
Medial Tibial Stress Syndrome (MTSS), which is more commonly known as shin splints, is a prevalent condition in field athletes and long-distance runners. It has the potential to sideline even the most experienced athletes and dedicated runners, and when left untreated can progress to other stress injuries.
This makes it important to understand what MTSS is, how it presents and strategies for prevention and treatment.
What is Medial Tibial Stress Syndrome?
Medial tibial stress syndrome refers to the pain experienced along the inside edge of the shinbone (tibia) due to repetitive strain of the muscle and tendons resulting in bony overload and periostitis. MTSS arises from repetitive stress through the bone due to increasing load, volume and high impact exercises.
Causes of MTSS
Several extrinsic and intrinsic factors contribute to the development of MTSS:
Intrinsic factors include female gender, a history of MTSS, a higher body mass index and navicular drop.
Extrinsic factors include:
Overuse: Sudden increases in load and volume of impact loading activities such as running can result in an acute overload of tissues around the shinbone. This increase in activity is often associated with inadequate rest to allow structures to adapt to the applied stress. This is often seen in athletes returning from injury too soon and too quickly.
Footwear: Shoes lacking adequate support or cushioning may contribute to MTSS. A change in footwear can also be associated with MTSS especially if you have changed the brand or type of shoes, as differences in heel and arch support will change the amount of loading in the structures around the foot and ankle.
Surfaces: Running surfaces can impact ground reaction forces and may result in increased stress of the structures of your shin.
Biomechanical Issues: Flat feet, high arches, or poor running mechanics can alter the way forces are distributed through your legs, leading to increased stress on the tibia.
Muscle Imbalances: Weakness or tightness in the calf muscles, quadriceps, hip flexors, glutes or core can impact your running form and increase susceptibility to shin splints.
Symptoms of MTSS
Early recognition of the symptoms associated with MTSS is crucial to prevent the progression of the condition and risk of more serious injury.
Common symptoms may include:
Exercise induced pain, generally localised to distal aspect of the medial tibial border.
Presence of pain that is provoked both during or after activity which resolves with rest.
In the early stages, pain may be felt at the beginning of exercises but decreases once warm.
Pain is often described as dull and aching
Diagnosis
If you are experiencing medial shin pain, it is important to consult a healthcare professional to help guide you in management and rule out a serious bone stress injury or neurovascular syndrome. As stated above, early diagnosis is vital to prevent worsening of the condition, and when addressed early we are able to modify factors that will allow you to keep running.
Treatment Options
While this injury can be frustrating at times to manage, there are some effective strategies that can be used to promote healing and prevent future reoccurrence.
Rest: Providing your body with the time to heal is paramount. This doesn’t necessarily mean a total removal of activity, but a reduction and planning around days of activity are crucial to prevent progression of your symptoms.
Ice: The use of ice following activity will help with pain relief and to reduce inflammation.
Footwear: An assessment of your both your daily footwear and running shoes can help us understand your loading patterns and factors predisposing you to injury. We may recommend a change in footwear or refer on to a specialised sports podiatrist if you have biomechanical issues.
Running Technique: Changes to your running technique can aid to offload your shins and reduce the risk of injury. A reduction in stride length, increase in cadence and a change in foot position on impact are often targeted in rehab.
Cross-Training: To help reduce pain and inflammation, we may advise the use of cross-training to help maintain cardiovascular fitness without exacerbating your shin pain. These exercises may include low impact activities such as swimming, cycling or elliptical.
Exercise: Following our physical assessment where we will look at factors such as strength, mobility, and functional movement patterns, our sports physiotherapists will help prescribe a structured rehabilitation program aimed at the identified impairments. These exercises may be targeted locally around the site of injury and could include things such as calf stretches and strengthening exercises, or more proximally towards structures such as your hips, with targeted exercises to improve your single leg stability and capacity.
Prevention
Preventing MTSS and reducing the risk of re-injury involves the combination of proper training techniques and self-care strategies:
Warm Up: An effective warm up before activity aimed at preparing the muscles and structures in your lower body is crucial.
Rest Days: Allowing adequate recovery time between workouts, especially days involving high impact activities such as running will help to reduce the risk of overuse injuries.
Awareness: Paying close attention to any signs of discomfort that arise and not pushing through pain.
Variety: Incorporating different types of training into your week will allow you to mitigate the risk of injury. Strength training is often forgotten in running but is crucial to build capacity of the muscles around the shin and lower limb, while also increasing bone density and strength.
Follow a plan: If you’re looking to get back into running following an injury, have a chat with one of our sports physiotherapists and we will help create a structured running program aimed at progressive increases in distance, intensity and volume to ensure you can return to running with no pain.
Conclusion
Medial Tibial Stress Syndrome can be a frustrating injury for even the most experienced trainer, but with the right guidance and understanding, athletes are able to return to sport feeling strong and confident. Early management is crucial and with the right understanding of the factors leading to injury and preventative measures, we can ensure you are able to maintain running/training without requiring extended periods of rest and de-loading.