Injury Prevention

Lower leg injuries - how to stay trouble free

Dick Travisano PhD explains how to avoid lower leg injuries.

All impact sports play havoc with the shins, calves and ankles. For instance, over 40 per cent of all running injuries occur there, and the list of possible maladies is like a menu of pain from which athletes make frequent selections. Tendinitis and muscle soreness are the starters, while the heavy-hitting main courses that can keep you on the sidelines for weeks and months are compartment syndromes, shin splints and stress fractures. But it does not have to be like that! Research shows exactly how the muscles in the ankle and lower part of the leg function during running, and provides clues about how to keep the areas between your knees and your feet injury free.

We'll show you what to do

In an investigation carried out at the Centinela Hospital Biomechanics Laboratory in lnglewood, California, 15 competitive and recreational runners ran at different speeds while their lower leg muscles were hooked up to a device which measured muscle activity. Five important muscles were studied, including three calf muscles (the gastroenemius, soleus, and tibialis posterior), one shin muscle (the tibialis anterior), and a unique muscle---the peroneus brevis-which runs down the lateral side of the lower leg to the outside of the foot.

Three important facts emerged from the Centinela study:

The calf muscles contract most powerfully during the "stance phase" of running when the feet are in contact with the ground. Contrary to popular belief, the three calf muscles do not provide much power for push off but instead prevent the ankle joint from collapsing forward when the foot hits the ground
Although the calf muscles are busy while the feet are on the ground, they're pretty lethargic during the rest of the gait cycle when the feet are off the ground, moving backwards or forwards. In fact, the most active lower leg muscle is actually the tibialis anterior, a strip of sinew which runs down the shin to the inside edge of the foot and pulls the foot inward and upward. During running, the tibialis anterior contracts forcefully about twice as often as any of the other four muscles, so it is probably the muscle most prone to fatigue. As it becomes tired, the risk of shin splints and stress fractures is likely to rise, as does the amount of pronation occurring at the ankle joint (excessive pronation has been linked to a variety of running problems, including knee injuries). Thus, it is critical for athletes to make their tibialis anterior muscles as strong and fatigue proof as possible
The peroneus brevis muscle contracts fairly lazily during medium and slow speed running but dramatically increases its activity at race speeds. Strengthening the peroneus brevis should improve foot speed and stabilize the ankle during high velocity running, lowering the risk of injury.

So how do you add steel to your calves, strengthen your tibialis anterior muscles and prop up each peroneus brevis? It's easy, with the following drills, which should be carried out on a track, basketball court, aerobics floor or grassy surface, but not on concrete. Before you actually start the drills, walk or jog for ten minutes to warm up. Then begin jumping in place, keeping your weight on the balls of your feet and avoiding actual contact between your heels and the ground. Complete about 30 "hops" not too fast and not too slow. Pretend you're jumping on a warm stove and get off the floor before your feet have a chance to warm up too much.

Lightning hopping

After a moment's rest, pretend the stove is now red hot and jump quickly, making the contact between your feet and the ground as brief as possible. Complete about 40 super fast jumps in about 8 to 12 seconds, just barely getting your feet off the ground and avoiding heel contact. After 30 seconds rest, complete this "hop and lightning hop" routine once more, and further strengthen your calves by walking quickly forward on your toes for 20 metres. Then point your feet outward at about a 45-degree angle ("duck walking") and stride along on your toes for 20 more metres. Finally, angle your toes inward ("pigeon toed" walking) and walk on your toes for a further 20 metres. For these manoeuvres, always make sure your hips are rotated outward or inward so your knees are lined up with the spaces between the big and second toes.

Walk, skip and jog

After these three types of fast walks, skip on your toes using all three techniques. 20 metres with feet straight ahead, 20 metres with toes out and 20 metres with toes slanted in. Finally, jog on your toes at a moderate pace using the three methods, for about the same distance. After a minute's rest, complete this walk-skip-jog protocol one more time. Over a period of several weeks, gradually increase the amount of hopping, walking, skipping and jogging that you do. Begin by doing the exercises twice a week, gradually advancing to four or five times a week. After several weeks, try doing the warm and hot stove hops on only one leg at a time, and cut the repetitions in half. Instead of carrying out 40 super fast jumps using both feet, for example, hop 20 times on your right foot and 20 times on your left.

Backs to the wall

But what about your poor tibialis anterior muscles, the ones that work hardest during running? Strengthen them by carrying out the following five exercises:

Stand about a foot away from a wall with your back to it and your feet directly below your hips. Lean backward until your buttocks and back touch the wall and then, while keeping your heels on the ground, flex your ankles so that your toes rise as high as possible towards your shins. Let your feet sink back so that they almost touch the ground, and repeat this action 15-20 times (the reps increase over time). On the descent, do not let your feet actually rest on the ground, which would give your tibialis anterior muscles too much of a rest between flexion's. Treat the ground as if it was an eggshell, too much pressure would crack it
After a moment's rest, try a slightly different tibialis-anterior exercise. This time, from the same basic body position, flex your ankles so that your toes ascend as high as possible, but do not let them move more than an inch towards the floor on the downswing. Quickly move your feet up and down within this one-inch arc for 15-20 repetitions (adding more reps later), and then rest for a moment
Once you've become adept at the first two exercises over a period of several weeks, you can move on to an advanced exercise. For this, keep your back and buttocks against the wall again but stand on only one foot at a time while carrying out No. 1 above. Position the foot slightly to the inside of the hip
You can also work on the anterior tibialis muscles while jumping. Again, try for quickness rather than height as you jump, but this time "dorsiflex" your ankles each time your feet leave the ground (i.e. try to pull your toes up to your shins on each ascent). 20 jumps should be about right for your first effort, with the total increasing over time
A fifth exercise is to walk on your heels for 20 metres or so. This heel walking can follow the walking, skipping and jogging routine described above.

Overall, these five exercises have helped many athletes afflicted with shin splints. Another strategy, designed to simultaneously strengthen all five calf and shin muscles, is to run barefoot on a somewhat uneven but soft grassy surface, such as a well-maintained athletic field or a golf fairway. Start cautiously, though, with no more than a half-mile on your first barefoot effort, adding an extra quarter mile during each subsequent run. The ultimate aim of these exercises is to fortify your feet, ankles, shins and calves so that injuries are unlikely. However, injury prevention won't be the only outcome. As you progress, your ankles become as powerful as rocket boosters and your feet will act as mini-trampolines. When you run, each foot strike will involve a sudden explosion of propulsive force, not a sad collapse of your foot against the ground.

Associated Pages

The following Sports Coach pages should be read in conjunction with this page: