What to Do About "Shin Splints"

“Pain insists upon being attended to.” - C.S. Lewis

            “Shin splints” are a common complaint among all different kinds of dancers that can lead to other complications like fractures, if not properly treated.

            The real name for “shin splints” is tibial stress syndrome and occurs when the muscles of the lower leg become swollen and irritated and stress and irritate the periosteum of the tibia.  The periosteum is a sheath that encases bone and has many nerve endings.  As the muscles pull on the periosteum, microscopic tearing occurs, and the nerve endings signal the brain that something is wrong, and we feel pain.

            Those experiencing tibial stress syndrome, will complain of a dull aching pain in the lower leg along the side of the tibia, or shin bone.  This condition most commonly occurs in the tibialis anterior muscle but can also occur in the tibialis posterior, the flexor digitorum longus or the peroneal muscles. (Fitt, 1988).  It is a chronic condition, meaning that it develops slowly over a period of time and then lingers.  Unlike an acute injury, like a fracture of sprain that occurs in an instant and then heals, this condition dissipates slowly and can recur over and over again.

            Tibial stress syndrome is classified as an overuse injury that can be caused by a sudden increase in training or bouts of excessive jumping, but can also be caused by other factors like dancing on a hard surface such as concrete, improper foot alignment which can lead to feet rolling inward when landing from jumps, improper weight distribution in the feet, or muscular imbalances in the lower leg.

            The treatment for tibial stress syndrome involves rest and a break from all jumping.  Ice will help decrease the inflammation of the muscles and the periosteum and will alleviate the pain as will taking an anti-inflammatory.  Gentle stretching can also help.  The muscles along the front of the shin can be stretched by pushing forward on the arches while either standing or kneeling, and the calf muscles can be stretched in exercises described in last week’s post about tight calf muscles.

            Although rest, ice, anti-inflammatories and stretching will alleviate the symptoms, it is important that the dancer determine the cause of tibial stress syndrome to prevent it from constantly recurring.  A physical therapist who is well versed in dance medicine will be able to do a screening to determine if the condition is being caused by muscular imbalances and/or misalignments that can be corrected through strengthening and stretching exercises.

            It is important that dancers do not ignore the pain and continue to dance, in spite of having “shin splints”, because of the additional damage that can be done.  Paying attention to the body’s signals and seeking treatment immediately will shorten the recovery period and keep the dancer healthy.

                                                                                                             

Fitt, S. (1988) Dance Kinesiology.  New York, NY: Schirmer Books.

Do I Really Need to Put My Heels Down When I Jump?

            The dance, just as the performance of the actor, is kinesthetic art, art of the muscle sense." - Rudolf Arnheim


          A pointed foot, a high relevé, a fully stretched foot in a jump – these are all sought after in dance.  Whether dancers study ballet and are constantly on their toes, study tap and dance on the balls of their feet, study Irish dance and are always in a relevé, or study modern and jazz and are stretching their feet in jumps, they demand a lot from their calf muscles.

            There are two calf muscles that are responsible for plantar flexion – what dancers call pointing their feet – the gastrocnemius and the soleus.  Each time a dancer relevés, points his or her feet, or stretches the foot in a jump, these muscles contract to make the action happen.

            The gastrocnemius is the bulging muscle that we see at the back of every dancer’s calf.  This muscle attaches to the femur, or the thighbone, crosses behind the knee, and connects to the calcaneus, or heel bone, via the Achilles tendon.  Its jobs are to flex, or bend, the knee and plantar flex the ankle.  The gastrocnemius is responsible for the movement required in walking, jumping, pointing the foot, and performing a relevé, and is strongly relied upon in fast moving exercises.

            The soleus is located underneath the gastrocnemius, closer to the bones of the lower leg, the tibia and fibula.  It is attached to these two bones near the knee joint, runs the length of the calf, and also connects to the calcaneus by way of the Achilles tendon.  The soleus is a stabilizing muscle that is responsible for maintaining proper alignment at the ankle joint.  This muscle is the one that holds the foot in relevé or in a pointed position.  The soleus is used extensively in adagio exercises or any movements that require held balances.

            Since these muscles are constantly worked, they grow stronger, and if they are not stretched, tighter.  Tight calf muscles create a muscular imbalance in the body that can lead to other issues.  The tighter the calf muscles are, the stronger the pull on the Achilles tendon.  An irritated Achilles tendon becomes inflamed and develops tendonitis. 

           

  A strained Achilles tendon exerts a strong pull on the calcaneus, which causes the bone in front of it, the talus, to tilt.  As the talus tilts, the joint between the talus and the navicular bone becomes misaligned and causes the foot to pronate, or roll inward.

            

             When tight calf muscles pull upward on the heel, the body weight is shifted forward over the ball of the foot.  To compensate for this weight shift, the curve in the lumbar spine increased to help maintain an upright posture.  This increase curve, however, results in lower back strain and causes pain.

            Although this muscular imbalance is a common one in dance, it is not unavoidable.  Dancers can work on maintaining flexibility in the calf muscles without sacrificing strength.  Being sure to keep the heels on the floor during demi-pliés stretches the calf as does making sure the heels connect with the floor after all relevés and jumps.

                                           Additionally, regularly stretching the calf muscles is a good idea for dancers.  The yoga position downward  dog is an excellent exercise for lengthening the calf as is lying on the back, extending a leg upward, and using a theraband around the foot to pull it into a flexed position.  A standing lunge will also stretch the calf.

All of these exercises should be done with a straight leg to stretch the gastrocnemius and repeated with a bent knee to stretch the soleus.  

These stretches should all be done in parallel positions to be sure that all the muscle fibers are stretched equally. 

            By simply being sure to keep the heels on the floor whenever possible, landing on the entire foot after jumps, and adding a few stretches to their routines, dancers can avoid the problems that tight calf muscles can create.