By: Christina Ramirez DPT, CKTP
We are about five weeks away from the New York City Marathon which means running longer distances than most runners are used to running. I had an on-again, off-again running routine of about 15-20 miles per week leading up to training for the marathon. I have also run numerous half marathons, two on back-to-back days, but I have never run consistently more than fourteen miles before I started training for the NYC marathon. One unfailing source of pain I have encountered while training is my over-used anterior compartment muscles of my leg (my shin). Starting during my first 8 mile run of my training program, I noticed pain in my shin that was made worse c pulling foot towards my shin (dorsiflexion) and pulling my toes towards my nose (toe extension). I hypothesized I was experiencing was an anterior tibialis strain.
The anterior tibialis is a muscle that originates on the lateral-proximal (outside-top) portion of the tibia (shin bone). The anterior tibialis inserts or ends as a muscle belly as it crosses medially (on the inside) over the ankle joint, and then becomes a tendon that insert/end on the first cuneiform and metatarsal (long bone in first toe). The purpose of the anterior tibialis muscle is to dorsiflex (bring up) your foot while walking or running to prevent tripping over your own foot, and eccentrically (controlling) lowering the foot back to the ground with walking and running to prevent foot drop or slap (uncontrolled lowering of foot back to the ground). The anterior tibialis can be strained with overuse usually caused by walking or running a longer distance.
As I said, I had moderate pain with dorsiflexing my foot after my first 8 mile training run and was concerned I had strained my anterior tibialis. Some of my favorite pain relieving treatments for anterior tibialis pain are stretching, massage, icing, and taping. I performed an anterior tibialis stretch by pointing my foot down, curling my toes under and shifting my weight onto my foot to perform the exact opposite motion as the anterior tibialis’ purpose. I held this stretch for 30-90 sec and repeated three times.
Next, I performed a self-massage where I ran parallel along the fibers of the anterior tibialis from the proximal-lateral tibia (top-outside shin bone) to the distal-medial tibia (bottom-inside shin bone). Any regions I found to be particularly painful, I would go over slower than non-painful regions. If I ever felt radicular symptoms (numbness, tingling, shooting, sharp pain) over one particular spot, I would hold my pressure over that spot for 1-2 minutes until the symptoms lessened or went completely away. A more advanced way to get deeper into the tissue while massaging would include moving the foot from dorsiflexion (toes up) to plantarflexion (toes pointing down) while moving from top to bottom or bottom to top of the muscle.
Icing is always a good treatment for any type of injury for the first 48 hours which is why I tried icing my anterior tibialis as another form of treatment. The usual acronym that is referred to my many health care providers is R.I.C.E.: Rest. Ice. Compression. Elevation. If you have an ACE wrap, you can layer a towel over your tibia (shin), then an ice pack, and finally use the wrap to snuggly keep the ice pack on your tibia for 10 minutes at a time while keeping your leg rested above your heart level.
The final treatment I tried at home, was taping my anterior tibialis. As I said before, I had pain with active dorsiflexion (moving my toes towards my nose), so I wanted to rest my muscle my inhibiting it using kinesio tape. I am a Certified Kinesio Taping Provider (CKTP), so I already knew a few methods to taping my anterior tibialis for rest. I tried the simplest method for this injury, and have attached a video with step by step visual and verbal instructions for how to do this yourself at home. A good way to test if the tape helped or not, is to actively pull your toes towards your nose before and then after the taping and see if your pain changed.
Although there is much conflicting evidence about the true benefits of kinesio tape, I find clinically it has a significantly positive impact on myself and my patients. As an article written by Matt Philips on Runners Connect (2015) stated “Many of you would be surprised to hear that much of the therapy used to treat injury is not backed by any quality research- ice, heat, massage, ibuprofen are some of the more common ones.” Another article that supports the use of kinesio tape for runners is IK et al (2015) where it was found that kinesio taping the rectus femoris, vastus lateralis, and vastus medialis helped restore muscle power in fatigued muscles as seen with digital manual muscle testing and single leg hop distance measured after the tape was applied following fatigue inducement protocol. Lastly, Bae et al (2014) discovered that kinesio taping application had an objective and subjective positive impact on reducing DOMS (delayed onset muscle soreness) in healthy subjects after a DOMS inducing exercise protocol.
Having any injury as a runner can lead to compensations using other muscles or can cause you to stand, walk, or run in an abnormal pattern which can lead to further injuries. This is why it is so important to address injuries as quickly as possible with home treatments or scheduling an appointment to see an expert. Remember to exercise in safe and healthy ways and if you can’t treat it yourself, go see a physical therapist!