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5012 Views 17 Replies Latest reply: Jun 27, 2011 2:19 PM by training4hours RSS 1 2 Previous Next
nicolefrances Amateur 15 posts since
May 11, 2007
Currently Being Moderated

Jun 16, 2011 8:19 AM

Distance runner, shin splints issue. Any help?

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!

  • Damien Howell Legend 308 posts since
    Feb 27, 2008

    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

  • Revel in Running Amateur 8 posts since
    Dec 14, 2007
    Currently Being Moderated
    2. Jun 16, 2011 12:32 PM (in response to nicolefrances)
    Re: Distance runner, shin splints issue. Any help?

    Try these sleeves, they are ideal for Shin Splint relief to be worn during activity and/or recovery http://t.co/pYi6KhU

  • JamesJohnsonLMT Legend 1,129 posts since
    Aug 23, 2009

    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

  • JamesJohnsonLMT Legend 1,129 posts since
    Aug 23, 2009
    Currently Being Moderated
    5. Jun 20, 2011 11:10 AM (in response to nicolefrances)
    Re: Distance runner, shin splints issue. Any help?

    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...

     

    http://www.getbodysmart.com/ap/muscularsystem/footmuscles/menu/menu.html

  • JamesJohnsonLMT Legend 1,129 posts since
    Aug 23, 2009

    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...

  • MtnDad Rookie 4 posts since
    Oct 6, 2008

    Hi Nicole,

     

    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).

     

    IMG_3802.JPG

     

    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.

    http://www.youtube.com/watch?v=ijDeABRuJlU

     

    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. 

  • JamesJohnsonLMT Legend 1,129 posts since
    Aug 23, 2009

    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.

  • QRP Rookie 7 posts since
    Sep 8, 2009
    Currently Being Moderated
    12. Jun 23, 2011 11:48 AM (in response to nicolefrances)
    Re: Distance runner, shin splints issue. Any help?

    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.....????

  • JamesJohnsonLMT Legend 1,129 posts since
    Aug 23, 2009
    Currently Being Moderated
    13. Jun 23, 2011 1:33 PM (in response to QRP)
    Re: Distance runner, shin splints issue. Any help?

    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!

  • QRP Rookie 7 posts since
    Sep 8, 2009

    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.

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