Chronic anterior tibialis cramping/DOMS - final call for help

Triathlon Forum
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I’ve posted about this before but I’m giving it one more shot, as I’ve got more information now than I had in the past.

I’ve suffered from a chronic cramping of my anterior tibialis muscles (both legs) for quite some time now. Been running for years and this condition has come and gone the whole time. I can go 6 months without it being a problem, then can go another 6 months where it happens almost every time I run. Taking time off does not seem to have any effect. It seems like it could be seasonal - last year when I abruptly went from cold weather running to warm weather running (took at week-long training vacation in Hawaii) it cleared up IMMEDIATELY and didn’t return until late this fall.

When I can run and avoid the cramping, I still suffer from severe DOMS in the tibialis anterior muscles the day after. If I try to ‘run through’ the cramps will I quickly develop periostitis (shin splints) which I assume is from the tight tibialis anterior muscles pulling on the tibial periosteum.

I am reasonably sure that the issue is NOT overstriding. I am pretty much a midfoot striker and my cadence is relatively high. I have developed reasonably good running form - I ‘look’ like an experienced, smooth runner.

I pronate somewhat, but not to any sort of extreme amount, and I use neutral shoes with superfeet insoles. I’m in the process of getting custom insoles made (had casting done and am waiting for some final modifications) but they are not going to be radically different from the superfeet as far as arch support. This condition has happened with every shoe - neutral, corrective, padded, low-profile. I am currently running in Mizuno Wave Riders but have tried all sorts of different shoes.

I generally run on asphalt but try to mix in trails and softer surfaces when I can. Even when I do a run on 50% trail and 50% road the effects seem to persist.

I have to emphasize that while this condition seems to CAUSE shinsplints, it doesn’t seem to fit the definition of shinsplints itself, in that it’s limited to the muscles themselves.

I have had no luck finding any good documentation on this condition on the web and have seen 2 separate sports chiro’s for it, both of whom are stumped. ART helps a bit the day I get it but makes no difference the day after.

I am considering giving up running entirely and focusing on bike racing. I love triathlon but this does not seem to be something that’s going away, and without getting it resolved I don’t see myself able to meet any of my goals in the sport.

If anyone has any insight at all, I would VERY much appreciate it!

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you have ruled out exertional anterior compartment syndrome?

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same issues or mine just started to feel like frozen wood blocks. you said you run in cold weather, how are the roads? mine was not just letting my foot/feet fall flat and like you i run midfoot and high cadence, i was too concerned with the high cadence or what my legs were doing which made me flex my feet(upwards) try to just run and relax your feet unless youve done that already then you might want to do the stretched tigerchick suggested i do which i forgot what was called(sorry) ive tried all kinds of shoes and it was not really the shoe after all for me. i can now run on my adidas tempos whereas comfortable before both lower legs will just be hard as stone after 5-10m mins. i do my long runs on my wave creations.

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Have you been to an orthopedic surgeon who specializes in athletic injuries? One might know a bit more than a sports chiropractor.

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you have ruled out exertional anterior compartment syndrome?

At one point I was told it was ‘extremely unlikely’ so I haven’t pursued it, but I’ll go to my local clinic and inquire about getting a pressure test. Is the pressure test something a GP can prescribe or will I need a referral to an orthopedist?

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Your GP will definitely not have a Stryker compartment pressure testor (nor will most orthopedists). Just need a referral to someplace (sports med clinic, possibly a large orthopedic practice, etc.) that has access to one and you will have to run first, then get the test. It probably is unlikely, but if you are facing not running any longer period (per your post), I think I’d start to rule out some things.

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Hey gbot…I’ll bite.
I’ve had this nasty nasty issue before. I hated it. I should be studying, but I’m not in medical school just to take exams, I want to make a difference…so here goes (bear with me)…
Yeah, compartment syndrome sucks and it might be worth ruling it out. I’d caution you against seeing a specialized ortho surgeon who will likely suggest…you guessed it…surgery. Certainly that’s an option, but IMHO I wouldn’t do that until you KNOW it’s compartment synd. or that you’ve exhausted ALL other options.

So here’s the deal…I’m going to shoot from the hip here since I can’t actually see you. I think the problem might not be your tib. anterior at all…that’s just where the pain manifests when you run (and in the days after, ouch). I think that the real problem may lay in the muscles on the posterior of your lower leg, and may involve muscles and supporting tissues all the way up to the iliac crest of your pelvis (hip bone).

I want you to think of your arm for a second. It’s a much better example for this…when you flex your arm, like in a curl, what happens? You contract your biceps, right? But what else must happen for your arm to move and do that curl? Your triceps must RELAX. So when you lift that twinkie to your mouth, there’s got to be stimulus to your biceps, but also NO contraction stimulus to your triceps. There’s got to be good co-operation here, because if your triceps contracts at the same time as your biceps…no curl, and no twinkie…you just get a frozen and confused bunch of muscles, and 1,000 less calories.

So that is kind of what I think is happening in your lower leg. It’s obviously a bit more complicated than that. There’s a lot of moving parts down there, and layers upon layers of different muscles. All these muscles, like an oiled machine, must run in near perfect synchrony if they are to allow you to run without too much complaining…I mean think of how fast muscles must contract and relax when you’re running, and the forces against which they must push. Really, it’s fascinating and amazing how remarkably designed we are for this…But if your muscles aren’t well primed to respond evenly and quickly to nerve signals, your well-oiled machine will come to a screeching halt (i.e. no twinkie, and bunched up muscles). So the muscles on the BACK of your legs aren’t cooperating with your tibialis anterior. These rear muscles are critical during the drive/push-off phase of your stride, and they are much stronger than the tibialis anterior. So if they are chronically tight in addition, the tibialis anterior never gets to fully relax and this gets aggravated during the quick relax-contract-relax motions of running. It yanks on itself. It yanks on its tendons. Constantly. And it hurts like hell after like 5 minutes, and for 5 days following…because it’s pissed. So you’ve got to help the poor thing out…by loosening the muscles on the REAR of your leg.

So where to apply that roller, that ART, etc? Tibialis posterior, Flexor hallucis longus, Flexor digitorum longus. These are the muscles on the BACK of your lower leg, and are the equivalent of the tricpes to your tib. anterior. They are probably very very stiff, and are also very difficult to stretch on their own. It also wouldn’t surprise me if your gluteus medius and tensor fasciae latae are pretty tight too. These are upper stabilizing muscles that get very worked in running, and chronic tightness in them can mess with the alignment of your knee, and thus the way the many muscles of your lower leg interact. Feel your hip bone, and follow it up your pelvis rearward. Your gluteus medius attaches all along there. Down a bit form there and more laterally (away from your spine), I bet you find some built up tension. Tensor fasciae latae joins up with the IT band in front and connects to the front of your hip on the other end.

Use lots of pressure in these places. Slow, firm, patiently and for a long time (that’s what she said), for a few days, and after swimming/biking workouts. Roll out your IT band like its your job/make love to your foam roller. Roll out your calves. Dig in there. Find tension, and release it with slow firm pressure. Not once, not twice, regularly. There are specialized sports med. physiologists (not Dr’s) who can do this for you with better precision than a lot of MD’s.

Warm up. Slowly. You felt great in Hawaii b/c you had better circulation to your muscles, and probably more relaxed muscle tone. Over time with stretching and all the above, you’ll lower the resting tone of your muscles, which is equivalent to giving a dirty/rusty engine brand new oil. It takes time, it takes patience. It certainly worked for me, and I really hope it can work for you too. Mine still act up during bricks/races from bike → run sometimes, and it makes sense why…I’m still trying to figure out my way around that. It’s sporadic. It’s unpredictable. It’s annoying. But if I’m diligent about stretching, rolling, and releasing tension, I’m good.

Please let me know if this works and if you have any questions. Best of luck.

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Thanks for the input. You may be right - I’ve always had tight calves. I do use ‘the stick’ fairly religiously on my calves, but it’s hard to tell if it really has any effect.

I went and got a referral to an orthopedist today, so that’s a good next step and I’m feeling positive about at least getting some better info. In the meantime I’ll definitely take your advice and work on my muscle tightness even more than I was doing before.

Another reason your ideas make sense is because I’m NOT a new runner. Been running consistently for about 6 years. That makes me think it’s less likely to be a mechanics/form/shoes issue and more likely to be something along the lines of what you’re talking about.

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While there is no way to say for sure, you might have a problem of your anterior tibs trying to work against very concentrically shortened gastrocs and soleus muscles (back of the calf). We find injuries occuring because of this reason. For example, many people pull hamstrings because the hams are having to work against quads that are too short and strong. This causes the hams to be injured even though the problem is in the quads.

I know you have severe cramps, but this could be your problem.

Do NOT stretch your gastrocs passively (like heel drop down on a stair step) for some time and see if symptom improves.

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I’ve struggled with this truly aggravating condition on and off for over a year. Right now, I’m not having any problems with it. Here’s what I’ve found:

This condition is truly due to tight calf muscles, in particular the Soleus which is the opposing muscle to the anterior tibialis. I recommend stretching everything from your hips down before running, but pay particular attention to your calves. I use the heel-drop method 30 seconds per leg, 3 reps. Then (and most importantly) a modified heel-drop with knee bent slightly which stretches the Soleus. 20 seconds each leg, 2 reps. After that, I do some active stretching by walking a full mile before I begin running.

I learned that this condition was manageable last year when I went to run my first half marathon. 3/4 of a mile from the start line, my anterior tibs locked up tight. Being 12 miles from the finish line, I began walking (madder than a long-tailed cat in a room full of rocking chairs). I had this happen prior during training, and knew that once it happened, the run was over. I was very surprised when about 3 miles later, I noticed my anterior tibs were starting to loosen up. By mile 5, I was back to full-on running… and I ran the remainder. I learned that day that a lot of walking would stretch things out.

People are different and your mileage may vary (literally and figuratively), but I know how aggravating this condition is, and I wanted to share my experiences and how I’ve dealt with it in hopes that it’ll help someone else.

Best,
Larry Wimble

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you have ruled out exertional anterior compartment syndrome?

my first thought as well…

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Compartment Syndrome. I had it for 4 years before it was diagnosed with the pressure test (for four years they said it was a ruptured gastroc/soleus), and it’s fairly rare so sometimes you have to specifically ask for the test. I had all 4 compartments released in both legs. I was running after about 4-6 weeks after each surgery, took it easy for 2 months (but taking it easy was more than what I was able to do before the surgeries), and a year and 2 months out of my second surgery, I just won a triathlon overall. First race that I won overall since the onset of the symptoms (about 5 years ago). I’m splitting 18 low in a sprint tri 5k, and with the condition I was lucky if I broke 21 for and open 5k.

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This thread is years old, but the condition is interesting. I would venture that anterior tibial artery entrapment due to anatomic anomaly, although quite rare, should be ruled out.

quote needmoreair]you have ruled out exertional anterior compartment syndrome?

my first thought as well…

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Hi, was wondering if there was a outcome to this.