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I've been running about 15 yrs and the one thing I get is shin splits. No ITB issues, no knee pain, no back pain, ever. Just...shin pain. It comes and goes. Often aggravated by things like old shoes or treadmill running. I've been fitted for shoes, and replace when they die (immediately, though some last longer than others..) and I have gait analysis (so many analyses!) done. I used to be an overpronator, and now I've been dubbed "a pretty cut and dry neutral runner". I do have a slight external rotation, however.
The issue, I was told, is that my calf muscles are incredibly tight. This is causing the shin pain. I'll admit when I neglect yoga it's not pretty, and so after a 5 week hiatus, I returned this week. This is definitely my own fault.
I have been using the stick, stretching, using a foam roller (my first time with this, ouchie). I also bought Zensah leg sleeves (these are great!) and I cross trained a couple of times this week, and ran this morning without issue. If I press really hard on my shins, it is sore. Otherwise no issues walking/running/stairs/squats/deadlifts/etc. I just feel like I shouldn't have any pain pressing on things.
I run about 50 miles a week, though I just started a training program for a marathon in October, and the mileage is low in the beginning, so I've dropped down a bit.
I guess I am just generally freaking out. I am looking to BQ (I've only run Boston as a charity runner before) and so I'm just worried.
Does anyone else experience this? I know splints are usually a cause of pronation, too much too soon, new runners, etc. None of these things apply to me, and I've been told to stretch it out.
Anything else I can do? Any kind words? LOL. Will this subside? I went through something similar in February, but I'd like to avoid the calf tightness/shin pain.
Something else I thought of: before last September, I only ran outside. I started doing some speedwork inside on the treadmill in the fall (as the track was dark in the morning). Do you think that could be a cause as well? I would do speedwork and about 1/2 my mileage inside and the rest outside. This was mainly b/c I had a girlfriend I like to run with who refuses to run outside, so I would run indoors with her for some comraderie.
If you read this whole thing, THANK YOU!
Take a look at short article Gait Analysis: Evaluation and Treatment of Shin Splints. Excessive pronation is one of 13 movement faults that can occur when running which research has shown a correlation with the development of shin pain. Once identified with a slow motion video gait analysis some of the these movement faults can be solved with a conscious modification of running form. Some of these movement faults need to be addressed with exercise. One impairment which is not talked about much relative to shin pain, but can be a significant factor is weak calf muscles. Excessive pronation can be correlated with shin pain, but a rapid supination has also been shown to be related to shin pain. In my experience the most common movement fault associated with shin pain is running with too long of a stride. This can be changed with a conscious effort to modify running form.
Damien Howell PT, DPT, OCS - www.damienhowellpt.com
A couple things follow that are very important for you to know..
First, don't worry about length here in the med tent. Most people here have a long attention span. If we have the patience to train for marathons, we can get through your post. Besides, I write some myself that are longer than I care to re-read, lol.
Next thing - possibly the most important - is that I have run BQ a few times on weekly averages of 20-25 miles for the year, never having to hit 50. Your case is no doubt based on overuse. Fewer quality miles will always beat lots o' junk miles, hands down.
Now a few things about them shins...
They are right when they tell you tight calves lead to shin splints, but the term "shin splints" is becoming more sharply defined in medical terms as we speak. After 15 years of running, I'll bet we can rule out the more exotic forms of this condition, settling on the overuse type that accompanies the aforementioned tight calves. One law of muscle rehab is that a tight muscle on one side of a joint is likely to lead to an equally messed up muscle on the other side of the joint, as they work in opposition to one another.
Another law is the "law of reciprocal inhibition," which states that when a muscle receives a motor nerve signal to flex on one side of a joint, the other side will not, in order to avoid this opposition. Here you can see a paradox, within which lies the truth, if you will excuse the pun/oxymoron. Here is where the laws of muscle physics begin to break down, much like in the transition from Newtonian to Quantum physics. After a while, muscles start ignoring the brain and develop "minds" of their own.
So, I write and write about this in the Med Tent, and sometimes feel like Einstein must have felt in the early days of Relativity (minus a few hundered IQ points, of course). The reactions to great truths, in order, tend to be ignorance and scoffing, followed by violent opposition, followed by acceptance as eternal truth, glad we thought of it style.
The great truth that lies within the story your muscles are telling, is that your calves are just plain baked. They are not really too strong or too weak, and as previously stated, it is obvious they are out of your conscious control. They are now a dysfunctional marriage with a 15 year itch that is begging for a divorce from your training regimen.
So, what to do? My answer is based on proven, peer reviewed science, tempered by a lot of professional experience - as well as my running resume'. Once again, they are right about the muscular opposition of the rear calf muscles creating lots of extra work for the smaller anterior calf muscles. To be more specific, you have as main plantarflexors, the Soleus and Gastrocnemius, which you have likely been foam-rolling (hopefully with pressure in the direction of the heart), along with the Peronius (Fibularis) Longus and Brevis (Lateral, along Fibula), and other bit-players that assist this motion, some of which your foam roller cannot touch, including the Flexor Digitorum Longus, Flexor Hallucis Longus, and Tibialis Posterior (all 3 deep to the Soleus and/or Gastroc), and more.
This A-list of Plantarflexors is opposed on the lateral front of your shin by the aching Tibialis Anterior, Extensors (Hallucis, Digitorum) Longi, and (in most people) Peroneus (Fibularis) Tertius - the A-team of dorsiflexors. The fact that this team is outnumbered and outweighed by more than a factor of two is the reason why blame for your pain can be laid at the feet (so to speak) of (even a little) tightness in one or more of the opposing plantarflexors. As you noted, newbies get this a lot, as their calves turn to stone within a few weeks to months of starting to run. So why is a seasoned runner having this problem?
Being "seasoned" involves years of insult from overdoing something, yet surviving it all. In this case, insult to injury has overwhelmed your survival, or recovery. Damage is being done faster than it can be undone. This probably, at least partly, is because you lose recovery speed as you age, and have to allow more time for it, which you may not have done, pulling those 50 mile weeks. I know.. there are people out there running 100+ mile weeks and surviving it. Godspeed to them all, but you and I both know people who have fallen prey to the same aggressive schedule. I know a 70-year old guy whose Great-Grandmaster coach had him doing 80+ a week, and he slowed down. I'm in my late fifties, run 2-3 times a week, and have the same leg speed I had 10 years ago. That's because I do fewer miles at greater speed (low 6s), and several long slow runs, way off marathon pace, per year, sometimes exceeding 30 miles a pop. The key is, just a few. Most of my running averages less than 20 a week now, 6 months after my last BQ. I'll bet you can do this too.
Back to your calves, the foam roller (which I often recommend, but not so much in a case like this), and the stick (which I own, but do not use) are not going to penetrate to the level needed to correct chronic calf muscle tightness. They are best for the kind of maintenance we in the trade call "muscle flushing," but are too general an appliance to address the many deeply hidden and contorted muscle fibers you have been accumulating for 15 years. Even though I am a professional Massage Therapist, I am not going to tell you to go to one - unless you have lots of money, and little time - because your dreams are too big for the average massage budget. You want to perform, so you are going to have to familiarize yourself with these muscles and how to fix them yourself. You already have demonstrated a willingness (and the time) to maintain them, and have located some of their tight spots. You just need to be more specific in your therapeutic approach. Unfortunately for many in my trade, they need a little more specificity themselves.
The bottom line is to engage in direct feedback with your muscles, finding and disarming them in one easy step, which is to scan the suspect muscle with your fingers or thumbs (plain skin, or with lotion, or with my fave - soap in a shower), finding the "hot spots," and compressing them deeply as you relax the host muscle. They will usually relax - sometimes one by one, sometimes in groups - as they become mildly ischemic, and remain so until you crank them up again. It is important to find and disarm as many on both sides of the joint you can find.
When you have found them all, you should become strangely drowsy, as your body prepares for the deep recovery phase of sleep (I've taken people from conversation to snoring in a few seconds). Make sure to lay off any stimulants and get that most important part (sleep) done, too. Do not eat within 4 hours of sleeping, or you will affect hormone production. Avoid sweets and coffee first thing in the morning, and right after workouts, for the same reason. Drink reasonable quantities of pure water, and maintain an anti-inflammatory diet low in refined sugars, starches, and omega 6 vegetable fats. Seek out Omega-3,9 and mono-unsaturated fats in your foods, with a healthy blend of saturated fats and cholesterol left in, so your body can manufacture vital hormoneshttp://www.weightrainer.net/nutrition/fats3.html.
Make sure your electrolytes are balanced with the potassium and magnesium that are missing from a lot of popular foods. Consider adding Turmeric or its active component, Curcumin, to a diet rich in other potent natural anti-inflammatory, anti-oxidant and free-radical scavenging substances. Revert to low impact training for a couple weeks, and check the shock-absorption on that treadmill. You may need to add a rubber mat underneath.
Now lets address your former over-pronation, which is likely to still be important to your case. Depending on how long you have been "cut and dry" neutral, you may be assigning seasoned mileage to newbie muscle use. If you recently changed your gait, you have to consider yourself at least partly newbie vv a need to gradually ramp up like any newbie. You mentioned many gait analyses, which indicated external rotation - this is extremely important. Yes there is a difference between the motions of over-pronation and external rotation, but they accomplish a similar goal, which is to emphasize the importance of the ball of your foot to propulsion. I have been very outspoken about how important this is to chronic pain, and how easy it is to fix at almost any stage of dysfunction, until it leads to advanced bunions or other exaggerated adaptations. If you have both over-pronation and external rotation in your history, regardless of conscious gait modification, you must determine if the first metatarsal head (not the toe tip) falls behind the second in relation to the remaining metatarsals. Most likely, it does.
For reference, check your muscle actions here... http://www.getbodysmart.com/ap/muscularsystem/footmuscles/menu/menu.html
Oh my - thanks so much for this long and thoughtful reply! A couple of responses, and questions.
As for my 50 mpw, I wasn't always running those (haha, in the early days, I would do 10 mpw and I thought that was fine. I was never training for anything. I always thought of those as junk miles). And I'm never doing that consistently, without fail. I generally rotate through training schedules to focus on say, working on speed, or working on distance. When I'm working on speed, my weeks have shorter miles, of course.
I guess I really never thought of my miles as junk miles since a) I have always had goals and a training schedule I'm using, b) I have been meeting my milestones and c) while I've had splints on and off, it's been more so since I started using the treadmill a few days a week, last fall. The treadmill isn't mine, but rather at the gym. I don't know if I can add a rubber mat under it.
I definitely will back off when I think I shouldn't run through something and have taken a few weeks off over the last 10 months (not consecutively, but whole weeks at a time) where I could cross train (swim, bike) and do more yoga. It's always welcome, to be honest.
So, I have just started just a foam roller (before this, I only used the stick, and not regularly). So, I will follow your instructions on the massage release. So if I understand correctly, I shouldn't use the roller or stick, and I should massage and cross train to let this heal up.
That said, the training programs I have used have dictated my mileage. I use Higdon schedules. What would you recommend instead?
Should I cross train my miles on the bike for the next 2 weeks, to allow my legs to heal up?
I like the bike idea (considering another purchase myself, after mine was stolen a ways back), and your general training strategy, which is the one I use. It's the best way to train for marathons, in my opinion. I've always thought of Higdon as a bit aggressive, on the other side of the spectrum from say, Galloway, which is newbie-friendly, but helpful to older guys like me.
Another note on the external rotation, if it still applies, is that it can be due to tight hip flexors, as well as tight external rotators deep to the glutes. How far back can you extend your thighs, and does it produce discomfort or lower back pain? I agree with Damien that over-pronation may have taken its toll, and you could be reaping what was a long time sowing. You may actually be on the upswing now, for all we know, as slow as it may seem. Cutting back on those miles was the best news I could have heard back, and that they are quality miles you are putting in. I am optimistic you will improve (if they find you a better treadmill lol).
Rollers and sticks in moderation, not too close to the workouts, and when the calves are soft but still warm, are acceptable maintenance for me, but I'd get into those shins and calves with some soap while in the shower (watch your step please) as I do every day. It's a great way to gauge your progress, and you may be surprised what you will find in those nooks and crannies. Avoid direct pressure on the Achilles except from the side, and keep all your gliding strokes, whether roller, stick, or by hand, in the direction of the heart to protect your veins. Think about the shoe mods; they are worth a try. Best of luck in your recovery! I've come back from much worse...
Ah, you are so super helpful! Ok, so something I am working on in my yoga practice is my hip flexors. TIGHT. No back pain whatsoever. In fact no pain in any other place in my body, which is .... noteworthy, maybe. When we do hip openers, I'm the one who needs the modifications, etc. Now, while I have core strength for say, handstands, ask me to do standing lotus and it's just not happening. I don't have any ITB pain, though. If that helps?
I actually just met with my Sports Therapist today. She said some of the same things you did (she wants me to halve my miles for 2 weeks, so down to about 15, and cross train the rest), but also suggested more supportive footwear when I'm not running. So, less flip flops, more actual shoes. She thinks the upswing in the pain is more due to weather and the tiny shoes I tend to run around in. Never heels, but always a tiny ballet flat.
As for the diet stuff - thanks for that, too. I actually follow an anti-inflammatory diet, and I don't drink coffee. I can't stand the stuff. But I'll admit I have been baking a bit more and having some ice cream here and there. The sugar probably isn't a great idea, I know. I'll monitor better and see how it goes. Thanks so much!
I hear ya about cheating on a diet. After yesterday's 12-miler I ate 3 Wendy's double-stacks with a bottle of water. That's 3/4 pounds of meat! At least I got the water right... Wasn't gonna have any sugar, then a friend offered me a piece of his father's day lemon cake.. I hadn't had a real meal since the day before, so I caved. If that weren't bad enough, today I went out to go to lunch and my tire was flat. I was trying to figure out what kind of snack I could probably stuff my face with, when somebody offered me a pint of blue bell fudge ripple ice cream. I took it.. and ate the whole thing! It must have been 100 grams of sugar in there, and a day's supply of saturated fat! (!). Well, in my defense I had a couple handfuls of fresh berries, cherries and grapes for breakfast, with an orange.. but it's not like there wasn't a boat load of fructose going down. So... those who can't do teach, I suppose. I have to confess I ate two M&M cookies that an MRI rep dropped off, just before reading this post, so I am never, ever going to run a hot 12 miler after not eating for 20 hours.. ever again! To think I was 5 pounds over when I started, and thought that run in the afternoon sun would help..
So back to your tight hip flexors, it's not unusual for an accomplished runner to have them. They may be hypertonic or they may be trigger-pointed, which is hard to solve because they are so difficult to get to. If you lay on your side so your bowels slide out of the way (mine are too full), you can reach under the center abs (rectus) just north of the belly button to check, if your obliques are relaxed enough. Sometimes a little touch helps, when a muscle is not used to feeling it. Other than that, it sounds like you are on top of things. Ditto on the skimpy shoes, by the way. They're almost as unstable as my will-power...
Dude, good on you for having man-tabolism! I will confess I have never had um, a double-stack. But sometimes I wish I could eat like a boy!
Thanks for all of your help, it's been much appreciated. No lie, 2 days of cross training and my new non-flip flop shoes (which I commuted to work in, as I walk a LOT for commuting, public transport, ya know) and I feel like I new woman. I did your shower trick this morning. Holy moly. My muscles seem much more pliable already. Gonna keep this up for a couple weeks. Hot yoga is happening tonight. I biked 15 miles this morning, so I am feeling good about that!
I suffered a couple of the same nagging problems you describe for years. I also sought advice and got so much mumbo jumbo and tried so many things I was getting discouraged. My shin splints were so bad that I actually developed micro bleeds under the skin and stil have what looks like a birthmark 4 inches long and two inches wide over my right shin. (13 years later).
After trying everything PT, sports medicine, yoga, suppliments, gait correction, orthodics, etc. had to offer guess what? The answer was so simple it defied reason....isn't that usually the truth?
Here ya go. When you run longer distances your calf muscles, which are much more dense than the muscles on the opposing side of the action (shin), develop much more quickly and become out of balance with the push and pull that all your levers do. (Imagine a tug of war between Arnold and Bill Gates) The little muscles on the front don't stand a chance and get torn. What to do? Simple, stretch. Not before your run, but after. Good, long wall pushes for a couple minutes on each side did it for me. It elongates and actually weakens the gastroc, et al, allowing the tibials to recover and strengthen at their own pace. By the way, running hills only worsens the problem since it forces the calf muscles to develop even more quickly. Solution, more stretching. Try that for about 3 months and see what you think.
Now that you've fixed your lower leg problems, guess what? Your training is now more efficient and muscles down the line (or up the line, depending on how you look at it) will start following the "out of balance" suit. The psoas is no exception. It is perhaps a bit less dense than the calf, so a good hurdlers stretch will produce results quickly...like 3-4 weeks.
I can't guarantee these will work for you, but they sure did for me. I think the biggest gain I received was a paradigm shift that taught me that stretching before exercise is for injury prevention while stretching afterward is for muscle/training balance.
What I can guarantee is that your tight calves and hip flexors will thank you.
Thank you so much for replying! Oh, the micro bleeds sound awful, I am sorry to hear that. I am glad you found something that helped.
This is nearly exactly what my ST said! She called it "explosive calf growth". She seemed generally unfazed (I've known her for years and I definitely trust her advice). She said more yoga (same reasons you mention), stretching and ice after (esp on long runs), and to try lowering my mileage for the next 2 weeks (but crosstraining my miles on the bike).
Today was the 3rd cross training day (on the bike) and I had hot yoga last night, which helped a lot. I haven't foam rollered since Monday, as I'm not sure HOW much it helps....it seemed to be more painful than anything. Like, it feels temporarily better, but the next morning I feel bruised. My husband and I have the roller with the grooves on it (well, we bought it for his hip, but I finally used it on my calves), so maybe it's too DEEP? I don't know.
Anyway, I will follow your suggestions as well! I definitely think not stretching after a run (ack) has played a big role in this. And esp if I run on the treadmill, I never stretch after. I will attest to it.
We did a lot of hip openers in yoga last night. I almost cried. More stretching is happening.
I feel better already. You guys are awesome.
Glad you are getting closer to a solution. Foam rolling? Be careful. Using a foam roller for therapeutic purposes (ridge or not) is like using a spray can to paint your nails. When you therapeutically treat tissue, deep pressure needs to be reserved for exact portions of dysfunctional tissue, otherwise you risk creating a problem that isn't already there. I think rollers are good for maintenance, but if using them hurts, your pressure needs to be more specific.
Popular videos of foam roller use show well-trained people using them wrong. They often show pressure being applied down the thigh as well as up, because it is difficult to reposition after each roll, and easier to just go back and forth. The lower limbs have special valves in the veins that restrict blood (and lymphatic) flow from moving downward, to prevent pooling of fluids in the extremities from centrifugal force when you run. These valves can be easily damaged by downward pressure against them, resulting in chronic edema and varicose veins. Roll with pressure toward the heart only.
It's interesting that you mention explosive calf muscle growth. One thing I have noted about the fastest runners (I've worked on many), is that their muscles aren't very large at all. Runners I know who accumulate excess scar tissue in their muscles from overtraining, over-racing, or over-stretching (usually all 3) tend to develop bigger calves, but this translates into lasting bulk, not lasting speed. If a muscle does outgrow its fascial compartment, the pressure can be not only painful, but dangerous. They call it compartment syndrome, which can lead to death (by internal strangulation) of muscle tissue. Repeated pressure to stretch the subcutaneous fascia, whether by roller or by hand, can be useful to stretch the fascia around healthy muscle, but the process can be painful. It's a balancing act, and very easy to take one step forward and two steps back.
They used to recommend stretching before running, but now, not so much. A cold muscle should never be stretched. One reason I do not recommend stretching (as it is usually done) right after a run is that your muscles are often doped up with natural endorphins right after training, and can't feel all the damage you may be inflicting. Same with massage. It can't be deep at this time. The safest thing to do then, is to move the muscles through their range of motion on their own power. Any pain felt then should be noted, but healthy muscles should not be used to stretch tired ones; neither should floors, ropes, or curbs be used to overpower them.
There is a point after running when stiffness begins to set in, and you begin to feel everything. The muscle is most sensitive at this time, but still warm with increased blood flow. Checking range of motion again allows you to compare notes between what hurts now and what hurt before, as well as during the run. Checking painful areas of the muscle for tightness, and tight areas of the muscle for pain (pain is often not real, but tight spots always are), helps narrow down what you should relax before proceeding with your stretch. When you stretch, you want to be stretching all fibers of the muscle equally with minimal damage. This is not possible if some of the muscle fibers are tighter than others. Sure, you can save time by just toughing it out, but who wants massive, scarred, dysfunctional calves?
Time after time, it has been shown that relaxing the tight spots in your muscles with manual pressure, followed by a gentle stretch, gives the safest and longest lasting results. Even a cave man (or hard-core after-run stretch junkie) can do it.
I suffer from Medial shin splints. I've been running for about 3 yrs and my shins never really bothered me until the last year or so. I've tried everything, stretching (pre and post run), strengthening, resistance training and an 8 week respite only to find out my shins were no better when I started running again. After my respite, I started out very slowly, only running 1-2 miles and gradually built up to 3M. It's at the 3M mark that the splints start screaming and then are so sore and painful for days after that I can't run. I've changed shoes also. Nothing seems to work. Should I just run through the pain and soreness and hope that my shins will adjust? Any advice? I'm almost frustrated enough that I think my running career may be coming to an end. But I don't know what else to do.....????
First, I don't recommend trying to run through pain more than once. I've been known to run out some soreness or kinks in a slow 10-miler, because sometimes the extra circulation is what I need. If the pain persists, though, I do not try to run through it. The extra wear and tear is obviously the problem, not the solution.
Medial shin splints can be due to multiple causes, but for most people, the front muscles tire as the rear muscles stiffen. The typical suggestion is to strengthen "weak" anterior calf muscles to fight the tight posterior muscles, and/or to stretch the rear muscles, as if that will stop them from pulling too hard on the front muscles. Neither of these approaches makes much sense in terms of muscle physiology.
Normally, when your ankle plantarflexes (toe down), the anterior Tibialis muscle and digital extensors relax. Conversely, when these anterior muscles dorsiflex (toe up) your foot, the posterior calf muscles relax. This is called the law of reciprocal inhibition, which states that the brain will only allow one side of the joint to flex at a time, relaxing the other side in order to facilitate this movement. What most people don't know about muscle physiology is that all actions performed by muscles are not under conscious control. They are not even always under unconscious control. Sometimes they control themselves in order to protect themselves from abuse. If your muscles perform this mutiny by involuntary stiffening, you are the one that needs to walk the plank, and back off your training.
Once your rear calf muscles are baked from overtraining, they are likely to remain in a stiffened state throughout much or all of the day. Any attempt of the anterior muscles to flex will tire them more quickly and result in pain and stiffening in those muscles too. Now, suppose you continue to use these muscles by stretching them or running through your pain. What happens? You've heard of muscle tearing when it is subjected to extreme force, but muscle is not the ony thing that can tear, and tearing is not the only painful thing that can happen.
Stiff rear calf muscles attach to the tibia on both sides, including along the medial border. A stiff, unyielding muscle that is continually jerked around will begin to inflame the spots along the bone where the muscle attaches. Most of this attachment is to the Periosteum, or "skin" that coats your bone. It is pinkish in color and can change to deeper colors when inflamed. This inflammation is called Periostitis, which is one form of medial shin splints. It can be called Tibial Traction Periostitis, or Medial Tibial Stress Syndrome. Sometimes it is not the Periosteum but the attachments to the Periosteum that are the problem. Sometimes the tendon sheaths, the lubrication inside, or tendons themselves are the problem (i.e: tendonitis, tenosynovitis). No matter what the result, the cause is going to be overuse of stiff, unyielding muscles.
The average person will tell you that when a muscle is tight, you simply need to stretch it like taffy, and it will stay at whatever length you wish. Umm, no. When you are dead, before rigor mortis sets in, your muscles are quite relaxed, I can assure you. When you are alive they are tight. Why is this? Usually, it is because your brain sets the tone of the muscle based on how it is used. As discussed above, the muscle often takes over on its own, in whole or in part. When you exercise or stretch against this tension, you are essentially wrestling yourself. Yes, this may tire the weakest muscle temporarily, but will not fix it. Instead, it often results in more damage, as you have seen. Why torture yourself?
Review this thread from the beginning for suggestions on how to systematically find and relax individual fibers of your muscles so they can be rehabilitated by simply moving them around. Once they are in a relaxed state and no longer in 24-hour contraction, they can begin to heal and rebuild while you sleep, which is one of the things that sleep is for. If you have the patience to complete this process, you can begin taking two steps forward for every step backward. Good luck, QRP!
Thank you James for all the detailed information, patho and great advice. I read the entire thread. Regardless of the many possible culprits causing my splints, I recognize that it will take time, trial and error, and alot of patience to find my fix. I love running and can't imagine not having it as part of my life.