treating injured runners. We even have a RunFit service that that analyses and retrains running technique. And to top it all off Lisa gets free treatment as an employee.  

So it might surprise you to hear that Lisa didn't mention her injured knee to any of us. Not one little peep!  

Why I hear you cry!  

The reason is something we hear all the time from our clients.  

She was scared we would tell her to stop doing the thing she loves, running. This is despite the fact that she had already stopped running because she was worried about the pain and doing more damage.  

Lisa finally fessed up and told us her tale of woe. We listened to her story including what she wanted to achieve with her running (a sub 2hr half marathon). We assessed her and found a sore hamstring tendon inserting into the back of her knee (hamstring tendinopathy). Lisa was given some exercises to help calm down her pain followed by strengthening exercises to help build strength in her hamstring. We explained her problem and told her she could even start running again as long as the pain stayed at a low level and wasn't worse the following day.  

Lisa is now gradually increasing her running and strengthening exercises. She has a lot less pain and we have analysed her running technique and identified some areas she can work on to help reduce her risk of injury, improve her running and smash her 1/2 marathon personal best.   

Lisa has very kindly agreed for us to share her story and some of her RunFit analysis videos and we will be catching up with her over the next few months to see how she gets on.  


Richard’s mid life crisis marathon

It's that time of year again!  My 39th birthday is rapidly approaching and I realised that time is running out (no pun intended) on me achieving my goal of running a marathon before I turn the big four zero.

Is it a mid life crisis type of thing? Possibly but it's certainly cheaper than buying a sports car! Now which one to enter London, Paris, New York? Well actually none of the above, instead I've decided to enter the Brathay Windermere marathon described as one of the most scenic road marathons in the UK as well as one of the most challenging courses.

Having chosen which marathon, it's time to get serious about my training and I've enlisted the help of Wayne Singleton from Jogging Pals to help me devise and stick to a training plan. Wayne is a top bloke as well as a UK Athletics Coach, seasoned marathon and ultra runner. Jogging pals is an amazing running group that is all about making running fun and inclusive go check out their programmes at https://www.joggingpals.co.uk/

I'm really interested to see how my body is going to cope with the increased training load and I will be writing a monthly blog to track my progress and giving you my insights as a physio and a runner along the way.

To follow my journey you can check out our blog, or like and follow the clinic Facebook page. You can also follow me on Strava by searching for Rich the physio.

4 ways to reduce your risk of injury

By Kris Baldock

It's that time of year again, whether you've started a new year fitness regime or are planning to hit the slopes for that ski holiday, a sudden change in physical activity can lead to injury.  A large number of people embark on a new exercise regime, and others increase their activity levels or intensity of an already established routine. As with any new activity or increase in training, there  is an increased amount of load being put through your tissues and this can lead to a higher risk of injury.

As prevention is better than cure, could you try incorporating some of the points below  which will help reduce your risk of injury.

1. Always include a warm up. Follow a specific warm up that recreates the movements of the exercise your are about to perform, once warm your muscles have a greater tolerance to loading and increased elasticity. This is what we call a dynamic warm up and is very different from the type of static stretching that many of you may be used to. Static stretching has been shown to have no effect on preventing injuries and in some studies has been shown to reduce your muscle ability to produce force, not something you want to do before a workout.

2. If your new to exercise, gradually increase your activity level. Recent research suggests an increase risk of injury is brought about by not only an increase of training load, but also too little training load. This therefore suggests that a sharp increase or excessive variation in training load may increase the risk of injury. Gradually increase and maintain your activity level and if you have time off for illness or injury, do not return to your
previous activity level too quickly. 

If you are used to exercise, don't increase your training by more than 10% per week. This could be an increase in the length of time you are exercising, the intensity of your workout or an increase in the weight you are lifting.

3. Take a rest day. Research has shown that if you load tissues above your current tissue capacity everyday, this can lead to a breakdown of collagen tissue. Collagen makes up a large part of our muscles, tendons and ligaments. We need periods of rest to allow our bodies to regenerate and repair. Loading your tissues everyday without rest over time can lead to weakness and structural changes in these tissues, and they can't cope with the demand of load and this can lead to pain.

4. Mix up your training. This changes the type of loading through your tissues.For runners this could be a change in footwear, running pace or mixing road running with trail running.  Doing some form of cross training (different type of exercise) e.g. cycling, swimming or gym based exercise can allow you to strengthen different muscle groups whilst helping you maintain your cardiovascular fitness.

5 easy tips to help reduce your Back Pain

“Is your back pain taking over your life, does it stop you enjoying an active outdoor lifestyle or prevent you from playing with your kids/grandkids? If this sounds like you or a friend or loved one you know you need to keep reading”.

1.Avoid bedrest, stay in work and gradually resume normal activities

Prolonged rest and avoidance of activity for people with low back pain actually leads to higher levels of pain, greater disability, poorer recovery and longer absence from work. In the first few days of a new episode of low back pain, avoiding aggravating activities may help to relieve pain. However, staying as active as possible and returning to all usual activities gradually is actually important in aiding recovery. While it is normal to move differently and more slowly in the first few days of having back pain, this can be unhealthy if continued in the long-term.

2.You should not fear bending or lifting 

Bending and lifting are often portrayed as causes of back pain and while an injury can occur if something is picked up in an awkward or unaccustomed way, it’s most likely to just be a sprain or strain.

3.Exercise and activity reduce and prevent back pain

Exercise is shown to be very helpful for tackling back pain and is also the most effective strategy to prevent future episodes.Start slowly and build up both the amount and intensity of what you do and don’t worry if it’s sore to begin with – you won’t be damaging your spine.

4.Painkillers will not speed up your recovery 

There is no strong evidence on the benefits of painkillers and they do not speed up recovery.They should only be used in conjunction with other measures, such as exercise, and even then just as a short-term option as they can have side effects.

5.Get good quality sleep

The importance of sleep in tackling back pain has become increasingly clear in recent years. This is because it reduces stress and improves your overall feeling of wellbeing, making you less susceptible to the triggers of pain in the first instance and helping you to cope when it does occur.

Need more help with your back problem? Why not request our free back pain report (worth £40).

Our 10 page report is packed full of more information that will help you get back to living an active outdoor lifestyle without having to rely on painkillers or having to bother your GP.

What causes running injuries?

What causes running injuries?

By Richard Clarke 16.02.2016

Despite what runners read & hear every day, studies have yet to discover what causes most running related injuries (RRIs). Well actually that’s not entirely true the thing that causes most running related injuries is surprise surprise… RUNNING!

So now we have got that one out of the way what other factors may also be involved?
A recent study by Saragiotto (2014) asked runners what they thought contributed to injuries in runners. The most common answers were:
• Not stretching
• Wearing the wrong shoes
• Foot-type changes
• Excess of training
• Not warming up
• Lack of strength
• Not respecting the body’s limitations
So time to examine what evidence there is for some of these commonly held beliefs.

Not stretching, a recent systematic review by Lauersen et al (2013) found no evidence to support stretching before or after sport to reduce injury risk. An earlier study by Wilson (2010) actually found that stretching may decrease endurance performance & increase the energy cost of running.paula radcliffe

A good example of this is Paula Radcliffe who in 2003 set the still unbeaten world record for the women’s marathon record of 2:14:25. As part of her training for this she saw her sit and reach test decrease by 4cm. This was in part due to a specialised strength and conditioning program that also saw her maximum vertical jump test increase by 10cm giving her increased power in her stride

Wearing the wrong shoes, over pronation is not a diagnosis. It seems likely that marketing from shoe companies labelling pronation as harmful and providing a solution (in the shape of an expensive shoe) is to blame for this widely held belief. A systematic review by Richards (2009) titled “Is your prescription of distance running shoes evidence-based?” concluded that there was no evidence base for the prescription of running shoes for distance runners. A more recent study by Malisoux et al (2013) found that using a variety of different running shoes may help to reduce running injuries by helping to vary loading patterns. Antoher study be Nielsen et al (2014) found that foot pronation was not associated with injury risk.haile

A good example is Haile Gebrselassie the legend is an over pronator. He won two Olympic gold medals over 10,000 metres and four World Championship titles in the event and set 27 world records, and is widely considered the greatest distance runner in history. …Geb races in Adidas Adizero Adios.

Another commonly held belief is that heel striking is bad and the root of all evil and that forefoot or mid foot striking is the answer to all running injury woes. This belief became popular following the rise of the famous “Born to run” book. Again when we examine the evidence this does not stand up to scrutiny, Larson (2010) examined foot strike patterns in recreational marathon runners during the 2009 Manchester city marathon. They found that the majority 88.9% of runners at 10km heel striked only 3.4% landed on their forefoot. By 32km the percentage heel striking had increased to 93%.
Not all heel strikes are equal as shown in a recent study by Davis et al (2015) where the researchers found that those runners who landed with less impact force had reduced rates of injury and many of these were heel strikers. What may be more important is whether you land with a slightly flexed or a straighter knee and how far four foot lands in front of your hips. Generally a small increase (5-10%) in your step cadence (the number of steps you take per minute) can help to reduce impact loading and has been shown to help reduce impact loading and may help reduce running related injuries (Heiderscheit 2011).

Excess of training, now were getting somewhere. Estimates suggest 60-70% of running injury is due to training error but some papers suggest it may be as much as 80%. Overuse injury occurs when load exceeds tissue capacity, if time for adaptation is too short or volume of running too high, an overuse injury can occur. The major causes of most overuse RRIs are due to training errors.

Not warming up, warming up has shown some evidence of reducing injury risk in some sports, there is little evidence to suggest it significantly reduces risk of running injury.
Lack of strength, again some research from non-running sports suggest strength training can reduce sports injuries to less than a 1/3 and reduce overuse injuries by almost 50% Lauersen (2013).

Not respecting the body’s limitations, now we have to remember that we are all individuals and what may constitute a normal running load for a highly trained elite athlete may be completely unachievable for the average recreational fell or marathon runner. A higher body mass index (BMI>25) has also been linked to an increase risk of injury as has a previous history of injury especially in the last 12 months (Malisoux et al. 2014, Saragiotto et al. 2014b).noble steed

An analogy from a previous lecturer that epitomises this is that of donkey from the film Shrek. Donkey dreams of being a noble steed much like many of us might dream we are the next Paula Radcliffe or Mo Farah but what donkey needs to remember is that he is not a noble steed he’s a donkey and if he tries to train and run like a noble steed he’s probably going to end up lame and looking like an ass.donkey

In summary, the main causes of running related injuries that are backed by the research literature are training errors, a high BMI and a previous history of injury. Things that can help to reduce injury risk are improving lower limb muscular strength, improving co-ordination and proprioception and trying to run with less impact either by landing with a slightly flexed knee or trying to increase your running cadence.


Information for this blog was gathered from an article by Tom Goon the running physio he’s on twitter @tomgoon and check out his blog at http://www.running-physio.com/

and from a presentation at Therapy Expo from Matt Phillips again you can find him on twitter @sportinjurymatt or check out his blog at http://www.sportinjurymatt.co.uk/

Both sites have some excellent evidence based running injury advice and articles

Shoulder injuries in rock climbers

sports injuries

Richard Clarke & Lennard Funk

Rock climbing has become a professional competitive sport with its own bi-annual international world cup and an estimated 25 million climbers involved in the sport in 140 countries (Danger 2013). The International Federation of Sport Climbing (IFSC) has been officially recognised by the International Olympic Committee and has been shortlisted alongside eight other sports as a possible new event for the 2020 Olympics (Danger 2013). Recreational rock climbing continues to grow in popularity in the UK with five million visits to indoor climbing walls every year (Gardner 2013). Membership of the British mountaineering council (BMC) has grown from 25,000 in 1990 to over 75,000 in 2014 and the number of indoor climbing walls has increased from 40 in 1988 to over 350 in 2013 (Giles et al. 2006, Gardner 2013).

Injuries are common and between 30% and 67% of climbers have sustained a climbing related injury. 33% to 93% of these are overuse injuries and the majority involve the upper limb (Backe et al. 2009, Paige et al. 1998, Maitland 1992, Wright et al. 2001, Pieber et al. 2012, Jones et al. 2008).

Repetitive loading of the shoulder in overhead positions combined with dynamic and static loads involving full body weight means climbers are prone to developing shoulder pathologies including shoulder impingement syndrome (SIS) rotator cuff tendinopathy, rotator cuff tears, labral tears and biceps tendinopathy (Peters 2001, Schweizer 2012). Epidemiological studies have shown that the increased risk of injury is associated with:

  1. male gender
  2. climbing at higher grades of difficulty
  3. climbing frequency
  4. More than 10 years of climbing
  5. Lead climbing or bouldering

(Backe et al. 2009, Wright et al. 2001, Pieber et al. 2012, Jones et al. 2008).

Several studies have examined physiological properties of rock climbers and have shown associations between strength and endurance of the hand, finger and shoulders and high levels of climbing performance. None of these variables have been associated with an increased injury risk. A study of climbers specialising in bouldering found that injuries were associated with a previous history of injury but were unrelated to climbing experience, gender or body mass index (Josephsen et al. 2007)

Rotator Cuff Disorders:

Rotator cuff tendinopathy, rotator cuff tears, SIS, labral lesions and biceps tendinopathy are common patho-anatomical diagnoses for shoulder pain reported in the climbing literature (Peters 2001, Schweizer 2012). Rotator cuff tendinopathy is proposed to develop through compressive and tensile loading of the tendons at a level exceeding their physiological capacity (Lewis 2010). A continuum of tendinopathy has been proposed where tendon overload leads to a reactive tendon characterised by a non-inflammatory proliferative response, acute pain, thickening and increased activity of tendon cells. If overload continues a state of tendon disrepair develops with collagen fibre changes followed by irreversible tendon degeneration with partial or full thickness rotator cuff tears (Lewis 2010, Cook 2009).

Internal impingement:

Internal impingement involves compression of the articular side of the rotator cuff tendons between the humeral head and the glenoid labrum (Kibler et al. 2013). Internal impingement was first observed in throwing athletes during the late cocking stage of throwing when the gleno-humeral joint is in end range abduction and external rotation (Heyworth & Williams 2009). Since then internal impingement has been recognised in non-athletic populations who regularly participate in overhead activities (Castagna et al. 2010). The exact aetiology of internal impingement remains unclear although several factors including gleno-humeral instability and gleno-humeral internal rotation deficit (GIRD) caused by increased posterior shoulder tightness and scapula dyskinesia have been implicated (Heyworth & Williams 2009). Gleno-humeral internal rotation deficits (GIRD) have been reported in overhead throwing athletes with and without shoulder symptoms (Mihata et al. 2013). The restriction of internal rotation is usually accompanied by an increase in external rotation and increased tightness of the posterior shoulder capsule and rotator cuff musculature (Thomas et al. 2010, Michener et al. 2003). Simulated GIRD in a cadaver study has been shown to cause altered scapula mechanics of decreased upward rotation and increased inward rotation (Mihata et al. 2013) which are also commonly seen in patients with SIS (Ludewig & Cook 2000). SLAP Lesions:
Superior labrum anterior posterior (SLAP) lesions are common in climbers (Haddock & Funk 2006). SLAP lesions can be caused by compression as in a fall onto an outstretched arm or through traction to the long head of biceps. Traction in a superior direction is commonly seen during normal climbing movements especially on overhanging routes if the climber loses their footing and has to take their full body weight through one arm. The repetitive nature of sport climbing and bouldering involves high climbing loads with relatively short rest periods in-between routes. Inadequate rest periods between episodes of tendon loading may not allow a tendon time to adapt and could lead to rotator cuff or biceps tendinopathy in climbers (Cook 2009).

Scapula Dysfunction in Climbers:

Clinically subjects with shoulder and arm symptoms are commonly observed with poor dynamic scapulo-thoracic and gleno-humeral control (Kibler et al. 2013). Scapula positioning on the thorax is important in order to create a stable base for shoulder movement and maintain the humeral head in the centre of the glenoid (Mottram 1997). The lateral tip of the acromium has been shown to upwardly rotate, posteriorly tilt and externally rotate during elevation in the scapula plane in asymptomatic subjects (McClure et al. 2001). This pattern of scapula movement is thought to help maintain the size of the sub-acromial space and prevent impingement of the sub-acromial bursa and rotator cuff (Michener et al. 2003). This viewpoint is supported by ultrasound and MRI studies that have shown increased anterior scapula tilt reduces the sub-acromial space in healthy individuals altered scapula kinematics (Silva et al. 2010, Solem-Bertoft et al. 1993). Altered scapula kinematics have also been linked with decreased isometric shoulder elevation and rotational strength in subjects with SIS and healthy individuals (Smith et al. 2003, Smith et al. 2006, Tate et al. 2008, Akyol et al. 2013, Wassinger et al. 2012). Roseborough & Lebec (2007) measured end of range static positions of the scapula and humerus to determine gleno-humeral to scapulo-thoracic ratios for climbers and non-climbers. Climbers had a significantly higher gleno-humeral to scapulo-thoracic ratio (3.6:1) compared to non-climbers (2.8:1). The authors concluded that this increased ratio may represent an increased risk of rock climbers developing SIS (Roseborough, Lebec 2007).

Altered thoracic posture has also been linked with changes in scapula kinematics and alterations in shoulder ROM and strength (Kebaetse et al, 2003). The fact that changes in thoracic position affect scapula kinematics and shoulder strength is not surprising given the extensive muscle attachment between the thoracic spine and scapula (Mottram 1997). Increases in thoracic kyphosis have been linked with increased age (Culham, Peat 1993) and shortened pectoral muscles (Borstad 2006).

Movement Patterns and Prevention:

Poor performance during movement control tests has been associated with an increased risk of future injury (Roussel et al. 2009, O’Connor et al. 2011, Kiesel et al. 2007). Several studies have been able to identify differences in movement patterns between patients with lumbo-pelvic pain and healthy controls during movement control tests and functional positions (Luomajoki et al. 2008, Dankaerts et al. 2009, O’Sullivan et al. 2003), but nothing similar has been done for the shoulder.

As part of an MSc Dissertation, Richard Clark, undertook a study to examine movement dysfunction of the shoulder and trunk in recreational rock climbers with and without a previous history of shoulder injury using low and high load movement control tests.

We found that there were significant differences between injured and uninjured climbers for low load movement control tests. Climbers with a history of shoulder injury displayed movement dysfunctions of scapula anterior tilt and internal rotation (winging). Self-reported injury severity was significantly correlated with poor performance during the movement control tests. Therefore, rock climbers with a history of shoulder injury display patterns of movement dysfunction during the performance of low load movement control tests.


Shoulder injuries are common in rock climbers, with the majority being overuse and fatigue injuries. Rotator cuff pathology is most common with SLAP tears also being common in younger climbers. Chronic scapula and trunk dysfunction can develop and can increase the risk of injury. Movement control tests may be beneficial in screening and identifying shoulder dysfunction and pathology in rock climbers.


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