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. Shawn Ferullo, our Deputy Chief Health Officer. Hey, Shawn, thanks for being on the show.

Shawn Ferullo, MD: Hi, Emily. How are you? Happy to be here.

Host: Thanks. All right. Before we get started, I'm going to just 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 going to 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 Shawn, 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 technically an inflammation along the lining of the shin bone, the tibia, which is on the inside of the leg; the fibula 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, you know, overuse or other things as well. But that's the easiest way to think about what shin splints are.

Host: So, it's kind of a little bit of a way of your body kind of saying maybe you got to 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 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, you know, 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 Couch 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.

Host: That's reassuring, because I feel like I'm kind of a runner. But I just sort of chug along. I'm not that good at it. But, you know, it's hard because it's a little snowy right now, but if you're 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 while you're getting used to it.

Shawn Ferullo, MD: Not at all. That's another great point, right? So, you know, 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 gaits, our stride gets shorter in order to increase cadence, right? So, take more steps. So, both speed and distance are things that people should be thinking about as you're kind of building into that running program. But no, not embarrassing at all. It 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.

Host: So, are there any kind of good ways to sort of prevent this from happening, you know, 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, you know, 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, if they don't want to do that, like walk the first half a mile, run a half a mile, walk the last half a mile, right? And then, gradually build in. 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 to that point, I think one of the key features, Emily, 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 doesn't improve performance. What does is this kind of little bit of stretching and warming the muscles up. So, you know, 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, because it's not to 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, you know, 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 than 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 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 can help that for sure.

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 that overkill?

Shawn Ferullo, MD: It's a great question, right? I think 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, it's not easy to just say this one brand or that one brand. You know, I think there is something in you get what you pay for sort of mode. But 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, truthfully, 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, you know, 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. Certainly, there are stores around that are quite good at this. And I wouldn't call it overkill. And many of those stores are good ones, aren't going to just try to sell you the highest model, right? They're going to 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 computerizeed 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. 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.

Host: Oh yeah, I've definitely been guilty of that, buying a bunch of different-- well, you know--

Shawn Ferullo, MD: We all have.

Host: Sometimes they just look so cool. You know, you're not thinking about, like, whether it's actually good for the activity.

Shawn Ferullo, MD: And what's interesting too is, you know, years ago-- God, I'm going to 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, I think just thinking of all of those factors does come into what support you get out of that shoe when you're running.

Host: So, this just kind of came in my mind. I have a friend who's really, really a serious, serious runner, and she's also a very serious foam roller user. And 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 every time I try to use one.

Shawn Ferullo, MD: And they hurt.

Host: Oh yeah, they're so painful. So, is that something that can help with the shin splints?

Shawn Ferullo, MD: Yeah, it definitely is. And, you know, I think the way that I describe this to patients 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 and our calves, you know, 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 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-- 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.

Host: So, okay. We have Get Fit kicking off beginning of next week. And although this episode will probably come out after Get Fit is started, it occurs to me. So, we have a lot of people who are on these teams and they're trying to get up their mileage so that they hit that 300-minute mark, and, you know, 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 some treatment.

Shawn Ferullo, MD: 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, like, when should you really seek professional guidance? You know, I think pain that is escalating. So, happening earlier in runs or more often or lingering, you know, not just during the run, but for days after the run 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 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's coming right back, for sure. And then, of course, any swelling or bruising, like any odd symptoms that are different than that for sure.

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, it seems like, you know, these shin splints are kind of come down to trying to get started with a program too quickly or having tight muscles, tired shoes and making sure that you're kind of thinking about dynamic stretching and using appropriate supports and using those good shoes is going to really kind of help you along. Does that sound good?

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

Host: Excellent. Well, thank you so much, Shawn, 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. And so, that's it, that's the end of the episode. And if you have a question for our clinicians, head on over to our website at health.mit.edu/thrive. That's T-H-R-I-V-E. 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.

Shawn Ferullo, MD: Thank you, Emily.