Tibial Periostitis in Runners and Trail Runners: A Complete Guide

Are you a runner or trail runner who feels a stabbing pain along your shin? You may be suffering from tibial periostitis, the dreaded injury that affects many running enthusiasts. It's one of the most common and frustrating running injuries. If left untreated, it can turn your passion into a nightmare.

"Tibial periostitis is often the result of over-enthusiasm: too fast, too hard, too soon."

Don't let this pain stop you from playing the sport you love. Let's find out everything you need to know to identify, treat and prevent this nagging injury.

What is tibial periostitis?

Tibial periostitis is an inflammation of the periosteum, the thin membrane that surrounds the tibia bone. It occurs mainly in sportspeople who take part in repeated-impact activities, such as running or trail running. This inflammation occurs as a result of repetitive microtrauma, which gradually irritates this sensitive membrane.

Unlike a stress fracture, tibial periostitis mainly affects the tissue surrounding the bone rather than the bone itself. It particularly affects beginner runners or those who have recently intensified their training. This condition is particularly common in trail running, where the technical descents put intense strain on the shins.

Tibial periostitis symptoms: How to recognise it

The symptoms of tibial periostitis are generally quite characteristic, making diagnosis relatively straightforward. Here are the signs that should alert you:

• Local pain on the inside edge of the tibia, often lasting several centimetres
• A burning or tingling sensation that intensifies during exercise
• Sensitivity to touch, sometimes accompanied by slight swelling
• Pain that can persist even at rest in the most advanced cases

I recently accompanied Thomas, an amateur runner preparing for his first ultra-trail. His tibial pain systematically appeared after 30 minutes of running and persisted for 24 hours after the effort. The diagnosis was clear: classic tibial periostitis. 🏃‍♂️

Common causes among runners and trailers

Tibial periostitis doesn't just happen. It is usually the result of a combination of factors that create excessive stress on the tibia and surrounding tissues:

• Overtraining : Too sudden an increase in training volume or intensity is often to blame. The famous 10% rule (never increase your weekly mileage by more than 10%) exists for a good reason!
  
• Unsuitable footwear : Worn-out shoes or shoes that are poorly adapted to your shape and stride can lead to the development of periostitis. Trail runners often overlook the importance of a drop that is adapted to their running technique.
  
• Drive surfaces : Constant running on hard surfaces such as tarmac or very compact paths increases the impact on the shin. A variety of terrain is essential to protect your legs.
  
• Biomechanical problems : Hyperpronation of the foot (excessive inward rotation) is a major risk factor for tibial periostitis. This poor posture subjects the tibia to abnormal stress during each stride.
  

Periostitis treatment: General approaches

Treating tibial periostitis requires patience and method. The approach must be comprehensive to ensure complete healing:

1. Relative rest : It's not always necessary to stop running altogether, but it is essential to reduce your training load significantly. Favour low-impact activities such as swimming or cycling to maintain your physical condition.
   
2. Managing inflammation : Regular application of ice to the painful area helps to control inflammation. Anti-inflammatories can be used occasionally, but always under medical supervision. Please note that anti-inflammatories are only intended to reduce pain. They are not a cure. On the contrary, a reduction in pain can lead to a return to sport that is too intensive.
   
3. Stride analysis : A consultation with a podiatrist specialising in sport can help you identify and correct biomechanical problems. The use of orthopaedic insoles is often recommended for runners with pronation problems.
   
4. Reinforcement programmeTargeted exercises to strengthen the muscles of the calf, anterior tibia and feet are essential for a complete and lasting recovery.
   

"Never ignore persistent tibial pain. Untreated periostitis can develop into a stress fracture, which takes much longer to heal.

Treating tibial periostitis quickly

There are a number of tried and tested methods for speeding up the healing of tibial periostitis:

Ice application

Apply ice to the painful area for 15 to 20 minutes, several times a day. This simple but effective method helps to reduce inflammation and relieve pain. For greater effectiveness, perform ice massages by sliding a cup of frozen water directly over the painful area.

Shock wave therapy

This technique, practised by health professionals, gives excellent results on resistant periostitis. The acoustic waves stimulate blood circulation and speed up tissue regeneration. I've seen spectacular results with several elite runners who were able to resume training after just 2-3 sessions.

Targeted food supplements

Certain nutrients can help strengthen bone tissue and accelerate healing. Vitamin D, calcium and collagen are particularly recommended. Consult a health professional before taking any supplements.

Electrostimulation

Using an electrostimulation device can help relieve pain and facilitate muscle recovery. The specific "pain relief" and "active recovery" programmes are particularly suitable for tibial periostitis.

Tibial periostitis exercises: Recovery programme

A well-designed exercise programme is essential for the effective treatment of tibial periostitis. Here are some particularly effective exercises:

1. Strengthening the calvesStand on your tiptoes on a step, then slowly lower yourself back down. Perform 3 sets of 15 repetitions, first with both legs and then on one side. This simple exercise strengthens the gastrocnemius muscles, which absorb a large proportion of the shock during running.
   
2. Targeted stretching : Stretch your calves by leaning against a wall with your back leg straight. Hold the position for 30 seconds and repeat 3 times for each leg. Don't forget to also stretch the tibialis anterior muscle and the toe flexors.
   
3. Proprioception : Work on your balance on one leg, first on a stable surface and then on an unstable surface (cushion, bosu). Hold for 30 seconds and repeat 5 times per leg. This exercise improves ankle stability and reduces stress on the tibia.
   
4. Progressive plyometric exercises: Start with light jumps on the spot, then progress to lateral jumps and more intense exercises. Plyometrics strengthen bone tissue and improve shock absorption. ✨
   

Pierre, a 45-year-old runner, had been suffering from chronic periostitis for over a year. After following this exercise programme for 6 weeks, he was gradually able to resume running without pain. Consistency in these exercises is the key to success!

Taping tibial periostitis: Technique and benefits

Taping (or adhesive bandaging) is an excellent complementary solution for relieving tibial periostitis. This technique stabilises the tibia and reduces tension on the periosteum.

Basic technique

1. Start by cleansing and drying the skin.
2. Apply a tension-free anchoring band just below the knee.
3. Apply "I" shaped bands along the tibia with a slight tension (approximately 50%).
4. Finish with horizontal locking strips.

Kinesiology taping (K-Tape) works differently to traditional rigid taping. It lifts the skin slightly to improve blood and lymph circulation in the painful area. These two approaches can be combined for optimum results.

"Taping is not a substitute for a strengthening programme, but it offers rapid relief and can speed up the return to sporting activity."

Periostitis massage: Methods and advice

Massage is an effective therapeutic approach for relieving tibial periostitis and promoting healing. Here's how:

Self-massage with massage stick

Use a massage stick to work the calf and leg muscles. Use slow back-and-forth movements, concentrating on tense areas. Avoid massaging directly into the painful area of the shin. A 5-minute session, 2 or 3 times a day, can considerably improve recovery.

Transverse friction techniques

This specific technique, generally practised by professionals, involves massaging perpendicularly to the fibres of the periosteum. It helps to mobilise the tissues and promote blood circulation. If you consult a physiotherapist, ask if he or she has mastered this technique, which is particularly effective for periostitis.

Massage with essential oils

Using anti-inflammatory essential oils such as wintergreen, lemon eucalyptus or peppermint can enhance the effectiveness of the massage. Always dilute these oils in a vegetable oil before application (10 drops of essential oil for 30 ml of vegetable oil).

Laura, a semi-professional runner, systematically applies this massage routine before and after each intensive session. This habit has enabled her to effectively prevent the recurrence of periostitis from which she regularly suffered. 🌿

Prevention: How to avoid recurrences

Prevention remains the best approach to tibial periostitis. Here are the most effective strategies for avoiding recurrence:

• Gradual progression : Increase your training volume gradually, never exceeding 10% per week. Be particularly careful when resuming training after a break.
  
• Suitable footwear: Renew your shoes after 600-800 km and choose them according to your morphology and your stride type. Trail runners should choose models that offer good cushioning while remaining stable on technical terrain.
  
• Vary the surfaces: Alternate between different types of terrain to limit repetitive impacts. Forest paths and dirt tracks are particularly recommended to protect your shins.
  
• Warming up and stretching : Never omit a gradual warm-up before your sessions. Regular stretching of the calf and tibialis anterior muscles is essential for maintaining good muscle flexibility.
  
• Regular muscle strengthening : Incorporate strengthening exercises into your weekly routine, even if there is no pain. A strong muscular system effectively protects your bones and joints.
  

Conclusion

Tibial periostitis is a challenge for many runners and trail runners, but it is not inevitable. With a combination of proper rest, appropriate treatment and intelligent prevention, you can overcome this injury and get back to enjoying pain-free running.

Remember that every body is unique and that certain strategies may work better than others, depending on your morphology and sporting history. Listening to your body is the best way to prevent and treat tibial periostitis.

So, are you ready to push back the limits while protecting your shins? Running is a long journey, so take care of your body so you can enjoy every kilometre! 🏔️