Emily Wade (Host): Welcome to Office Hours with MIT Health, where we answer your curious, confusing, and sometimes cringe-worthy health questions. I'm your host, Emily Wade, and today we're talking Shin splints with Dr. Sean Faro, our Deputy Chief Health Officer. Hey Sean, thanks for being on the show.

Shawn Ferullo, MD: How are you happy to be here?

Emily Wade (Host): Thanks. All right. Before we get started, I'm going to, remind everybody that the information in this podcast is for educational purposes only. It's not a substitute for medical advice, diagnosis, or treatment. So if you have a medical concern, consult your primary care provider or another. Qualified medical professional. All right, so I'm gonna get to today's question, which came from one of our, MIT community members.

Dear Office hours, I'm trying to get into running, but every time I try to build up mileage, my shins just freak out. I keep hearing that if you're a pronator, you're doomed to shin splints, but I don't know if that's me. Can shoes fix this problem or am I dealing with something deeper?

So Sean, This is like good timing because we just attended the, kickoff for the MIT get Fit yesterday, so I'm sure we have a lot of people out there who are trying to get into running. so maybe you can start by just kind of explaining what Shin splints are And what causes them.

Shawn Ferullo, MD: Yeah, happy to. It's a great question. Well formed. so I think the easiest way to think about shin splints is that they're, they are technically an inflammation along the lining of the shin bone, the tibia, which is on the inside of The leg, the fibular is on the outside our calf muscles and some of our muscles that help us push off while running.

Attach along that, border of the tibia. And what shin splints are is a tightness and irritation, And then a resulting inflammation of the lining of the bone, the periosteum that occurs from tension and traction and pulling of the muscles on there. So frequently not uncommonly experienced by people building into running for, the beginning, but also sometimes, overuse or other things as well.

But, that's the easiest way to think about what chin splints are.

Emily Wade (Host): So it's kind of a little bit of a way of your body kind of saying maybe you gotta take a little extra time to get from the couch to the 5K.

Shawn Ferullo, MD: Yeah, I think that's a great point, right? Oftentimes it is, muscle tightness, muscle imbalance, tightness or as you're building in, right? So oftentimes what I experience, especially in New England, is people are sometimes in shape. Cardiovascularly from going to the gym in the winter and doing biking or swimming, but then their legs aren't as in shape as their cardiovascular system.

So when you start into that running, it's almost too much for your legs all at once. And that coach to 5K or walk, run walk cycles for a truly new novice runner is really helpful to kind of. Gauge a bit of the tension and muscle strength And then a little bit of walking with blood flow, flexibility And then back and forth and gradually build up.

And so it's a really good technique for building into running for sure.

Emily Wade (Host): That's reassuring because, I, feel like I'm kind of a runner, but just sort. To chug along. I'm not that good at it. And So, it, but hard because, if you're on, it's a little snowy right now, but if you're like running on Memorial Drive and you see somebody flying past you, it's just a little hard to just not instinctively try to speed up.

So it's, good to know that it's not so embarrassing if you need to like slow down and walk a little bit, to, while you're getting used to it.

Shawn Ferullo, MD: Not at all. That's another great point, right. So, in that intro to running both speed. where, more muscle force is needed, more muscle contraction is needed to propel faster. And when we run faster, our gates, our stride gets shorter in order to increase cadence. Right? So you take more steps.

So both speed and distance or things that people should be thinking about, as you're kind of building into that running program. But no, not embarrassing at all. Shouldn't be. I think getting out there and doing things is way better than not doing things. I think another unique part of New England is we are blessed with a few great months for running weather And then it's too hot And then a few great months of running weather And then it's icy and snowy.

So even people who are avid runners often have these periods of less road running because of the climate and changes that happen.

Emily Wade (Host): So are there any, good ways to prevent. This from happening besides kind of like taking it slow maybe adhering to one of those kind of like walk run programs.

Shawn Ferullo, MD: Yeah, I think it's a great question. I think of it holistically always, right? So what are all the things our body needs to do to run, right? So I think one of them is, training program, right? Walk, run, walk cycles. Sometimes I advise people to just. If they don't wanna do that, like walk the first half a mile, run a half mile, walk the last half a mile, right.

And then gradually build in. There's an, You know, it doesn't always have to be so broken up, but, build in that way. I think, as with other things, a good flexibility program, which is not comfortable to stretch ever as a human, I think. And I think. To that point, I think one of the key features in Emily And in prevention is that oftentimes a dynamic warmup is more important than just stretching for five minutes before you run, right?

So cold static stretching evidence shows that it does not reduce injury risk, and actually it's not, it doesn't improve performance. What does is this kind of little bit of stretching and warming the muscles up, so, a little stretch, walk a bit warm up or jumping jacks or something along the lines of just getting the muscles.

And blood flowing is, I think, a really important piece of that prevention. 'cause it's not just stretch for three minutes as we were taught as kids in a circle And then just go run. so I think there's a big piece, certainly running shoes, right? So, if someone's truly building into running, making sure you do have a running shoe and not like a walking shoe or a flat sneaker That is more.

For design, then support, that sometimes will help people who pronate alone just by getting a good arch support and a running shoe. Pronation does put more pressure on the inner ankle because as we stride, the foot turns in so those muscles on the inside of the calf are holding up, which is why shin splints are more common, but it doesn't necessarily mean people can't run like some strengthening, sometimes physical therapy.

If someone pronates a fair bit as a, as a. Bootcamp strengthening program. good shoes, good supportive shoes, hamstring stretching, even like quad hip and glute strengthening because as we run all those muscles support our leg. so it's hard to give one dynamic program, but all these factors come into play.

And, to the question to us, no, a pronator is not doomed to never be a runner. but there are different techniques that can help that for sure.

Emily Wade (Host): So you, mentioned shoes and I, am a little curious, do you recommend that somebody who's maybe getting into running get fitted for shoes? Is it something where it makes sense to go to like a running store or is it something where is that overkill

Shawn Ferullo, MD: it's a great question, right? one of the, most complicated part in advising people for shoes is that shoes have become such a fashion component now, And the same companies that make running really good high quality running shoes make lower cheaper model. Similar, looking from the outside fashion forward shoes that aren't as supportive.

So there isn't, it's not easy to just say this one brand or that one brand. I think there is something you get what you pay for sort of mode. That doesn't mean you have to go out and buy the most expensive shoe. That doesn't mean it's the best shoe, but a good shoe That is well built does tend to cost more than you'll find in a.

Bargain basement store or something, unless you get really lucky and they're trying to move the product along. So I do think there's good, truthfully, in a good store that works with runners and can give honest guidance and advice is really the key. And some of the more. Mall forward stores are, younger workers that are, not as trained in fitting shoe type And that sort of stuff.

Not that that's bad, but I think a little bit of research into shoe type. I think a little bit of. Certainly there are stores around that are quite good at this, and I wouldn't call it overkill. And many of those stores or good ones aren't gonna just try to sell you the highest model, right?

They're gonna really talk to you about how much running do you do, what's your mileage, You know, right. Because that then factors into what type of shoe might be best and they'll even watch you walk and sometimes even walk on a computer as pad. All of those things to kind of fit you to the right type of shoe.

So. I don't say to people they have to go to one of those stores, but I certainly don't discourage people from trying that. cause it, is a, good way to try to get a good shoe so you don't just keep buying something and it doesn't feel right. And then you buy another thing And then you go round and round.

Emily Wade (Host): I've definitely, been guilty of that, uh, buying a bunch of different, well, You know, but they, sometimes they just look so cool, you're not thinking about like, whether it's actually good for

Shawn Ferullo, MD: Yeah. And what's interesting too is, years ago, God gonna date myself, but 20 years ago or so, right? Cross training shoes were really, really popular, right? You can do all your activities in it, but they didn't always have the best running support, right? And so, yeah, I think just thinking of all of those factors, does come into what support you get out of that shoe when you're running.

Emily Wade (Host): So this just came in my mind. have, I have a friend who's really, really a serious, serious runner. And, she's also a very serious, foam roller user.

Shawn Ferullo, MD: sure.

Emily Wade (Host): is that something that can kind of help with shin splints? I, am so incapable of using a foam roller. I just sort of like fall off of it every time I try to use one. But is that Oh yeah, they're so painful. So, is that something that, can help with the shin splint?

Shawn Ferullo, MD: Yeah, it definitely is. And the way that I describe this to patient's is, think of your muscle as a rope, right? And so our muscles can be stiff and you can have a rope that's really tight, but we also can get little spasms and knots in our muscles. And, the analogy of that would be, and it's not a perfect science analogy, is if you had that rope and there was a knot tied in it.

The more you stretch, the more you just tighten that knot. And so in some ways, if we have these areas or trigger points or spasms in our muscles, in our calfs, you can stretch, but you might actually be just tightening that knot over time. And what the foam roller, or like a rolling stick or that sort of my myofascial release is doing, is trying to untie those knots.

And then followed by stretching can actually get you much more relief. And so, foam rolling. Rolling sticks. Uh, rolling. Sticks are a little easier, than foam rolling. Do have a, place, in there. they're not mandatory, but there is definitely a component of that.

Emily Wade (Host): So, okay, we have Get Fit kicking off. The beginning of next week, although this episode will probably come out. After GetFit is started, it occurs to me. but we have a lot of people who are on these teams and they're trying to get up their mileage so that they can hit that, 300 minute mark.

And their team can win. and if they start to feel pain or, they've done everything we've recommended in this video, and, they're still kind of feeling not great when is the moment when they should give, sports medicine, maybe sports medicine at MIT Health, A call, and, see about getting treatment.

Shawn Ferullo, MD: Yeah, it's a great question. So we're always there to help and people have questions even if their symptoms are not debilitating. We're always available. I think that like when should you really seek professional guidance? I think pain That is escalating. So happening, earlier in runs or more often or, lingering, not just during the run, but for days after the run.

And that then is affecting the next run. Certainly any pain or discomfort even That is lingering into walking, right? Or anything That is sore enough that you're limping. we always want to think about stress fractures as a, another potential source of bony pain in the legs. but I think certainly persistence, frustration if you feel like you're doing all the right stuff, but it's still not getting better, even if they're not horrible.

And then certainly like escalating discomfort where a little bit of rest or a little bit of, training break isn't actually helping it or it is coming right back. For sure. And then of course, any swelling or bruising, like any odd symptoms that are different than that for sure.

Emily Wade (Host): Okay. So I hope you all paid attention to that. don't just, smile through the pain. Give us a call if you need us. so, to recap, seems like, these chin splints are kind of come down to. Trying to get started, with a program too quickly or having tight muscles or tired shoes and, making sure that you're kind of thinking about dynamic stretching and using appropriate supports and using those good shoes is gonna really kind of help you along.

Does that sound good?

Shawn Ferullo, MD: yeah. And I think, you there's a little bit of, muscle soreness from building into any new exercise routine. And so, Fitting in that, stretching that, maybe rolling stick, as part of that routine, is important. But that sounds exactly right.

Emily Wade (Host): Excellent. Well, thank you so much, Sean, for being here and being on our very first episode of Office Hours. I hope we have you back again. I have a feeling we will, so that's the end of the episode. and if you have a question for our clinicians, head on over to our website@health.mit edu slash thrive.

That's at THR Ive, and, you can find the web form so that you can submit your very own question. Thanks so much for tuning in. See you next time.