[dcgm]

Hi all,

Short version: for the last five years I’ve had issues with mild to moderate medial tibial pain, most likely a bone stress injury, whenever my running volume gets above about 3 hours/week at MAF pace. What can I do?

Have tried orthotics, various different shoe gear, and building up slowly. Cadence is at least 168spm and usually closer to 180, very much an “old man shuffle” gait. BW has fluctuated between 180 and 195 at 5’11”, heavy but not excessively so. No weird dietary restrictions, no history prior to this of tibial stress injury, extensive history of strength training. Work in wildland fire, interested in recreational backcountry travel, and that’s what’s currently determining my goals. I could keep going pretty much ad infinitum so let me know if there’s anything else you need to know to help.

Topic

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on February 15, 2020 at 7:17 pm #38259

Is it on one side, or both? Interesting problem, especially when altering shoe choice and orthotic intervention hasn’t helped. I usually don’t initially recommend a running gait change unless all other avenues are exhausted, but after 5 years this might be a direction needed to create change. Maybe Alison can pipe in with some recommendations. Strength training to stress the attachments of the posterior tibialis on the tibia would also be appropriate. Doing heel raise holds for 45 sec x5 is a good place to start. Then progress to greater load, then jump landings in a heel raise position.
Pete

[dcgm]

dcgm on February 16, 2020 at 11:45 am #38270

Hey Pete, thanks for getting back to me. I’ve noticed pain on both sides but predominantly on the left, in right around the same spot on the medial tibia. By “heel raise holds” do you just mean something like this: https://www.wikihow.com/Perform-a-Heel-Raise ? I’ve done these as reps on and off, bilaterally and unilaterally at a variety of tempos, loadings, and ranges of motion. Haven’t noticed any lasting effect (and generally notice fatigue in the soleus, very little in the gastrocnemius) but haven’t been consistent with it for more than 6-10 weeks either and still have awfully skinny calves–will give isometrics a try.

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on February 17, 2020 at 8:47 am #38317

Yes, that’s basically the exercise, you can do it single leg and no need to use a step. Another strategy is to get aggressive with your hip strength, as that also controls the loads in your lower leg.
Pete