This 20-plus man was a passionate spin bowler for his local cricket team. He would attend practice twice a week and wreak havoc on the opposition batsmen. His teammate encouraged him to sign up for a local half marathon coming up in the off-season, thinking it would be a great way to keep fit without having to hit the gym. The bowler had never thought of running in a marathon before but because his friend was relentless in his encouragement, he decided to give it a try.
He was surprised at how hard it was to run for continuous stretches. He had often done short sprint work and some fast 2km runs with his cricket team to develop speed for batting and fielding, but these long slow runs were brutal and unrelenting.
After about six weeks of running three times a week, he started noticing some discomfort in his right shin just on the inside of his leg bone. It seemed to be in a very specific place, about two-thirds down the bone from his knee. It wasn’t very painful, so he iced it and did some light stretching and continued to run and play cricket. Over the next few weeks, the pain intensified and spread up and down his shin bone. When it started hurting while bowling, he consulted a sports doctor, who diagnosed the condition as medial shin splints (also called medial tibial stress syndrome). The doctor explained to him that this was the result of starting a new sport too quickly and not allowing enough recovery between workouts for his muscles and shin bones. The doctor went on to explain that he should have started with two runs a week and increased this to three only after two-three weeks, once his body had adjusted to the load of running. The lack of recovery time meant that small tears in the muscles of the medial shins happened during exercise and did not get enough time to heal between workouts.
The bowler was given painkillers and told to rest and consult a sports physiotherapist. The doctor told him to carry his running and cricket shoes when he went to the physiotherapist so he could assess the way he walks and runs. This would help him better understand the biomechanics and predisposing factors for the injury.
At the end of the assessment, the physiotherapist told him that he had sustained an overload injury to his tibialis posterior muscle probably because he had flat feet and weak muscles in the feet and lower leg. This weakness meant that his foot collapsed under the weight of his body each time he took a step and that action overstretched his muscle, eventually leading to pain and inflammation where the muscle attached on to the bone. He was advised to buy compression socks to support the muscles of the lower leg both during the rehab work and when he returned to the sport. After about a week of rest, and three-four treatments with the physiotherapist, he was back playing cricket and running pain-free. He still does all his stretches and strengthening exercises twice a week to make sure the pain doesn’t return.
Try these exercises from the bowler’s programme to help strengthen your feet and ankles even if you don’t have any injuries. These are good for preventing injury and strengthening the lower half of the body. Consult an orthopaedic surgeon or a physiotherapist if you have any pain.
Toes-in heel drops
Start by standing on the bottom step of a flight of stairs or on some other elevated stable surface. Stand on the surface so that your toes and the front half of your foot are on the surface and the back half of your foot hangs off the back in the air. Make sure you have something to hold on to during this exercise so that if you lose your footing, you maintain your balance with the upper body. Start the exercise by lowering your heels as far down below the height of the step as you can and then lift your heels up as high as you can. Repeat this movement for the desired number of repetitions.
Knee to wall achilles stretch
This is a good stretch to increase the flexibility of the Achilles Tendon and muscles on the back of the leg. It is also helpful in increasing the mobility of the ankle joint.
Start by placing your foot about 5cm away from a wall. Without lifting your foot or heel off the floor, bend the knee until the knee cap touches the wall. Lift your foot and place it 1-2cm further back from the wall and repeat the stretch. Keep moving your foot further and further away from the wall until you find you are not able to touch your knee to the wall without lifting your heel. Measure the distance between your big toe and the wall. In future, start at that distance and try to increase the flexibility and mobility of your ankle using this stretch so you can slowly move your foot further from the wall.
Single leg hip bridge
Lie on your back and flex your knees up so that they bend to 90 degrees and your feet are flat on the floor. Rest your hands at your sides so that your palms face downwards. From this position, lift your hips and pelvis up into the air using your hip and lower back muscles. Contract your gluteal muscles as much as possible to lift your hips into the air as high as you can. Maintain this position while you slowly lift one foot off the ground. Try not to let your pelvis shift to one side or drop on the side that corresponds to the leg you just lifted. Lower your hips back down slowly from this position until your hips lightly touch the floor again and then lift them back up into the air. Continue lifting and lowering your hips for the desired number of repetitions.
Heath Matthews is a consultant sports physiotherapist with Sir HN Reliance Foundation Hospital, Mumbai.