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Prevention & Treatment for Cramps and Shin Splints

From the Show: Train Your Body
Summary: If you're a runner, you've probably suffered from shin splint or cramps. Fortunately, there are ways to prevent them from occurring.
Air Date: 5/12/15
Duration: 10
Host: Melanie Cole, MS
Guest Bio: Jordan D. Metzl, MD
Dr MtezlJordan D. Metzl, MD, ( is a sports medicine physician at Hospital for Special Surgery, America’s premier orthopedic hospital located in New York City. Regularly voted among New York’s top sports medicine doctors by New York Magazine, Dr. Metzl takes care of athletic patients of all ages and lectures and teaches extensively both nationally and internationally. 

With a practice of more than 20,000 patients, Dr. Metzl is widely known for his passion for sports medicine and fitness. His focus is to safely return athletes to the playing field of their choice and to keep them there. In addition to his busy medical practices in New York City and Old Greenwich, Connecticut, Dr. Metzl is the author of the bestselling titles The Exercise Cure (Rodale 2014) and The Athlete's Book of Home Remedies (Rodale 2013) and has also authored three other books, including The Young Athlete (Little Brown). Dr. Metzl is also the medical columnist for Triathlete Magazine. His upcoming book entitled Run Your Best Life is expected in 2015 (Rodale). 

His research interests include the treatment and prevention of running related injury, the effectiveness of preventive wellness programs, and the prevention of youth sport injury.

Dr. Metzl appears regularly on media programs including the Today Show, on radio including National Public Radio (NPR) and in print media including the New York Times, discussing the issues of fitness and health. In addition to his busy medical practice and academic interests, he practices what he preaches. 

Dr. Metzl created the Ironstrength Workout, a functional fitness program for improved performance and injury prevention that he teaches in fitness venues throughout the country. The workout is featured on where it has been performed by more than nine million athletes around the world. 

A former collegiate soccer player, 31-time marathon runner and 12-time Ironman finisher, he lives, works, and works out in New York City.
Prevention & Treatment for Cramps and Shin Splints
If you're a runner, you've probably suffered from shin splint or cramps. They can be painful, but fortunately, there are ways to prevent them from occurring. Shin splints and cramps are a few running-related injuries that, with proper equipment and training, can be avoided.

But, if you do get them, what can you do to relieve the pain as quick as possible?

Hydration is the best and most important way to begin.

Stretching before running and using proper equipment goes a long way in avoiding injuries in the first place.

Jordan D. Metzl, MD, discusses the best ways to avoid running injuries, including cramps and shin splints.

RadioMD PresentsTrain Your Body | Original Air Date: May 12, 2015
Host: Melanie Cole, MS
Guest: Jordan D. Metzl, MD

Your trainer Melanie Cole is here to motivate and help you perform. It’s time now for Train Your Body.

MELANIE: So what are shin splints? And what are muscle cramps? You get them, you start to run, maybe you’re out walking, maybe you’re doing a lunge, maybe you’re just bending over to pick up your kid, or sleeping at night, and all of a sudden this thing grabs your leg behind your leg, you know, or in your foot, what is that? And if you’re out exercising what can you even do about it? My guest is Dr. Jordan Metzl. He is a nationally recognized sports medicine physician, and best-selling author of Running Strong.

Welcome to the show Dr. Metzl.

So tell us first, what is a cramp? What is it?

DR. METZL: So, you know, running and cramps and cramps from sports are a very common thing that we see in the office. As an athlete myself, I want to make sure that I hopefully don’t get too many cramps when they come on they are really horrid. Nothing worse than in the middle of an iron man or a marathon and you get a hamstring or a quad cramp and you’re just like “Aw, man. I put in all this training. This sucks.” So, why do they happen? Muscle cramp just means the muscle is kind of going into spasm. They tend to happen for a couple of reasons. The number one reason is that the muscle is not strong or flexible enough. So, there is kind of a mechanical cramp, which tends to be related to just not being strong or flexible enough. That’s probably about 20% of cramps are related to that. So, you just put too much loading force on the muscle, and in quite English terms, the muscle gets pissed off. It starts to cramp up and get very sore and goes into spasm and it doesn’t like it. You know. The other group which is much more common are nutritional cramps. So, those fall in the category of things like dehydration. If you get severely dehydrated your muscle tends to go into a cramp and a spasmodic type pattern. Electrolyte imbalance. Things like sodium, potassium, magnesium. Those deficiencies, particularly after doing a lot of sweating. You can lose a lot of electrolytes. Those can cause muscular cramping as well, so if you’re somebody that is in a hot, humid environment, you want to make sure you’re pre-hydrating and definitely pre-electrolyte loading and replacing those electrolytes as you go so you don’t end up down the road with all kinds of problems. So, muscle cramping is a common thing I see and it is also a common thing I try and give people guidance on how to prevent because, generally speaking, if you’re smart about it, not always, but certainly much of the time, you can avoid these.

MELANIE: Now are those kinds of cramps that are exercise related or, you know, nutritionally related to muscle imbalance, whatever, you know, are the reasons, are those different than those ones that wake you up screaming in the night? That your hamstring or your foot juts out in a direction, you hop around for a while, and then the next day that muscle is actually sore.

DR. METZL: Yea that’s a different type of drill. So, that’s a different thing. These tend to be exertional related cramps that I’m talking about versus just some of the night time cramping which maybe sometimes related to dehydration or something, but, generally speaking, those are sometime positional at night and some people just get those.

MELANIE: So, you don’t have any remedies for those middle of the night things?

DR. METZL: I’m sorry, if I did I would be the first person that would buy it. I, thankfully, you know, it’s not something I get a lot of, but I’d say stretch out before bed and don’t move.

MELANIE: And what about, you mentioned electrolytes and sodium potassium, you know, so is eating a banana, half a banana, is that going to help you? Is that enough potassium? Or, do you like energy drinks? Or, you know, like a Gatorade electrolyte replacement drink?

DR. METZL: I got to say, my patients, and I have people that do all kinds of different things. I’ve had the best success with some of the new high sodium sports drinks. So, like endurance formula Gatorade has been very, very helpful. And then I have a whole other crowd. The patients that seem to get this the worst are my iron man people, like me, who are doing stuff in hot, humid environments and my tennis players who are playing, particularly down in the southeast, where they get a lot of heat and humidity down there and they lose a ton of electrolytes. Those tennis folks swear by dill pickle juice. I’m not kidding.

MELANIE: I’ve heard that before.

DR. METZL: They love it. They go crazy for dill pickle juice, and they really believe in it. I mean it really. It’s a great. It’s brine salt. It’s readily available in terms of the absorption capacity is very quick. They love it. So, that works for them but for everybody else I think some of the salt containing, high salt sport drinks probably are the best.

MELANIE: Now, what is a shin splint? You know we’ve talked on the show with so many experts about various muscle conditions and things, but shin splints, in particular, seem to be a common one and a bit of a confusing one because there is like, it feels like there is no muscle there, it’s like it’s just a bone. But we know that there is muscle. What is a shin splint?

DR. METZL: So, basically, shin splint means an irritated, or, as I say in my videos on Runners World, pissed off my shin. I’ve irritated my shin. And there are kind of two main, broad categories of shin splint. The less common is what we call muscular shin pain, and the person with muscular shin pain is the following person: “Hi I’m Melanie and I’m a runner and I run. After about 15 or 20 minutes the outside or the back of my leg starts to get really tight and my leg is killing me and the more I step the tighter it gets and I feel like something is squeezing inside my leg.” Now, that’s sometimes called a shin splint. It’s in a broad category of shin splint with running, but that’s what we call muscular shin pain. And what you’re describing is something called exertional compartment syndrome meaning that the muscle is expanding and there is not enough room for it to expand and it gets squeezed by the wrapping called the fascia and it becomes really tight and we do things to help that. We shorten peoples’ running stride. Then, if that doesn’t work, we do a diagnostic test called Compartment Syndrome Test, and then if that shows an elevated pressure, sometimes these people need surgery to fix that. Now, the much more common shin pain are the people who run and they start running and running and running and they get pain either in the front or the back inside part of their bone, particularly their tibia bone. And that is called Tibial Stress Syndrome, most commonly, Posterior Tibial Stress Syndrome on the inside part of the leg. And when people get that problem, it’s most often related to a combination of their foot mechanics and their stride length. So, the things I really educate my patients on are: number one, I use oftentimes a corrective type orthotic. The kind I like are the types that you just get in the mail for forty bucks. You heat them up in the oven and then step in them and they mold to your feet. Those have been very…

MELANIE: Yeah. I like those too.

DR. METZL: They’re great, and then in terms of stride length I have them shorten up that stride. I have them use the shorter stride. Try and get to a cadence 175/180 and try and match that cadence to see what that feels like and that should help as well.

MELANIE: Well and I want to point out that he mentions running because he is like, you know, iron man runner but walkers get shin splints, too, and it’s easy to get these things. It’s the same issues. You get them in aerobics class or you get them in yoga, you get them in… and it doesn’t even matter. But walking, also. So, you mentioned orthotics and shoes, base, stride length, gait. All of its involved. Are there certain stretches or things because sometimes taking your toe, tucking it under across the leg. It’s a very hard area to stretch.

DR. METZL: Yes. So, here’s the story on this. I’m a big fan, in all my books, I have whole illustrated workout on how to use your foam roller. I think getting on that sucker makes a huge difference and I think that’s the best way. It’s very difficult to stretch that. I have a lot information on using a foam roller and how to do that.

MELANIE: So, using a foam roller would be the best way to learn to stretch that area because it is, as you say, a difficult area…

DR. METZL: Impossible.

MELANIE: It certainly is. In the last minute, the best advice on those little nagging things, shin splints, cramps, things that come up when we run or walk, because some of us are walkers, Dr. Metzl. We are not all Iron Men, but I’m a long distance walker. I’ll walk forty miles. You know, I just can’t seem to run but we will talk about that on another show. Best advice.

DR. METZL: For what? For people who do that?

MELANIE: On all of this shin splints, cramps, any of it.

DR. METZL: Yes. So, my best advice is, number one: if pain changes your mechanic of movement, get it checked out meaning if shin pain is changing the way you walk or run, if knee pain is changing the walk or run, get it checked out. I see so many injuries in my office that are getting worse by people changing their mechanical movement patterns because of pain. So, that’s number one. And number two is, figure out why the pain is happening. We can do so much. I want to educate what runner and walkers around the world on how they can take care of their bodies and prevent problems from happening. With a little bit of education you can make a huge difference and be your own best advocate in this space.

MELANIE: Wow, he is ending this just like he is a complete pro, which he is. The book: Dr. Jordan Metzl’s Running Strong. You can get it on Amazon. You’re listening to RadioMD.

This is Melanie Cole.

Stay well.