[NandaDevi]

I experienced a bit of a problem with the step ups over the last couple of max strength workouts. I have been doing them with ~62 lbs added weight. At the second such workout (no issues during the first one with the same weight), I started experiencing some shin pain on my left leg when I put that leg on the box and use it to step up. The pain was worse at the third workout with the same weight and I could not step up (I use an 18’ step). My right leg was fine.
I decided to use a lower step (12”), and I could use the exercise that way. I’m guessing I could probably use a 14” step too. The heel touch when the weight was on my left foot was also slighly awkward (I could feel some strain on my shins), but it was doable. I should say that this is not completely unprecedented – when I was training a couple of years ago and doing box step ups with a heavy pack I did experience some shin pain in one my legs. At the time, I decided to focus on other exercises to avoid any possible injury. I’m wondering what to do now. I could probably even increase the weight for my right leg, which feels fine. Should I use a shorter step for my left leg, or reduce the weight and use the same step height? Or should I just avoid doing the exercise with the weight on my left leg for a week or so? Also, the sensation seems to be specific to the box step and (less so) to the heel touch. I mean, I have not seen any issues while running. Any advice? Thanks!

Topic

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on February 25, 2019 at 1:12 pm #16993

Interesting response to step ups! Great job doing your single leg strengthening as this is an important component of any outdoor sport plan. I’ll assume here that you aren’t getting a ‘shin splints’ response to running that is showing up in your step ups. Shin strain during a fixed closed chain movement can occur due to your unique structure. We see this in squats and deadlifts as well. The relative length of your tibia compared to your femur affects the angle of the ankle/knee/hip during the step up. This can really load the anterior lower leg causing your shin to wig out.

Try observing how far your knee moves over the ankle during the movement. It might help to treat it more as a hip hinge movement causing a more vertical shin as you step up. For you, there might be a sweet spot between doing the movement as a squat vs deadlift (hip hinge). We would love to have it replicate steep uphill hiking with weight for best carry over, but keeping your pain under control is most important. You should be able to tell a difference as you explore the different positions if this is a helpful modification.

Pete

[NandaDevi]

NandaDevi on February 28, 2019 at 1:28 am #17099

Hi Pete,

Thanks for the response! I did 2 workouts over the weekend with a total of ~ 5 hours with running/hiking on hilly terrain just after the Friday max strength workout and I did not notice any shin discomfort. My next max strength workout is scheduled for Friday, so I will try again and vary the angles and experiment a bit. I was trying today without weights and I could feel my shin on the left leg (though no pain). My hip is at about a right angle to my shin before the movement and I move my knees in the direction of my toes as I step up.
I have not felt this way while actually carrying a heavy pack on hilly terrain, for what it is worth.
At the gym I usually use, I discovered a device that I was told could be used to strength the shins (photo attached). You can put weights on either side and you sit with your feet locked and sort of do ‘curls’ (you push down with your heels, raising the front part). I tried a few of these and found it is working my leg above the ankle, but I’m not sure what muscles (if at all) it is working. Have you seen something like this and is it worthwhile using?

Thanks!
Shyam

[NandaDevi]

NandaDevi on February 28, 2019 at 1:36 am #17100

here is the photo of the apparatus again.

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[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on February 28, 2019 at 3:32 pm #17157

Cool machine but I don’t think it’s a weakness issue. When you explore different positions for the step up, try making the hip angle greater to start with, and actively power through the hip into extension as you stand up. This will get greater contribution for the movement from the hip, taking some load off the front of the leg (quad/shin). Post a pic of your start position on the step, and that will show your relative femur/tibia lengths. Having shin pain is just unacceptable!! We gotta figure this out.
Pete

[NandaDevi]

NandaDevi on March 2, 2019 at 11:32 am #17301

Hi Pete,

I think that worked! I was able to do a step up with the full weight by starting further back from the box (i.e. large angle at the knee). A video of each leg at

Now, I only have the shin pain when I do the heel touch with my right foot (i.e. putting my weight on the left leg while going straight down and up). Is there a possible fix for this (side step)? Again, the right leg is fine and I can probably go higher in weight there.

Thanks again!!
Cheers,
S

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on March 3, 2019 at 1:13 pm #17332

Great to hear about your improvement! Now that you have a way of doing step ups, start moving your back foot in closer to the box ~1-2inches a week to begin approximating what you are doing on your non-painful side. This will help you build strength in the movement gradually. For the heel touch exercise, try loading your stance foot at the heel as you lower down, don’t let the weight shift to the ball of the foot.
Cheers,
Pete

[NandaDevi]

NandaDevi on March 6, 2019 at 1:34 pm #17649

Thanks, Pete.

I think with the heel touch I will have to find the right weight. I can do 28 lbs for the right leg without problem, but with similar weight for the left leg, my right leg lands with a thud and all the weight gets on the ball of my left foot and consequently shin pain. With no weight it seems ok. I’ll just have to experiment a bit and slowly progress.

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on March 7, 2019 at 8:11 pm #17757

I recommend using a weight you can successfully do with your left leg to accommodate for the strength differential. Don’t worry that you can do more with the right. The most important thing is to correct the strength imbalance on the left. Make sure you keep a strength focus with the step down, if balance is an issue, use a ski pole to stabilize the movement. 4 sets of 8-10 to start,then 5×5 with appropriate load for strength.
Pete

[NandaDevi]

NandaDevi on March 31, 2019 at 9:22 pm #19639

Hi Pete,

I am now at the point where I can do the heel touches with weights while balanced on the left leg. I think what seemed to make a big difference is doing a few warm up sets without added weight, and also using mountaineering boots instead of sneakers (which I was using earlier). The additional support seems to help. Thanks again for the help!!