Welcome to Part II of our getting “Ready to Run” guide! We addressed the mighty Quadriceps muscle of the thigh in our last issue. Now it’s time to turn our attention to the lower leg and learn about a muscle that causes three major performance and pain issues for runners of all ages: Shin Splints, Foot Slap, and Foot Drop. The culprit is named Tibialis Anterior, and it’s a good idea to make sure this important muscle is functioning properly to reduce risk of injury and increase performance during your running season!
Anterior Shin Splints
Trigger points in the Tibialis Anterior cause referred pain down the front of the shin, the top of the ankle, and into the great toe as shown here1. However, the pain that might cause the most problems while running is commonly known as anterior shin splints. Anterior shin splints are caused by repetitive injury to the muscle fibers that connect to the shin bone from the knee down to the ankle. Trigger points can cause the Tibialis Anterior to be weaker than normal, which puts extra stress on these connective muscle fibers when we run or jog, causing significant pain and injury along the shin bone. (Please note that pain along the front of the shin can also indicate a serious condition, called Anterior Compartment Syndrome, especially when the pain is accompanied by swelling, pallor, numbness, loss of pulse, or paralysis. Please have a qualified professional evaluate your leg if you are experiencing any of these symptoms.)
The Tibialis Anterior is the most important muscle that controls the speed at which the ball of the foot hits the ground when running. A weak Tibialis Anterior (due to trigger points, for instance) will cause the foot to slap down onto the ground quickly after the heel strikes. You might have heard this slapping sound when someone was running and wondered what was causing it. Foot Slap can cause excess shock to the feet, ankles, knees and on up. It can also reduce performance, including speed and distance of running.
The Tibialis Anterior is a primary muscle that dorsiflexes the ankle, which means pulling the foot upward toward the knee. Dorsiflexion is important when running because it allows the foot and toes to clear the ground when swinging the leg forward. When trigger points cause the Tibialis Anterior to be weak, the foot has trouble staying dorsiflexed when the leg swings forward. The foot and toes will then tend to drop, sometimes hitting the ground and causing the runner to trip or stumble (Note: Severe foot drop may be caused by nerve damage rather than trigger points and should be evaluated by a medical professional).
Fortunately, trigger points in the Tibialis Anterior can be evaluated and treated to optimize performance and reduce risk of injury. Perform the following tests and self-care tips to identify and correct possible trigger points and enjoy a safer, stronger running season!
*The information in this article is not intended to diagnose or treat any medical condition and does not substitute for a thorough evaluation by a medical professional. Please consult your physician to determine whether these self-care tips are appropriate for you.
Quick Self-Tests to Tell if You have Trigger Points in Your Tibialis Anterior:
Follow the instructions below to test whether you have myofascial trigger points in the “Shin Splint, Foot Slap, Foot Drop” muscle.
Test 1: Tibialis Anterior Stretch Test
While standing or sitting in a chair, bring your leg back behind you and place the top of the great toe on the floor, as shown. Leaving the toe in the same spot, bring the knee forward as far as possible, stretching the top of your foot and ankle. A Passing result is when the ankle can flex backward 40 degrees or more, which you can eyeball by checking if your foot and shin are approximately in line with one another, as shown by the red line in the drawing above. A Failing result occurs when the ankle cannot stretch far enough to form a straight line with the shin.
TEST 2: Heel Down Squat
Stand with your feet shoulder-width apart and your feet pointing forward. Squat down as low as you can go without lifting your heels off the ground. A Passing result is if you can squat all the way down without raising your heels. A Failing result is when your heels lift off the ground before you attain a full squat (as shown in the pictures below) or you cannot attain a full squat. This test indicates difficulty with the Tibialis Anterior due to tight antagonistic muscles of the calf (namely the Soleus muscle).
Test 3: Palpation
As always, the best assessment of trigger points and myofascial dysfunction in a muscle is to examine it with our own hands. Feel and press into the muscle tissue in the front of the lower leg and along the shin, covering the entire Anterior Tibialis. Check for tender spots and taut bands of muscle tissue, indicating that you have trigger points in these areas. This is also a nice form of warm up before performing the self-care steps.
3-Step Simple Self-Care Remedies
Here are simple self-care remedies for treating myofascial trigger points in your Tibialis Anterior. Repeat 2-3 times per day, especially before running.
Step 1: Warming Up with Moist Heat
The taut bands of muscle (trigger points) in your Lower leg that you will be treating may appreciate some moist heat to soften them up. Soaking in a tub of warm water for 5-10 minutes or during a shower works very well. You can also lay a Fomentek Bag on top of your shin and underneath your calf.
Step 2: Compression
To compress trigger points in the Tibialis Anterior, position yourself and your self-care tool as shown.Using your hands in the same way as you palpated earlier can be a good warm up and starting point to compress the trigger points in your Tibialis Anterior. Then add the Jacknobber for better compression and focus, as shown. Compression allows the taut band to loosen and blood flow to increase when you release the compression. Another method is to roll on top of a foam roller, as illustrated. When you find a tender point, press into it with enough pressure to feel the tenderness but not cause you to withdraw from the pain. Hold for 10 seconds while completing at least two full breaths in and out. Continue searching for more tender areas until you have covered the entire Tibialis Anterior.
It is also important to address the tight calf muscles that are antagonists to the Tibialis Anterior. Use a Tiger Tail and roll over the back and sides of the calf. When you find a tender spot, press into the muscle to pain tolerance (“good pain” – not pain that is sharp or makes you want to withdraw). Hold for 10 seconds while completing at least two full breaths in and out. Then continue searching for more tender spots until the entire Tibialis Anterior muscle is covered.
Step 3: Range of Motion Exercise / Foot Pedal
To take your calf muscles and Tibialis Anterior through its full range of motion, alternate rolling the foot back and forth, flexing the toes back as far as you can (dorsiflexion) and then pressing the toes back down and lifting the heel off the floor as far as possible. Do the same on the other foot but opposite timing so that one heel is up while the other heel is down. Repeat 30 repetitions per foot after finishing your self-care compression. Perpetuating Factors: Sometimes, regardless of how much treatment and self-care we administer, problems in the lower leg simply will not stay recovered unless we address underlying perpetuating factors of myofascial pain and dysfunction. The major perpetuating factor for the Tibialis Anterior is Morton’s Foot syndrome, an incredibly common foot condition that cause a surprising amount of pain and problems for us.
Other perpetuating factors causing trigger points in the Tibialis Anterior might include:
- Stiff soled shoes – Please make sure your footwear is flexible.
- Walking or running on rough ground – Try smooth surfaces instead.
- Driving with a high gas pedal for prolonged periods – Use cruise control or place a folded towel under your heel to reduce the amount of dorsiflexion you have to maintain in your ankle.
- Sleeping with ankle and foot flexed downward – Use a pillow or headboard to prop the toes and foot up so the foot is in a more neutral position. Sleeping on your stomach will especially cause the foot to be forced into a prolonged downward flexed position and should be avoided!
Enjoy your running season!
1 Diagram from Travell and Simon’s Myofascial Pain and Dysfunction: The Trigger Point Manual – Volume 2, page 356